title: Use of a structured medication history to establish medication use at admission to an old age psychiatric clinic: a prospective observational study.
abstract: OBJECTIVE
  Medication reconciliation results in fewer adverse drug events. The first step in medication reconciliation is to carry out a structured interview about medication use. It is not known whether such an interview is useful in inpatient old age psychiatry. The object of this study was to determine at admission the number of discrepancies in medication use, comparing the structured history of medication use (SHIM) procedure with the usual procedure for taking the medication history.
  
  
  METHODS
  A prospective observational study was conducted. All consecutive patients aged 55 years and older admitted from January until April 2011 to the inpatient old age psychiatric clinic of a large psychiatric teaching hospital in The Hague, the Netherlands, were eligible for inclusion; 50 patients were included. In every patient, the usual procedure (medication history-taking at admission by the treating physician) was compared with the SHIM procedure administered by the researcher. The SHIM procedure consists of a structured interview with the patient about the actual use of medication, incorporating the information from the community pharmacy and the patient's medications brought to the interview. The main outcome was the number of discrepancies in recorded medication use between the SHIM and the usual procedure.
  
  
  RESULTS
  In total, 100 discrepancies (median 2 per patient, range 0-8) in medication use were identified; 78 % (n = 39) of the patients had at least one discrepancy. Of the discrepancies, 69 % were drug omissions, and 31 % were drug additions or discrepancies in the frequency or dosage of medications. Eighty-two percent of all discrepancies were potentially clinically relevant. In 24 % of the patients, the discrepancies had clinical consequences.
  
  
  CONCLUSIONS
  The number of discrepancies that were found suggests that the usual procedure for taking the medication history can be improved. The SHIM procedure enables a comprehensive and accurate overview of the medication used by older patients admitted to a psychiatric hospital, and contributes to the prevention of clinically relevant adverse drug events.
authors: Meike C
authors: MC
authors: Prins
authors: A Clara
authors: AC
authors: Drenth-van Maanen
authors: Rob M
authors: RM
authors: Kok
authors: Paul A F
authors: PA
authors: Jansen
mesh_terms: D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006778:Hospitals, Psychiatric; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods* / Q000592:standards; D059065:Medication Reconciliation / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009426:Netherlands; D010343:Patient Admission / Q000592:standards*; D011446:Prospective Studies
references: J Clin Pharmacol. 2007 Nov;47(11):1440-9
references: 17962430
references: Arch Intern Med. 2005 Feb 28;165(4):424-9
references: 15738372
references: Int J Geriatr Psychiatry. 2008 Jun;23(6):564-73
references: 18058830
references: Jt Comm J Qual Patient Saf. 2005 Jul;31(7):406-13
references: 16130984
references: CNS Drugs. 2010 Jul;24(7):595-609
references: 20356315
references: J Am Geriatr Soc. 2011 Oct;59(10):1976-7
references: 22091519
references: J Psychopharmacol. 2006 Jul;20(4):553-61
references: 16401663
references: J Am Geriatr Soc. 1990 Nov;38(11):1183-7
references: 2246454
references: Eur J Intern Med. 2008 May;19(3):225-6
references: 18395174
references: Clin Pharmacol Ther. 1981 Aug;30(2):239-45
references: 7249508
references: Ann Pharmacother. 2010 Oct;44(10):1596-603
references: 20736427
references: Am J Health Syst Pharm. 2003 Oct 1;60(19):1982-6
references: 14531244
references: Br J Clin Pharmacol. 2000 Jun;49(6):597-603
references: 10848724
references: Jt Comm J Qual Saf. 2004 Jan;30(1):5-14
references: 14738031