title: A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department.
abstract: BACKGROUND
  Admission to an emergency department (ED) is a key vulnerable moment when patients are at increased risk of medication discrepancies and medication histories are an effective way of ensuring that fewer errors are made. This study measured whether a pharmacist-acquired medication history in an ED focusing on a patient's current home medication regimen, and available to be used by a doctor when consulting in the ED, would reduce the number of patients having at least 1 medication discrepancy related to home medication.
  
  
  METHODS
  This multicentre, double-blind, randomised, controlled parallel-group study was conducted at 3 large teaching hospitals. Two hundred and seventy participants were randomly allocated to an intervention (n = 134) or a standard care (n = 136) arm. All consecutive patients >18 years old admitted through the ED were eligible. The intervention consisted of pharmacists conducting a standardised comprehensive medication history interview focusing on a patient's current home medication regimen, prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The admission medication order form was given to doctors at a later stage in the control arm for them to amend prescriptions. The effect of the intervention was assessed primarily by comparing the number of patients having at least 1 admission medication discrepancy regarding medication being taken at home. Secondary outcomes concerned the characteristics and clinical severity of such medication discrepancies.
  
  
  RESULTS
  The intervention reduced discrepancies occurring by 33% (p < 0.0001; 0.1055 odds ratio, 0.05-0.24 95% confidence interval), despite recall bias. Regarding total discrepancies, omitting medication occurred most frequently (55.1%) and most discrepancies (42.7%) were judged to have the potential to cause moderate discomfort or clinical deterioration.
  
  
  CONCLUSIONS
  A pharmacist-acquired medication history in an ED focusing on a patient's current home medication regimen available to be used by a doctor at the time of consulting in the ED reduced the number of patients having at least 1 home medication-related discrepancy.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN63455839.
authors.affiliation: Pharmacy Department, Universidad Nacional de Colombia, Ciudad Universitaria, Edificio 450 oficina 204, Bogotá 14490, Colombia. jbecerrac@unal.edu.co.
authors.forename: Jesus
authors.initials: J
authors.lastname: Becerra-Camargo
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez-Martinez
authors.forename: Emilio
authors.initials: E
authors.lastname: Garcia-Jimenez
mesh_terms: D004311:Double-Blind Method; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000379:methods / Q000458:organization & administration; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation / Q000379:methods / Q000458:organization & administration; D008875:Middle Aged; D010343:Patient Admission; D010595:Pharmacists; D015397:Program Evaluation