Determining the accuracy of a medication history at the point of a Comprehensive Geriatric Assessments (CGA) within an inpatient setting on a Frailty Assessment Unit

Abstract

This retrospective analysis aims to determine the accuracy of medication histories undertaken during a Comprehensive Geriatric Assessment (CGA) (at the point of admission) in an inpatient setting within an acute hospital. The CGA can be completed by a range of healthcare professionals, which will be directly compared. Medication reviews are an integral part of the CGA, therefore the accuracy of the history is integral to the review. A retrospective analysis of patient electronic records between October 2018 and February 2020 was conducted. The accuracy of medication histories recorded as part of the CGA completed by Advanced Nurse Practitioners, Advanced Pharmacist Practitioners and Doctors was compared. This was done using electronic records, any discrepancies were captured. Descriptive statistics were applied. Across the 50 patients and 421 medicines identified, there were 59 discrepancies; 24 (48%) patients were noted with at least one discrepancy in their medication history. An omission of current medication was the most common error (49%), followed by incorrect dose (19%) and a record of a medication not taken pre-admission (15%). The total number of prescribed medications was found to positively correlate with the rate of error (Pearson’s correlation 0.455, P > 0.001). An independent t-test determined a significant difference between the rate of errors between pharmacists and nurses (t-test: −4.48, P < 0.001). This study re-confirmed risks of medication errors when patients change care settings. This is more prevalent with higher numbers of medications, requiring greater care in instances of polypharmacy, particularly in frail patients. This can support risk stratification of patients. A difference in outcomes between pharmacists and nurses warrants further exploration to determine the reasons for this and structuring multi-disciplinary teams accordingly. Consideration to ensure that medication history taking is included as part of the Advanced Clinical Practitioner is important, particularly with the expansion of these roles in the UK.