Difference between Pharmacist-Obtained and Physician-Obtained Medication Histories in the Intensive Care Unit

Abstract

Purpose To quantify the differences between medication histories obtained by physicians and pharmacists from critically ill patients in the intensive care unit (ICU) and to identify patient types at greatest risk of medication errors. Methods Retrospective medical record review of 200 consecutively admitted critically ill patients to the medical/surgical ICU of a university-affiliated hospital. The pharmacist-obtained medication history was compared to the physician-obtained medication history. Variations assessed included the number of drugs identified, drug name, drug formulation, dose, and frequency of administration. Inpatient medication orders were reviewed to obtain the number and accuracy of home medications prescribed in the ICU. Patients were divided into predefined groups: trauma, medical, and nontrauma surgical to assess the risk of medication error by patient type. Results Pharmacists and physicians identified a total of 981 and 665 medications, respectively. The mean (± SD) number of home medications per history was 4.2 (±4.9) for physicians and 6.2 (±5.7) for pharmacists ( P < .0001). Physician-obtained medication histories contained 1,628 variances relative to the pharmacist-obtained medication histories. The variances by type included the frequency of administration, 37%; drug dose, 34.6%; missing drugs, 22.3%; extra drugs, 3.6%; and drug formulation, 2.5%. Thirty-nine patients received continuation of their home medications in the ICU totaling 97 orders (9.9% of home medications identified by pharmacists). Thirty of these orders varied from the pharmacy history and 27 were subsequently corrected. Conclusion. Pharmacists identified more home medications than physicians when obtaining a medication history in the ICU. This may improve the accuracy of home medications ordered in the ICU.