Redland Hospital
Common Traps with Medication History Sources
Medication History
Source
Advantages
Disadvantages
GP lists
 Referral letter often
accompanies patient
 Administration officers can
fax request for lists
 Useful for confirming details
e.g. strengths




Community Pharmacies
 Dispensing histories
 Administration officers can
phone then fax request
 Most Redland patients only
use one pharmacy
 Will have information about
dispensed items additional
to a Webster pack
 A list from the ‘source’
(patient/carer)
 Generally kept up-to-date by
patient/carer
 May not be complete (other
pharmacies, GP samples)
 Prescription and S3 (label
required) items only
 Need to go back in time eg digoxin
comes in bottles of 200: may not
have dispensed for 7 months
Patient/Community
Nurse Lists
Previous admission
records
 All QH admissions easily
accessible online via eLMS
program
Often incomplete/not up-to-date
Not necessarily updated/deleted
Generally records of only 1 GP
Doesn’t include OTCs/CAMs/nonscript/specialists
 Generally need to cross-reference
with patient
 May only consist of ‘prescribed
medications’/those deemed
‘important’
 Often
inaccurate/incomplete/missing
doses
 Ensure still up-to-date and fully
complete
 Still need to ask other specific
questions
eg puffers, patches, eye drops,
CAMs…
 Useful, presuming that nothing
has changed
 Verbal changes to discharge
medications not communicated to
Pharmacy  no changes made to
eLMS
 Patient ceases items due to
misunderstanding/dislike/cost/exh
austed discharge supply etc
 Items ceased/added by
patient/GP/specialist/OPD clinic
 Prescribing/dispensing/administrat
ion errors
 List may not have been complete
on last admission
 The DMR is usually out-of-date
the moment the patient leaves Ensure still up-to-date and fully
complete
Residential care facility
 Should be an accurate
representation of ALL
medications

Patient’s Own
Medications
 Many details immediately
evident e.g.
 Drug/strength/dose
 Compliance - # of tablets left
vs dispensing dates vs
expiry dates
 GP/community pharmacy
information
 Taking other people’s
medications/dispensing
errors
 Convenient, relatively
accurate source of MOST
medications taken
Webster Packs
Patients/carers
 Best when patient’s own
medicines are present
 Ask open-ended questions
 Specifically ask about: (see
MAP checklist)
 INJECTIONS: Insulin has
been previously missed
 Patches/creams/eye
drops/inhalers
 Once a week/month
 CAMs
 Non-prescribed items…
 NB Check for the RIGHT
PATIENT!
 Directions can be ambiguous
 Check for ‘cease date’ – order not
necessarily crossed out
 Chart may not be most recent
orders
 Check dates
 RNs may give doses from a range
eg ‘0-40mg’
 Look at nurse administration
section
 More than 1 page of medication
list
 Check for eg ‘2 of 2’
 May not correspond with
community pharmacy supplies
 Good practice to also request
community pharmacy list
 Instructions may be out-of-date
(refills of old Rx)
 Patient may have brought in other
people’s medication
 CHECK NAME carefully & confirm
with patient that still taking
 Patient may not bring in all items
eg if stored in the fridge
 Contents may not match
packaging eg halved tablets
 MUST look inside the bottle
 Back of pack may not match
contents
 Patient may not take all of
contents eg frusemide
 Patient may take additional items
eg warfarin, patches, puffers…
 Some Webster’s wording groups
multiple medications with the
same strength together
e.g. aspirin/allopurinol 100mg
mane, instead of creating 2
separate entries for each drug
 Patients may not realise the
importance of non-tablet forms
 Some patients have filled new
prescriptions but have not actually
started taking