• Simone Taylor, Susan Welch, Andrew Harding, Leonie Abbott, Baljit Riyat, Mel Morrow, Dona Lawrence, Sheridan Rodda, and Sarah Heward.
• PharmD, GC CRM, Senior Pharmacist, Emergency Medicine and Research, Pharmacy Department, Austin Health, Heidelberg, VIC.
• Aust Fam Physician. 2014 Oct 1; 43 (10): 728.

BackgroundClinical handover and obtaining best possible medication histories (BPMH) at transition points in care are key patient safety pri-orities. This study aimed to determine the accuracy of medication histories documented on general practitioner (GP) referral letters for patients referred to emergency departments.MethodsThis was a multicentre prospective observational study in eight emergency departments. Patients taking ≥1 regular medication, referred to the emergency department with a GP letter and seen by a pharmacist were included. GP medication regimens were compared with BPMH documented by the emergency department pharmacist.ResultsOf the GP letters (total 414), 361 (87%) had one or more discrepancies in the patients' regular medications and 62% had one or more regular medication discrepancies of moderate-high significance. Omission of medication was more prevalent in hand-written letters (P DISCUSSION: GP referral letters should not be used in isolation to determine the medication regimen taken before an emergency department presentation. Interventions are indicated to improve awareness and accuracy of medication documentation.

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