• Christopher F Green, Kirti Burgul, and David J Armstrong.
• Pharmacy Department, Countess of Chester NHS Foundation Trust, Liverpool, UK. chris.green@coch.nhs.uk
• Int J Pharm Pract. 2010 Apr 1;18(2):116-21.

ObjectivesMedication history-taking is recognised as a potential source of medication errors and is the subject of the first National Patient Safety Agency/National Institute for Health and Clinical Excellence Patient Safety Guidance. Medication lists are suggested as a way of improving medicines reconciliation, but, anecdotally, can falsely reassure prescribers that they have an accurate list of medicines if used in isolation.MethodsPatients in possession of a medicines list on admission to hospital were approached as part of routine care. Data were collated regarding medication-history discrepancies, their source and whether a prescription amendment was made.Key FindingsOne hundred and twenty patients were reviewed and the median time for pharmacists to complete medicines reconciliation was 15 min. Eighty-three patients (69.2%) had only one medication list, 31 (26%) had two, five (4%) had three and one patient (0.8%) had four lists. In total, 447 discrepancies were identified of which 49 (11.0%) were initiated by the patient, including 32 (65.3%) to adjust a dosage regimen or not to comply with a dosing regime. For the 279 (62.4%) discrepancies attributable to secondary care staff, 119 (42.6%) prescribed medicines were omitted unintentionally. For the 119 (26.6%) discrepancies attributable to the primary care medicines lists, 48 (40.3%) related to inadequate or inaccurate information regarding medicine doses, frequency, strength or form. Each patient required a mean of 1.6 amendments to their prescription despite bringing a list of medicines with them.ConclusionsMedication lists should be interpreted with caution and assessed in combination with other sources of information, particularly the patient or their carer. Strategies to improve medicines reconciliation on admission to hospital are still needed and a single electronic patient record encompassing primary and secondary care medication records would be a positive step forward.

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