A pharmacist researcher has warned about high prevalence of medication record discrepancies at a national conference, pointing to digital records as a solution
Medicine-related problems are common because using medicines is our most common healthcare treatment, Professor Amanda Wheeler told delegates at the National Medicines Symposium (NMS), hosted virtually by NPS MedicineWise on Monday.
Over one million Australians experienced an adverse medicine event in the last six months—and some groups are at higher risk, including those with long-term conditions, on multiple medications, older people and migrant populations.
Medicine discrepancies can cause particular problems, said Professor Wheeler, a pharmacist and mental health researcher with Griffith University in Queensland.
“There are significant discrepancies between the medicines people take at home, that are prescribed by GP, that are listed in healthcare plans, and what they obtain from community pharmacies,” she said.
Professor Wheeler described recent research with antipsychotic medicine clozapine, where prescribing is commonly restricted to psychiatrists and dispensed by hospital pharmacy. However maintenance doses can be prescribed by GPs and dispensed by community pharmacies under shared care arrangements.
Consumers (18-65 years old) prescribed clozapine under shared care management with capacity to consent were eligible to participate in the study, results of which were published in the Journal of Evaluation in Clinical Practice.
Medication records held by each of the shared care stakeholders were compared to a best possible medication history compiled by a pharmacist. A total of 35 consumers gave consent to collection and review of records.
Under the shared care program, the Griffith University researchers found over 91% of consumers had at least one medicine discrepancy in their records, with an average of 4.9 discrepancies per consumer.
Secondary care records contained the highest number of discrepancies (74.3%). Meanwhile 70% of GP records and 62.5% of community pharmacy records had discrepancies. About 20% of discrepancies involved clozapine.
“In some cases there were up to 12 medicines that were missing from secondary health records. Clozapine was omitted in 41% of community pharmacy records,” explained Professor Wheeler.
Most consumers assumed their clinicians communicated with one another.
“However if we combine the high prevalence of medication discrepancies and the assumption that their clinicians were in communication with one another, this highlights the urgent need to address all aspects of medication safety,” said Professor Wheeler.
She said the key to reducing medicine-related harm is timely access to an accurate, comprehensive and shared digital health record, noting that 84% of GPs, 88% of pharmacies and 94% of public hospitals are registered with My Health Record (MHR) and uploading documents.
The Pharmacist Shared Medicines List (PSML) is another important document, which she believes will grow in time.
“It’s coming up as a searchable document in the MHR, people will be requesting it and more pharmacists will become involved in providing these. It’s become a requirement in HMRs and RMMRs and I think Webstercare came on board so when Websterpacking is being done, that will form the creation of PSML as well,” said Professor Wheeler.
“Everyone needs to commit to the consumer being central to the goal of medication accuracy. But a lot of it comes to the consumer asking for it as well, a lot of education needs to be done, it’s all of our responsibility.”
At the symposium, Brisbane consultant clinical pharmacist Debbie Rigby queried how collaborative medications reviews such as HMRs and RMMRs could help with medication reconciliation and use of medicines like clozapine.
Professor Wheeler said digital records need to be used and uploaded to MHR, which then needs to be integrated effectively into GP software.
“If pharmacists are working in isolation and doing the medicines reconciliation process and creating the review and report, it needs to be available to people. The commitment in the recent HMR/RMMR guidelines is that this goes in the MHR,” she said.
“This will help, but GPs will have to use MHR as well. The interoperability of the software system and MHR has to be worked on.
“I think being able to, with a nominated GP, if you’re a pharmacist that’s just completed an HMR, to ensure that’s being transferred to that GP securely – not by a fax machine – is one of the ways, and if that comes up within the prescribing software the GP is using, that’s going to manage that,” said the professor.
Another NMS commenter noted that regional hospitals are still using handwritten records and prescriptions, highlighting a further need to address this.
The theme for this year’s NMS was ‘Rising to the medication safety challenge’.