Managing Medication History in Emergency Department

Overview of BPMH

• According to ISMP- Canada (2016) a BPMH is a history created using 1) a systematic process of interviewing the patient/family; and 2) review of at least one other reliable source of information to obtain and verify all of a patient's medication use (prescribed and non prescribed).
• BPMH in this module refers to a list of medications generated in partnership with clients/patients, families or caregivers as appropriate using interviews, medication containers, medication list, local pharmacy list, electronic records or past medication profile or records from hospital.
• This list is used to reconcile client medication at care transitions including in ED.
• Any medication discrepancies are to be clearly identified, documented and communicated to the physician.
• Knowing that the ED nurses are often multitasking and time is a factor in their roles, BPMH does not always have to be done during triage, although it is initiated on triage, it should be completed while the patient is in the ED before their discharge from ED.

Why is BPMH important in ED?

Reconciling medications of patients in ED, in particular for patients with multiple conditions and on a number of medications is important to prevent any medication errors arising from new prescriptions in ED.

• BPMH is the first step in this process. Collecting a BPMH is ED leads to an accurate Medication reconciliation and eventual prevention of the errors and ADEs. According to Emmanuel et al.,(2014) when BPMH is effectively executed, it can intercept omission of medications in the medication reconciliation process and errors before they lead to adverse drug events.
• It engages the patients, and ensures that the patients realize that they have to be accountable  (where possible) for their medications rather than putting all the accountability of their medications on the system.
• Ensures that there is a process in place to ensure that there is patient teaching especially where new meds have been ordered, changes have been made to home medications and they are follow up appointments.
• Research has shown that when effectively implemented, not only are medication errors reduced, but a reduction in ED visits and rehospitalisations. Hellstrom et al., (2012) rightly notes that there is convincing evidence that medication reconciliation and reviews decrease medication errors and other drug-related problems, and improve the appropriateness and patient's adherence to treatment.