Managing Medication History in Emergency Department

Who are high risk patients in ED?

Much as all patients visiting ED would  benefit from BPMH. Is it really realistic that a BPMH can be created for each and every patient? Not really. A 20 year old Hockey player with a puck laceration to chin and not on any medication at home will unlikely need the creation of a BPMH. However the following patients will need BPMH;

• The elderly, the frail
• patients with multiple chronic or terminal conditions
• patients with cognitive impairment
• patients with recurrent visits to ED
• patients with recurrent hospitalisations or recent hospitalisations

This list is not exhaustive but a guide to the population of patients likely to require the creation of a BPMH. Patients in these population categories are at a higher risk for medication errors as most often they are on multiple medications and treatment regimens. Thus it is important to ensure that a BPMH is done in the medication reconciliation to ensure that any possible medication errors or adverse drug events are intercepted before they can occur.

Can I use CTAS scores in ...?

Patients with CTAS scores of 3 and higher (1 and 2) are likely to benefit from a BPMH.  However, it is important to note that there are numerous times  when a patient is scored as a 4 by one nurse in ED, and 3 by another with the same presentation. It is not uncommon to have a patient who was triaged as a 4 having multiple changes in medications on discharge from ED or a patient who came with a more stable presentation (CTAS score 4) getting unstable and requiring more attention than anticipated. Thus the ED nurse as a clinician needs to apply judgement throughout the care of the patient as to whether there is an anticipated need for medication reconciliation. Should such be the case, creation of a BPMH becomes a necessity.