Audit of General Practitioner Medication Lists for Older Patients at a Regional Hospital

Background Complete medication reconciliation is often difficult to achieve, particularly in the emergency department (ED). General practitioner (GP) medication lists may be used by some doctors for charting medications. Aim To determine the discrepancies in the medication history information between GP medication lists and the actual medication usage of older patients admitted via a regional ED. Method A clinical audit was conducted over a 2 ‐week period at a small regional hospital. Patients 65 years and over, taking 3 or more medications prior to admission, admitted via the ED and with a national inpatient medication chart (NIMC) prepared by a medical officer were identified. Eligible patients were provided with medication reconciliation by a pharmacist. Discrepancies between the medication history obtained by the pharmacist, the GP medication list and the NIMC were assessed. The clinical significance of the discrepancies were classified using a severity assessment code matrix. Results 48 patients were eligible and 75% had 1 or more discrepancy in their GP medication list. Almost half of the discrepancies were related to non‐current medications being recorded. Potential clinical significance of the discrepancies in 19% of patients was ‘moderate’ or ‘major‘. Conclusion While a GP medication list is a useful tool in the medication reconciliation process, it is not a complete representation of the patient's medications prior to admission.