A medication history is a record of all the medications, including prescription, over-the-counter and complementary medicines a patient is taking in the period prior to admission, and includes information about previous adverse drug events and allergies. A complete and accurate medication history is the foundation for all decisions concerning medication management to ensure quality use of medicines throughout the episode of care. It assists patient care by reducing medication omissions and other discrepancies in medication orders thereby reducing the risk of adverse drug events and optimising patient outcomes.
Medication lists (eg GP referral letters), medicine labels and medication charts from previous admissions do not necessarily reflect a patient’s current medication regimen accurately and so it is important that details are verified by an appropriately skilled health care professional (eg a pharmacist). The physical presence of medications is a memory trigger for patients and assists health care professionals when establishing a medication history and can be a useful tool during the medication history interview.
The administration of POMs to patients during their hospital stay can enhance the continuity of care by facilitating the timely provision of essential medications not routinely available at the hospital. It also creates opportunities for detection of issues and patient counselling relating to current medicines.
Administration of POMs to patients must be in accordance with Local Health Network (LHN)/hospital policy and the SA Health policy directive on Patients’ Own Medications (PDF 178KB). LHNs/Hospitals may choose whether to allow administration of POMs to their patients where appropriate, depending on anticipated risks versus benefits and availability of appropriately qualified staff to assess suitability of POMs.
Medications brought into hospital by patients are often not readily identifiable and/or suitable for use so it is critical that they are appropriately assessed before being administered to the patient to ensure that it is safe and appropriate to do so. The following checklist may assist hospital staff in assessing POMs for in-hospital use:
The SA Health policy directive on Patients’ Own Medications (PDF 178KB) provides that POMs brought into hospital must be documented and stored and transported safely and securely. This is to ensure that POMs are available for use if and when they are required and able to be returned to patients on discharge, where appropriate.
It is important that POMs are reconciled with all other medications at discharge to ensure continuity of medication management and optimise patient outcomes. This includes review of the medication history to check that any medicines withheld on admission have been re-initiated where appropriate and that any changes have been documented and explained to the patient.
Where medications have been continued, POMs brought into hospital should be returned to them on discharge and any changes to the medication regime should be communicated to the patient. If medicines taken prior to admission are ceased, then consent should be sought from the patient to destroy the discontinued medicines.
Information about how to conduct medication reconciliation on discharge is available from Continuity in Medication Management – A Handbook for South Australian Hospitals.
Information for patients
Information for patients in relation to medicines is available from:
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