3.5 Reliability of medication history
Both doctors and pharmacists were cognisant of the information vacuum
within which they were working at the AMU. The initial clerking of a
patient focused upon obtaining up-to-date knowledge of the medication
history and this was often thwarted because of incompleteness or
datedness of records or lack of confidence in the patient’s story. This
was recognised particularly as a problem of prescribing within the unit
as prescribers were working within an imperfect communications
environment, piecing together a jigsaw, and filling in gaps using
collateral sources. The following quotation is illustrative of
frustration that several doctors expressed: -
“The whole med rec [reconciliation] part of it is a nightmare
in terms of … getting access to what they are on reliably, and
you can say – “yes” [“it is correct”]– not on a scrap bit of
paper that they have written their drug doses down on 10 years
before…. (Doctor 2016)
Owing to difficulties when working within an uncertain medication
history, problems persist as prescribers’ intentions remain insecure.
For example,
“There [is] some medication [that is] specifically
very distinctly difficult such as warfarin… you never know what
the dose is and if the patient doesn’t know then it’s very difficult to
prescribe appropriately. And also, insulin and pain relief – if it’s
‘prn’ [when required] you may prescribe the lowest dose prn
but they might be on the maximum dose which makes it very difficult(Doctor, 2015).
“Sometimes…the medical notes don’t match up to the EPMA
[Electronic Prescribing and Medicines Administration] system…
certain medicines have been missed off, so we’re not too sure whether
they have actually been stopped or just accidentally missed off”
(Doctor, 2016).
Under such circumstances, it is clear that some prescribing decisions
were left unmade with prescribers hoping that the issue will be picked
up at a later point when more information or advice was available.