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.