gms | German Medical Science

Background: With an increasing number of medications, especially in older patients, the risk of adverse drug events (ADE) increases [1]. The most effective way to improve drug therapy safety is the knowledge of the complete medication of a patient [2]. The nationwide medication plan (Bundesmedikationsplan, BMP) summarizes the patients medication information and allows the exchange of medication information between physicians, pharmacists and patients [3].

It is essential to update the BMP when medication changes. A prerequisite is that patients always have their medication plan with them. Several pilot projects assessed that patients forgot medication plans and/or these were not centrally available [3]. Especially in emergency care valid medication information is rarely available [1]. Even for emergency room patients, the BMP was not available or complete for all patients [1]. For drug therapy safety timeliness is necessary. Particularily BMPs older than a month must be examined critically [4]. The BMP has not yet become established in nursing homes because it is not adapted to their requirements and is primarily suitable for patient information [5]. Despite discrepancies and the lack of timeliness a significant improvement on the drug therapy safety was proven [3]. Further research on the use of the BMP and its timeliness, also in comparison to other medication plans, is required.

The aim of this study was to evaluate the availability of the BMP and other medication plans for patients in an emergency department. The number of patients taking medication, having documented medication plans and how many of them are BMP was evaluated. Also the timeliness of these documents was examined.

Materials and Methods: 500 digital medical records of patients 65 years or older, presented to the Department of Emergency Medicine (Klinik für Notfallmedizin, KfN) of the University Hospital Jena in 2020 were searched for medication plans in the form of a standalone document. Any source of information that provided information on the active substance and/or product, dosage and dosing schedule was considered a medication plan. Patients from nursing homes, assisted living and without information about the living situation were excluded from the study. The age of the medication plans was determined from the difference between the date on the medication plan and the time the patient was presented. Medication plans issued (printed or faxed to the hospital) before admission or during the stay resulting from admission were included.

Results: 284 patients out of 500 were included in the study because of their living situation (living alone, living with relatives and outpatient nursing service). No information on medication was available for 25 patients (9%).

Out of 259 patients for whom medication information was available, 9 patients (3%) were not taking any medication. 153 of 259 patients had a medication plan (61%). 78 (51%) medication plans were BMPs and 67 (44%) were other medication plans (handwritten, doctor’s office layout, etc.). 8 patients had both types of medication plan.

36 patients had more than one medication plan document in their patient record (maximum of 4). 13 patients had more than one BMP and 19 patients had more than one other medication plan.

In total out of 198 medication plan documents, 100 were BMPs and 98 were other medication plans.

32% of the BMPs had handwritten additions.

The median age of all medication plans was 44 days. The BMPs had a median age of 57.5 days and other medication plans had a median age of 27.5 days.

18 medication plans had no information about the date, which is why the age could not be determined and they were not included in this part of the study.

Conclusion: Medication information was available for most patients (259 patients out of 284, 91%), suggesting good documentation in the emergency department.

In 61% of the patients who did take medication (153 patients out of 250) the information was provided in the form of a medication plan document.

The BMP was available for only 56% (86 patients out of 153) of the patients.

This study shows that the BMP still has unused potential. Physicians can only make the right decisions in terms of patient safety if they have complete and updated information of the patients medication [1]. The interdisciplinary [5] and correct use of the BMP [2] (not handwritten, up-to-date and complete [4]) should therefore be further promoted. Training patients to use and carry their medication plan is just as important. Acceptance and benefits of the BMP have already been proven [3] and it can be expected that further integration into care routine will contribute to patient safety.