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Question:
In my ED, the triage nurses no longer list the patient's current medications. Is this a safe practice?

Answer:
This question is an important one that reflects a frightening trend across the county. Some hospitals have determined that ascertaining and documenting a patient's current medications can wait until the patient is placed in the treatment area. This is clearly an unsafe practice if the patient is waiting any length of time at all. Multiple resources, including the Emergency Nurses Association's Sheehy's Emergency Nursing Principles and Practice (5th ed.), Emergency Nursing Core Curriculum (6th ed.,,) and Sheehy's Manual of Emergency Care (6th ed.), as well as Valerie Grossman's Quick Reference to Triage (2nd ed.), all validate (albeit with slightly different words) that obtaining current medications is part and parcel of the comprehensive triage assessment. Current medication includes all prescription medications, over-the-counter medications, alternative-healing interventions, and herbal and home remedies that the patient is taking. The rationale for this is not to simply create more work for the triage nurse (and let's be honest - there are some patients that come with more medications than a millipede has legs), but to apply that knowledge in critical decision-making about possible worst-case scenarios and triage acuity. (And questioning about medications may need to be specific: It is not uncommon for patients to deny any medical history only to find out later that they're taking combinations like glucophage, Norvasc, and Atenolol.) Knowing the patient's current medications assists in driving the interview and objective assessment while considering worst-case scenarios. Consider the possible ramifications in the following scenarios:

• A 29-year-old obese female with right-sided chest pain - taking oral contraceptives x 10 years
• A 62-year-old male with vomiting and diarrhea - taking beta blockers or calcium channel blockers
• A 50-year-old female with nausea, vomiting, and visual disturbances - taking digoxin
• A 34-year-old woman with slight tremulousness - taking lithium
• An 84-year-old male who struck his head against a cabinet - taking Coumadin
• A 40-year-old female with rectal bleeding - taking Coumadin
• A 16-year-old male with hives and shakiness - used EpiPen prior to arrival
• All of these scenarios demonstrate the importance of considering a patient's medications when determining triage acuity.

One exception to obtaining current medications at triage is the patient meeting the 3 mandatory rapid-triage criteria for immediate bedding. It would indeed be inappropriate to delay a patient at triage to obtain a medication list when the patient is obviously seriously ill, and there are open beds and appropriate available care providers.

Emergency Nurses Association. (2007). Emergency Nurses Core Curriculum (6th ed.) p 30. Saunders: St. Louis.
Emergency Nurses Association. (2003). Sheehy's Emergency Nursing Principles and Practice (5th ed.) p 81. Mosby: St. Louis.
Emergency Nurses Association. (2005). Sheehy's Manual of Emergency Care (6th ed.) p 75. Mosby: St. Louis.
Grossman, V. (2003). Quick Reference to Triage (2nd ed.) p 12. Lippincott: Philadelphia.

Side Note
Understanding and meeting best practice is one of the professional goals of emergency nurses across America. Questions submitted to Ask the Experts often reflect issues applicable across the spectrum of triage nursing. We encourage submissions to the column and hope you keep in mind that if you have a question about a particular issue, chances are that many of your colleagues have the same question.

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