Clinical and Financial Impact of Pharmacist Involvement in Discharge Medication Reconciliation at an Academic Medical Center: A Prospective Pilot Study

Abstract

Pharmacists involved in this pilot discharge process identified and resolved significant errors on medication reconciliation orders that resulted in a financial benefit to the institution.

Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability

“…A recent study by Wilcock et al [20] demonstrated sustained benefits of pharmacists improving the quality of discharge summaries and information on medication changes in their three-year audit but noted that pharmacists only contributed to 25% of discharge summaries. The expansion of pharmacists' roles in the discharge process will require additional workflow and workload considerations [29,30]. There is evidence that pharmacist medication reconciliation interventions at the time of discharge from hospital can be cost saving, through the avoidance of adverse medication events and re-presentations to hospital [31], which suggests that health services should invest in adequate pharmacist resourcing to enable this to be consistently delivered.…”

The Hematopoietic Cell Transplant Pharmacist: Roles, Responsibilities, and Recommendations from the ASBMT Pharmacy Special Interest Group

“…This translated to a cost avoidance of $42,300 and was further extrapolated to an annual net savings of $16,415,000. The 7-day readmission rate was the same as historical controls while the 30-day admission rate was numerically lower though not statistically different [53]. Such cost avoidance strategies have also been successfully implemented in hematology/oncology practices.…”

“…These efforts can be cost effective in a variety of avenues such as preventing delays in hospital discharge due to lack of access to high-cost medications and by minimizing cost absorbed by the institution for patients who lack financial resources to pay for necessary therapy in the outpatient setting. Sebaaly et al [53] reported on incorporating a pharmacist into the discharge medication reconciliation process of 67 discharges on a medical surgical unit. Pharmacist identified and resolved 84 errors for a mean of 1.25 per patient (range, 0 to 6 per patient).…”

Contextualising the Pharmacist Practicing Clinical Pharmacy in South Africa – Do we Practice What we Preach?

“…The top clinical functions pharmacists spend time on include adverse drug reaction monitoring, evaluating prescriptions, checking medication safety, medication reconciliation, ward rounds and therapeutic drug monitoring. The role of clinical pharmacists in medication errors, adverse drug events, therapeutic drug monitoring and antimicrobial stewardship [18][19][20][21][22][23] have been described extensively, both internationally and nationally. Furthermore, the role of the pharmacist in speciality settings like critical care, neonatology, cardiology and infectious diseases has been described [24][25][26][27].…”