Effectiveness of a Medication Reconciliation Project Conducted by PharmD Students

Abstract

Objectives. This study evaluated the effectiveness of a medication reconciliation program conducted by doctor of pharmacy (PharmD) students during an advanced pharmacy practice experience. Methods. Patients admitted to medicine or surgery units at 3 hospitals were included. Students were instructed to interview each patient to obtain a medication history, reconcile this list with the medical chart, and identify and solve drug-related problems. Results. Eleven students reconciled medications for 330 patients over 10 months and identified 922 discrepancies. The median number of discrepancies found per patient was 2, and no discrepancies were found in 25% of the cases. In cases in which discrepancies were identified, a greater number of medications had been prescribed for the patient (7.9 6 4.0 medications compared to 5.4 6 3.9 medications; p , 0.05). The students completed 59 interventions. Differences were found in the numbers of discrepancies and drug-related problems that different students at different sites identified (p , 0.05). Conclusions. Pharmacy students provided a valuable service to 3 community hospitals. The students improved the quality of patient care by identifying and solving significant drug-related problems, identifying drug allergy information, and resolving home and admission medication discrepancies.

An Exploratory Comparison of Medication Lists at Hospital Admission with Administrative Database Records

“…Studies have evaluated the impact of medication histories collected by a variety of health care and allied professionals 12,[14][15][16]18,[24][25][26][27][28] and the use of tools to assist in the process 10,[19][20][21]29,30 and have compared electronic medical records with actual medication use, 17 but to the authors' knowledge, a comparison of a health plan's claims database with patient interview to formulate a list of medication names and doses/strengths has not been investigated.…”

Report of the 2014-2015 Professional Affairs Standing Committee: Producing Practice-Ready Pharmacy Graduates in an Era of Value-Based Health Care

“…There are numerous studies highlighting the value added through pharmacist performed medication reconciliation. 53,54,55,56,57,58,59,60,61,62,63,64 This is one area where development of new APPEs can directly link with institutional needs to improve patient care metrics.…”

Insufficient Medication Documentation at Hospital Admission of Cardiac Patients: A Challenge for Medication Reconciliation

“…Many studies have assessed the problems of continuing medication at the interface between hospitals and primary care at hospital discharge (6). In recent years, however, the process of "medication reconciliation" at hospital admission has gained more attention (7)(8)(9). Medication reconciliation remains a challenge especially in situations where the quality of medication documentation is poor.…”