Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center

Abstract

Objective Patients who have an up-to-date and accurate medication list are less susceptible to medication errors and allow care teams to make more informed treatment decisions. Through utilizing student pharmacists to provide medication history services, we anticipate improved patient safety and overall quality of patient care. The purpose of this project was to implement a medication history service for ambulatory oncology patients of the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital. Methods A phased approach was utilized to implement a standardized operating procedure for completing medication histories in ambulatory oncology patients. Data collection included number of total medication discrepancies, percentage of patients with high-risk medications, and high-risk medication classes involved in discrepancies. Additionally, time data were collected, including time spent calling the patient, completing patient work up, and preceptor oversight. Results Students completed medication histories for 60 patients; 83% of patients had at least one discrepancy with 21% of those discrepancies involving a high-risk medication. High-risk medications involved in discrepancies included oral chemotherapeutic agents, anticoagulants, insulin, and opioids. Conclusion The majority of patients seen had at least one medication discrepancy that was identified and corrected through the medication history service. By correcting the discrepancy, the likelihood of medication errors occurring was decreased. Continuous workflow changes are being made to identify the number and type of resources to expand the service to all appropriate ambulatory oncology patients at the Sidney Kimmel Comprehensive Cancer Center.

EAHP European Statements Survey 2018, focusing on Section 1: Introductory Statements and Governance, Section 3: Production and Compounding, and Section 4: Clinical Pharmacy Services

“…Another highly ranked reason was that other healthcare professionals are doing this at the moment. As the results from many projects have shown, hospital pharmacists are very well accepted if they provide services to patients;7 8 the professionals who carry out these services at the moment should be considered as partners for future change.…”

The impact of medication reconciliation and review in patients using oral chemotherapy

“…This is in line with previous research, where discrepancies were identified in 37-88% of all cancer patients. [25][26][27][28] In a pilot study by Somers et al an average of 2.7 discrepancies per patient were reported. 29 Bertsch et al even reported an average of six discrepancies per patient.…”

Exploring practice site contributions and professionalization impact of engaging student pharmacists on hematology-oncology advanced pharmacy practice experience rotations

“…Two identified studies reported the positive contributions of student pharmacists in assisting preceptors with oncology medication reconciliation interventions or medication history-taking services. 7,8 We recognize through our own experiences that student pharmacists contribute to more than medication reconciliation activities on oncology rotations; further, a survey of pharmacy practice department chairs reported that collectively students on oncology rotations that were offered through their respective colleges of pharmacy performed duties such as patient care work-ups, drug information requests, journal clubs, and patient chemotherapy counseling. 9 Moreover, May and Ladd 10 advocate that oncology pharmacists should expand their roles to include precepting APPE students, to not only enhance the student's education, but also to spark interest in pursuing a career as an oncology pharmacist, as oncology pharmacists are vitally needed to fill a gap in the anticipated shortage of oncologists.…”