Date of Original Version
Background: Medication reconciliation is endorsed by the Joint Commission as a process to reduce negative patient outcomes associated with medication discrepancies across transitions in care. Pharmacist-performed MR in the Emergency Department (ED) compared to medication reconciliation performed by physicians has been shown to identify more medication discrepancies prior to admission.
Objective: The primary objective of this study is to determine if pharmacy participation during the admission medication reconciliation process increases the number of medication discrepancies identified at the Providence VAMC in comparison to the standard of care. Secondary objectives are to evaluate the discrepancies based on the type of discrepancy, medication class, and medication supplier.
Methods: A retrospective electronic chart review was performed for veterans at the medical center who had a pharmacy representative (sixth year pharmacy student or PGY-1 pharmacy resident), complete medication reconciliation template upon admission from January 1, 2015 to May 1, 2015. Patients included were admitted through the ED and had an outpatient medication reconciliation clinical reminder documented in the physician intake note. Patients were excluded if admitted from a facility that had oversight in the dispensing of medications, unable to participate in medication reconciliation, or admitted while pharmacy representatives were not on-site. The number of discrepancies documented by pharmacy personnel and the number of discrepancies documented by the ED staff were compared. The percentage of discrepancies was determined type of discrepancy, medication class, and medication supplier.
Results: A total of 157 patient charts were reviewed. 348 discrepancies were identified by pharmacy compared to 41 discrepancies identified by ED staff. The mean number of discrepancies documented per patient was 2.21 for pharmacy representatives and 0.26 for the ED, CI (1.58-2.32) p
Conclusion: Pharmacy identified significantly more discrepancies during the admission medication reconciliation process in comparison to the standard of care in the ED. The findings of this study support the importance of incorporating pharmacists in the medication reconciliation process at the medical center to improve patient care.
Morgans, R. A., Asal, N. J. & Botelho, C. (2015). Impact of pharmacy participation on number of discrepancies identified during admission medication reconciliation process: A pilot study [Poster presentation]. American Society of Health System Pharmacists Midyear Clinical Meeting.