Pharmacy collected medication histories in an observation unit

Abstract

Background:Clear processes to facilitate medication reconciliation in a hospital setting are still undefined. The observation unit allows for a high patient turnover rate, where obtaining accurate medication histories is critical.Objectives:The objective of this study was to assess the ability of pharmacists and student pharmacists to identify discrepancies in medication histories obtained at triage in observation patients.Methods:Pharmacists and student pharmacists obtained a medication history for each patient placed in observation status. Patients were excluded if they were unable to provide a medication history and family, caregiver, or community pharmacy was also unable to provide the history. A comparison was made between triage and pharmacy collected medication histories to identify discrepancies.Results:A total of 501 medications histories were collected, accounting for 3213 medication records. There were 1176 (37%) matched medication records and 1467 discrepancies identified, including 808 (55%) omissions, 296 (20.2%) wrong frequency, 278 (19%) wrong dose, 51 (3.5%) discontinued, and 34 (2.3%) wrong medication. There was an average of 2.9 discrepancies per patient profile. In all, 76 (15%) of the profiles were matched. The median time to obtain a medication history was 4 min (range: 1–48 min).Conclusion:Pharmacy collected medication histories in an observation unit identify discrepancies that can be reconciled by the interdisciplinary team.

Clinical Outcomes of Student Pharmacist–Driven Medication Histories at an Academic Medical Center

“…14,16 Similarly, several of the studies had greater than 75% of patients identified as having an inaccurate medication history (Padiyara 75%, Lubowski et al 75%, Procopio et al 76%, ours 96%). 13,16,18 Study by Mersfelder and Bickel stated that 67% of patient charts had a medication or dosage omitted but did not include clarifications for directions or frequency in this and therefore was lower than the other stated studies. 15 A high number of patients required additional pharmacy intervention of contacting their outpatient pharmacy to obtain a recent medication list (Padiyara 68%, ours 79%, Mersfelder and Bickel 99%).…”

“…8 We identified 7 studies that describe the benefit of student pharmacist-obtained medication histories that have similarities in student training required and in the general patient interview process. [13][14][15][16][17][18][19] Similar to our practice site, all of the previously published studies were at institutions without pharmacy services that were established in obtaining medication histories. [13][14][15][16][17][18][19] Some similarities and differences existed between our results and those previously published when looking at patient types and intervention rates.…”

“…This may have increased the likelihood of contacting outpatient pharmacies because of increased patient acuity close to admission. 15 Lastly, differences existed in the average amount of time reported in taking the actual medication histories and ranged from about 16,18,19 These differences may be due to methods of data reporting. Student pharmacists in our study included all communications with pharmacies and caregivers and not just the time spent in the patient room in the time required for completing the medication history.…”

“…The benefit which students offer to the medication history and reconciliation process has been evaluated in at least 7 published reports. [13][14][15][16][17][18][19] Each of these reports evaluated the number of discrepancies identified between medication histories obtained by nonpharmacy staff and one obtained by the student pharmacist. Each study demonstrated a significant impact on the accuracy of the documented home medication list and provided a rationale for extending the pharmacy departments' ability to be involved in medication history taking and medication reconciliation by involving students.…”

Comparison of Medication History Accuracy Between Nurses and Pharmacy Personnel

“…11 Additionally, Procopio et al found that pharmacists and pharmacy students identified an average of 2.9 medication discrepancies per patient among medication histories completed by nursing. 13 Recently, our 230-bed community hospital expanded pharmacy-led medication histories by allocating 2 full-time equivalents (FTEs) for pharmacy technicians and 0.8 FTEs for student pharmacist interns dedicated to completing medication histories. In this model, clinical pharmacists are occasionally called upon to complete complex histories or when a timely history completion is important and the designated technician or intern is not readily available.…”