Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students

Abstract

Background: Medication reconciliation aims to prevent unintentional medication discrepancies that can result in patient harm at transitions of care. Pharmacist-led medication reconciliation has clear benefits, however workforce limitations can be a barrier to providing this service. Pharmacy students are a potential workforce solution.
 Objective: To evaluate the number and type of medication discrepancies identified by pharmacy students.
 Methods: Fourth year pharmacy students completed best possible medication histories and identified discrepancies with prescribed medications for patients admitted to hospital. A retrospective audit was conducted to determine the number and type of medication discrepancies identified by pharmacy students, types of patients and medicines involved in discrepancies.
 Results: There were 294 patients included in the study. Overall, 72% (n=212/294) had medication discrepancies, the most common type being drug omission. A total of 645 discrepancies were identified, which was a median of three per patient. Patients with discrepancies were older than patients without discrepancies with a median (IQR) age of 74 (65-84) vs 68 (53-77) years (p=0.001). They also took more medicines with a median (IQR) number of 9 (6-3) vs 7 (2-10) medicines per patient (p<0.001). The most common types of medicines involved were those related to the alimentary tract and cardiovascular system.
 Conclusions: Pharmacy students identified medication discrepancies in over 70% of hospital inpatients, categorised primarily as drug omission. Pharmacy students can provide a beneficial service to the hospital and contribute to improved patient safety by assisting pharmacists with medication reconciliation.

Obtaining medication histories via telepharmacy: an observational study

“…The most common medication deviation type in our study were omissions, with the most commonly omitted medications being non-prescription. This is consistent with other studies that identified omissions [ 6 , 14 , 20 – 25 ] and vitamins/over-the-counter products [ 22 , 26 ] as the most common causes for medication deviations when a second in-person obtained BPMH is conducted against an initial in-person BMPH. This suggests that medications which were identified in the second, in-person, encounter, may be due to memory recall bias, as a result of prompting the patient multiple times, and not as a result of telepharmacy.…”

Accuracy of best possible medication histories by pharmacy students: an observational study

“…Our study identified that high-risk medication deviations were significantly associated with 'blood and blood forming organs' medications, which is consistent with literature [33,34]. Similarly, to other studies, the most common discrepancy type was drug omission [4,14,15,17,20,34,35]. Our study also identified that no-or-low-risk medication deviations were predominantly associated with non-prescription medications (e.g., vitamins, and "when needed" medications), which implies a difference between the pharmacist and the student's BPMH questioning process.…”