Fewer Errors in Hospitals When Pharmacists Are Involved
Researchers reported last week at the conference of American Society of Health-System Pharmacists that, when pharmacists lead the medication reconciliation effort, providers see more accurate, complete, and up-to-date patient information at the time of hospital admission and discharge.
Richard Mioni, PharmD, BCPS, of Little Company of Mary Hospital and Health Care Centers (LCMH) in Chicago, Ill., and colleagues reported that, after pharmacists took over gathering patient medication histories and supplemented patient charts with medication progress reports at the time of hospital admission, accurate and complete medication reconciliation went from 32.3% to 94.2%.
Nationwide, roughly 54% of patients experience one or more errors in their medication reconciliation in the hospital setting. At LCMH, they found errors in as many as 67% of admission medication lists, and 80% of discharge lists.
Mioni and colleagues tested whether having pharmacists lead medication reconciliation upon patient admissions into the emergency department from September 2012 through March 2013 made a difference in the number of errors.
During the first step of the process, pharmacists reviewed patient charts to identify disease states and medical histories and to look for unidentified medications, any potential errors, or non-evidence based treatments.
Next, pharmacists interviewed patients in person to gather medication histories. And, if they deemed it necessary, they contacted the patients’ pharmacies, family members, and physician offices for further information. Pharmacists then entered their assessments into the electronic medical records and added printed versions to patient charts.
Pharmacists added progress notes to the charts to update any and all medication changes and any possible recommendations for medication changes of adjustments.
At baseline, complete and accurate medication reconciliation occurred 32.3% of the time at admission, and went to 50%; and 16.7% of the time at hospital discharge, which went to 25% at admission, as soon as the pharmacists started taking charge of reconciliations.
By the end of the study period, 94.2% of medication reconciliations were complete and accurate at the time of admission.
Mioni and colleagues noted that medication omission and frequency of administration were the most common errors in reconciliation at 28.1%-31.4% and 25%-28.5% of the errors. Other errors included dose (19.8%-22.6%), incorrect medication (13.1%-14.0%), dosage form errors (6.2%-9.1%), and therapeutic duplication (0.6%-1.5%).
Prior to the use of pharmacists, the number of errors in medication reconciliation averaged 2.94 per patient at the time of admission and 4.2 at the time of discharge. At the start of the program, the rate fell to 0.92 at the time of admission and 2.92 at discharge.
By the end of the study, the average admission errors dropped to an average of 0.07 per patient. Discharge error data were absent from the end of the study period.
L.L. Huang and colleagues at the Bryan Health System in Lincoln, Neb., also presented evidence at ASHP on the success of pharmacist-led medication reconciliation in a hospital setting.
Over the course of 4 months in 2013, the researchers looked at pharmacist medication reconciliation for 81 patients in a single hospital.
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