Impact of Students Pharmacists on the Medication Reconciliation Process in High-Risk Hospitalized General Medicine Patients

Article excerpt


An extensive body of published literature exists on the importance of medication reconciliation within the hospital setting, including the 2013 National Patient Safety Goals put forth by The Joint Commission. (1) Additionally, several studies have reported that high-quality medication reconciliation improves the overall care provided to hospitalized patients. (2-5) Up to a quarter of all prescription medications taken by patients prior to admission are not accurately recorded within the medical record. (4) Patients who are taking 7 or more medications are more likely to experience 1 or more medication-related discrepancies. (6) These discrepancies have been categorized as omission of prescription or nonprescription medications; differing dosage form, dose, or route recorded; and/or therapeutic substitutions; among others. Furthermore, the impact of these discrepancies can be great, with up to 40% of noted discrepancies having the potential to cause "moderate to severe" patient discomfort and/or a decline in patient clinical status. (2)

Aside from the literature regarding the impact of pharmacists in providing medication reconciliation, 3 publications have evaluated the impact of student pharmacists in providing medication reconciliation services at community hospitals. (6-8) Lubowski and colleagues demonstrated that, when student pharmacists performed medication reconciliation in over 300 patients, approximately 1000 discrepancies were identified. (6) These discrepancies largely consisted of omitted prescription medications. Furthermore, Lubowski and colleagues demonstrated that discrepancies were directly associated with the number of medications patients were taking prior to admission. From this study the authors determined that patients whose admission medication list included 1 or more discrepancies contained on average 8[+ or -] 4 medications as compared with 5[+ or -] 4 medications for patients whose lists did not have discrepancies (p=0.05). (6) Pardiyara demonstrated similar outcomes in her study in which student pharmacists identified approximately 3 discrepancies per patient, with a similar number of omissions as identified in the study by Lubowski. (7) Walker and colleagues evaluated the impact that student pharmacists can have on clinical interventions within a transition of care setting, with results similar to those from the other studies noted. (8) These studies show that student pharmacists can have a positive impact on patient care that is similar to that of licensed pharmacists. As the role of student pharmacists continues to expand, particularly as part of their clinical advanced pharmacy practice experiences, they are being asked to participate in a number of patient care areas previously limited to pharmacists, including medication reconciliation. It is important for pharmacy educators to provide students with appropriate activities that not only ensure they receive high impact, meaningful, experiences as part of their training, but also positively impact patient care.

A thorough literature search failed to identify any studies evaluating the accuracy of admission medication lists obtained by pharmacy students as part of a medication reconciliation process compared to those lists obtained by nurses and physicians. Thus, pharmacy faculty members at Northeastern University and Massachusetts College of Pharmacy and Health Sciences University undertook a study to evaluate the role of student pharmacists within the medication reconciliation process and to compare the accuracy of the medication list obtained by student pharmacists with that of nurses and physicians caring for the same patients. The objectives of this study were to: (1) compare and contrast the accuracy of medication lists obtained by student pharmacists with those obtained by nurses and physicians for inpatients admitted to a tertiary academic medical center, and (2) categorize and quantify the type and nature of any interventions made as a result of performing medication reconciliation. …


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