Cedarville University School of Pharmacy Implements Medication Reconciliation Programs

Cedarville University School of Pharmacy Implements Medication Reconciliation Programs

By: Dr.Thad Franz,

Cedarville University School of Pharmacy

Ohio,USA

 

As hospital accreditation makes “accurate and complete reconciling of medications across the continuum of care” a priority, it is imperative that institutions find a way to meet the standard while providing excellent patient care.It is estimated that up to 27% of all prescribing errors in the hospital result from incomplete medication histories at the time of admission[1].  Several studies conducted in the emergency department (ED) documented a decrease in medication errors as a result of medication reconciliation programs initiated on admission from the unit[2].  Thus, the requirement for health systems to conduct medication reconciliation provides both an educational and service opportunity for students[3].  Studies also suggest pharmacist or pharmacy students providing this type of service provide more complete, accurate medication lists; fewer errors in documentation, and increased compliance to policy and procedures[4][5][6].

Cedarville University School of Pharmacy has developed partnerships with three local, community hospitals to provide a student-pharmacist led medication[U1]

reconciliation service to high risk patients within the institution’s ED.  High risk patients would include patients with complex disease state(s), complex medication regimens, and those patients most likely to be admitted to a hospital unit. Second year professional students participate in obtaining medication histories on Monday through Friday from 5-9pm.  This time is reflective of highest utilization of the ED, as well as and student availability. This model helps to meet the needs within the hospital while satisfying pharmacy school accreditation requirements by affording the student pharmacists the opportunity to meet institutional practice competencies while providing direct patient care through the medication reconciliation initiative. 

 Student’s daily responsibilities include:

Ø Review patients admitted to ED to target high risks patients based on criteria Review medication list documented in the hospital medical record system

Ø Interview patients while conducting a medication history

Ø Identify potential discrepancies making note of them within the medical record system

Ø Document progress note identifying interventions made and forward to preceptor and/or physician for final review

Ø If discrepancies are identified, follow up with responsible physician either by phone or through medical record system

In-class training was provided to each pharmacy student covering the basics of the medication reconciliation process, basic training on the hospitals electronic medical record system, and discussion of patient case scenarios.  More in depth training is provided at each hospital detailing specifics of the medication reconciliation process at the particular institution.  Assessment tools were developed to ensure each student would be competent in each of the responsibilities before allowing the student more autonomy during the remainder of the experience.  

In the future, data will be compiled focusing on the number of interventions initiated by the student pharmacist as well as acceptance rate by attending physicians.  Intervention is defined as a discrepancy necessitating a change to the patient’s current medication regimen.  Secondary objectives will focus on assessing the student’s attitude, understanding of the medication reconciliation process, and overall impact within the health care team.   Finally, the compilation of data will be analyzed to assess the impact of patient readmission rates, there by further defining the impact of the pharmacy-led initiative.

References

1. Dobrzanski S, Hammond I, Khan G et al.  The nature of hospital prescribing errors.  Br J Clin Govern. 2002; 7:187-93.

2. Pronovost P, Weast B, Schwarz M, et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003;18(4):201-5

3. Lubowski T, Cronin L, et al.  Effectiveness of a Medication Reconciliation Project Conducted by PharmD Students.  J Pharm Ed 2007; 71 (5) Article 94.

4.Lubowski TJ, Cronin LM, Pavelka RW et al. Effectiveness of a medication reconciliation project conducted by PharmD students.  Am J Pharm Educ. 2007 Oct 15;71(5)94.

5. Hayes BD, Donovan JL, Smith BS, et al. Pharmacist-conducted medication reconciliation in an emergency department.  Am J Health Syst Pharm 2007 Aug 15;64(16):  1720-3.

6. Carter, M. K., D. M. Allin, L. A. Scott and D. Grauer.  Pharmacist-acquired medication histories in a university hospital emergency department. Am J Health Syst Pharm. ( 2006). 63(24):2500-3

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