Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students
Keywords:Medication Reconciliation, Students, Pharmacy, Professional Competence, Pharmaceutical Services, Medical History Taking, Hospitalization, Pharmacists, Workforce, Cross-Sectional Studies, Australia
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.
The World Health Organisation. Medication without harm: Global patient safety challenge on medication safety. https://apps.who.int/iris/rest/bitstreams/1083775/retrieve (Aug 10, 2020).
Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069. https://doi.org/10.1001/archinternmed.2012.2246
Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424-429. https://doi.org/10.1001/archinte.165.4.424
Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005;173(5):510-515. https://doi.org/10.1503/cmaj.045311
Penm J, Vaillancourt R, Pouliot A. Defining and identifying concepts of medication reconciliation: An international pharmacy perspective. Res Social Adm Pharm. 2019;15(6):632-640. https://doi.org/10.1016/j.sapharm.2018.07.020
Almanasreh E, Moles R, Chen TF. The medication discrepancy taxonomy (MedTax): The development and validation of a classification system for medication discrepancies identified through medication reconciliation. Res Social Adm Pharm. 2020;16(2):142-148. https://doi.org/10.1016/j.sapharm.2019.04.005
The Australian Commission on Safety and Quality in Health Care. The National Safety and Quality Health Service Standards Second Edition. https://www.safetyandquality.gov.au/sites/default/files/2019-04/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf (accessed Aug 10, 2020).
Stark HE, Graudins LV, McGuire TM, Lee CYY, Duguid MJ. Implementing a sustainable medication reconciliation process in Australian hospitals: The World Health Organization High 5s project. Res Social Adm Pharm. 2020;16(3):290-298. https://doi.org/10.1016/j.sapharm.2019.05.011
Mekonnen AB, McLachlan AJ, Brien JA. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):e010003. https://doi.org/10.1136/bmjopen-2015-010003
Allende Bandrés MÁ, Arenere Mendoza M, Gutiérrez Nicolás F, Calleja Hernández MÁ, Ruiz La Iglesia F. Pharmacist-led medication reconciliation to reduce discrepancies in transitions of care in Spain. Int J Clin Pharm. 2013;35(6):1083-1090. https://doi.org/10.1007/s11096-013-9824-6
Becerra-Camargo J, Martinez-Martinez F, Garcia-Jimenez E. A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department. BMC Health Serv Res. 2013;13:337. https://doi.org/10.1186/1472-6963-13-337
Champion HM, Loosen JA, Kennelty KA. Pharmacy Students and Pharmacy Technicians in Medication Reconciliation: A Review of the Current Literature. J Pharm Pract. 2019;32(2):207-218. https://doi.org/10.1177/0897190017738916
Sproul A, Goodine C, Moore D, et al. Quality of best possible medication history upon admission to hospital: Comparison of nurses and pharmacy students and consideration of national quality indicators. Can J Hosp Pharm. 2018;71(2):128-134. https://doi.org/10.4212/cjhp.v71i2.1863
Lubowski TJ, Cronin LM, Pavelka RW, Briscoe-Dwyer LA, Briceland LL, Hamilton RA. Effectiveness of a medication reconciliation project conducted by PharmD students. Am J Pharm Educ. 2007;71(5):94. https://doi.org/10.5688/aj710594
Lancaster JW, Grgurich PE. Impact of students pharmacists on the medication reconciliation process in high-risk hospitalized general medicine patients. Am J Pharm Educ. 2014;78(2):34. https://doi.org/10.5688/ajpe78234
Andrus MR. Student pharmacist initiated medication reconciliation in the outpatient setting. Pharm Pract (Granada). 2012;10(2):78-82. https://doi.org/10.4321/s1886-36552012000200003
National Competency Standards Framework for Pharmacists in Australia 2016. Pharmaceutical Society of Australia. https://my.psa.org.au/s/article/2016-Competency-Framework (accessed Dec 20, 2020).
WHO Collaborating Centre for Drug Statistics Methodology. ATC classification index with DDDs, 2020. https://www.whocc.no/atc_ddd_index/ (accessed Sep 13, 2020).
Petrov K, Varadarajan R, Healy M, Darvish E, Cowden C. Improving Medication History at Admission Utilizing Pharmacy Students and Technicians: A Pharmacy-Driven Improvement Initiative. P T. 2018;43(11):676-684.
Guo Q, Guo H, Song J, et al. The role of clinical pharmacist trainees in medication reconciliation process at hospital admission. Int J Clin Pharm. 2020;42(2):796-804. https://doi.org/10.1007/s11096-020-01015-2
Canning ML, Munns A, Tai B. Accuracy of best possible medication history documentation by pharmacists at an Australian tertiary referral metropolitan hospital. Eur J Hosp Pharm. 2018;25(e1):e52-e58. https://doi.org/10.1136/ejhpharm-2016-001177
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