Pharmacists Reduce Errors in In-Hospital Medications

A new study shows that when pharmacists lead patient medication-history gathering and supplemented patient charts with medication progress reports, medication reconciliation errors dropped dramatically.

Researchers at the Little Company of Mary Hospital and Health Care Centers (LCMH; Chicago, IL, USA) tested having pharmacists lead medication reconciliation upon patient admissions into the emergency department (ED) from September 2012 through March 2013. 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. They then interviewed patients in person to gather medication histories and contacted the patients' pharmacies, family members, and physician offices for further information when necessary.

The pharmacists then entered their assessments into the electronic medical records (EMRs) and added printed versions to patient charts. Progress notes were added to the charts to update any and all medication changes and any possible recommendations for medication changes of adjustments. The results showed that while at baseline complete and accurate medication reconciliation occurred 32.3% of the time at admission, by the end of the study, 94.2% of medication reconciliations was complete and accurate.

The study also found that medication omission (28.1%–31.4%) and frequency of administration (25%–28.5%) were the most common errors in reconciliation. Other errors included dose (19.8%–22.6%), incorrect medication (13.1%–14%), 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; by the end of the study, the average admission errors dropped to an average of 0.07 per patient. The study results were reported at the midyear conference of the American Society of Health-System Pharmacists, held during December 2013 in Orlando (FL, USA).

“When it comes to medication reconciliation, who better to lead the initiative than the experts in the medication field—pharmacists,” said lead author Richard Mioni, PharmD, BCPS.

Medication reconciliation is the formal process of comparing a patient's medication orders to all of the medications that the patient has been taking to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. A comprehensive list of medications should include all prescription medications, herbals, vitamins, nutritional supplements, over-the-counter (OTC) drugs, vaccines, diagnostic and contrast agents, radioactive medications, parenteral nutrition, blood derivatives, and intravenous solutions.

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Little Company of Mary Hospital and Health Care Centers