Inpatient medication vertification by pharmacy student

2273Am J Health-Syst Pharm—Vol 65 Dec 1, 2008n o t eT racey L. M ersfeLder , P harM .d., BcPs, is Associate Professor, College of Pharmacy, Ferris State University, Big Rapids, MI. r yan J. B ickeL , P harM .d., is Clinical Pharmacy Specialist, Borgess Medical Center, Kalamazoo, MI.Address correspondence to Dr. Mersfelder at the College of Phar-macy, Ferris State University, 220 Ferris Drive, Big Rapids, MI 49307 (traceymersfelder@).Presented at the ASHP Midyear Clinical Meeting, Las Vegas, NV, December 4, 2007.The authors have declared no potential conflicts of interest.Copyright © 2008, American Society of Health-System Pharma-cists, Inc. All rights reserved. 1079-2082/08/1201-2273$06.00.DOI 10.2146/ajhp080013Inpatient medication history verification by pharmacy studentsT racey L. M ersfeLder and r yan J. B ickeL Purpose. The ability of pharmacy students to improve the accuracy of patients’ medi-cation histories was studied.Methods. This prospective study was con-ducted between January and April 2007 at a 424-bed community teaching hospital. Pharmacy students were assigned one ortwo patients daily admitted to the inpa-tient internal medicine service and were required to perform a thorough medication history for each. Patients were included in the study if a medication history was performed and recorded on the medica-tion reconciliation form. Students were instructed to obtain medication historiesby interviewing the patient, a family mem-ber, or both and calling the patient’s com-munity pharmacy to verify all medications. If there were any discrepancies between these sources of information and the initial medication reconciliation form, the infor-mation was reconfirmed with the patient. Any information obtained by the studentsthat had not already been documented on the medication reconciliation record was updated in the patient’s chart. Results. A total of 326 charts were included in this analysis. Student-obtained medica-tion histories resulted in the addition of previously undocumented prescription medications to 175 charts (53.7%) and nonprescription medications or natural products to 167 charts (51.2%). Calling the patients’ community pharmacy helped to identify omissions or discrepancies approximately 75% of the time. Overall, the students improved the accuracy of medication histories for 220 (67%) of the 326 patients.Conclusion. Pharmacy students’ participa-tion in obtaining medication histories im-proved the completeness and accuracy of patient medication records.Index terms: Patient information; Phar-maceutical services; Pharmacy; Pharmacy, institutional, hospital; Quality assurance Am J Health-Syst Pharm. 2008; 65:2273-5O btaining medication histories has been an important func-tion performed by pharmacists since the 1970s.1-3 The collection of thorough medication histories is time-consuming, and these histories are usually obtained by physicians and nurses. Subsequent to the Joint Commission’s mandate that an ac-curate medication list be included in every patient’s profile,4 many hospitals are researching innovative ways to obtain accurate medication histories. Some institutions have investigated the use of supervised pharmacy students for providing assistance in verifying medication histories and updating medication reconciliation forms.5-9 The objec-tives of this study were to determine the frequency of discrepancies dis-covered and corrected by pharmacystudents and to determine if tele-phoning the patients’ communitypharmacy was valuable in obtainingaccurate information.Methods A prospective study was conduct-ed between January and April 2007 at a 424-bed community teaching hos-pital after receiving permission from the investigational review board.Pharmacy students who participated in performing verifications of medi-cation histories were completing aninternal medicine rotation. Studentswere prepared for study participationbefore beginning the rotation by at-tending a three-hour didactic lecture and obtaining a mock medication history of a family member, which was formally critiqued. In addition, students received oral and written in-structions on performing medication histories and a standardized medica-note Medication history 2274Am J Health-Syst Pharm—Vol 65 Dec 1, 2008tion history form during orientation of the rotation.One or two patients were ran-domly assigned to the students daily, depending on the census of the in-patient internal medicine service. Patients were included in the study if a medication history was obtained and recorded on the medication reconciliation form. The medication reconciliation form at this institu-tion is generally completed by physi-cians, physician assistants, nurses, or nursing assistants. Students were instructed to obtain medication his-tories by interviewing the patient, a family member, or both and calling the patient’s community pharmacy to verify all medications. If there were any discrepancies between these sources of information and the initial medication reconciliation form, the information was reconfirmed with the patient. Each patient’s medica-tion history was then reviewed with a preceptor for accuracy. In addi-tion, preceptors randomly observed patient interviews to ensure quality. If needed, any new information was documented in the patient’s chart. Discrepancies were recorded by the investigator on a data collection sheet.ResultsA total of 346 charts were re-viewed by seven students. Twenty charts were excluded from the study. Three charts were excluded because they were not from internal medi-cine patients, and 17 were excluded because a medication reconciliation form had not been completed for comparison. For excluded patients, a medication history had still been obtained by the students and inter-ventions were noted in the chart, if needed.The remaining 326 charts were included in the analysis. Student- obtained medication histories re-sulted in the addition of previ-ously undocumented prescription medications to 175 charts (53.7%) and nonprescription medications or natural products to 167 charts (51.2%). A total of 440 prescription medications and 414 nonprescrip-tion medications or natural products were documented, for an average of 1.35 prescription medications and 1.27 nonprescription medications or natural products per chart. An overview of the types of previously undocumented prescription medi-cations reported by the pharmacy students is provided in Table 1. A summary of prescription medi-cation additions and clarifications made by the students is provided in Table 2. Of the 326 charts included in the analysis, 307 included 2270 prescription medications. This was an average of 7.39 medications per chart. The students clarified dos-age information in over 30% of the completed medication reconcilia-tion forms. Over 67% of the patient charts had either a medication or a dosage omitted that was clarified by the pharmacy students. The students conducted 316 patient interviews and telephoned 312 of the patients’ community pharmacies. Calling the pharmacy helped identify omissions or discrepancies approximately 75% of the time. The students’ interven-tions were communicated throughnote Medication history 2275Am J Health-Syst Pharm—Vol 65 Dec 1, 2008documentation in the patients’ charts, as applicable.Discussion The eighth National Patient Safety Goal established by the Joint Com-mission is to “accurately and com-pletely reconcile medications across the continuum of care.”4 This has peaked the interest of clinicians and administrators in finding ways to obtain accurate medication his-tories over the past few years. It is important to obtain the most accu-rate medication history possible to prevent medication errors. Unfortu-nately, medication histories are time-consuming to obtain, and health care systems have limited resources. Pharmacy students are frequently placed in health care systems to gain training but can actively contribute to patient care by performing accu-rate, thorough medication histories. In this study, the pharmacy students demonstrated that they can contrib-ute to the accuracy of the medication histories available to other health care providers. They identified medi-cations that were omitted from the original medication histories in over 50% of the charts. In addition, they reconciled dosage information that had been omitted in approximately 30% of the charts.The published data from other institutions regarding medication histories obtained by pharmacy stu-dents were only available in abstract form at the time of writing; therefore, it is difficult to compare our results with those of other facilities.5-9 How-ever, all of the authors reported that pharmacy students contributed to the overall information provided, with 15–75% of patients’ charts up-dated and 3–85% of medications rec-onciled.5-7 Also, authors of one study reported that pharmacy students were able to add a mean of one medi-cation previously unreported per patient chart.9 Our data were consis-tent with these ranges. The authorsof one study that included the use of pharmacy students determined that 57% of the medication histories had omissions.10 In addition, over 30% of the medication histories contained differing information, which is also similar to our findings. Our results do not correlate with those of Carter and colleagues,11 who aimed to identify discrepancies between medication histories taken by emergency department staff and a clinical pharmacist. They reported the rate of medication omissions as 25% and the rate of dosage in-formation missing as 78%. One ex-planation for a lower rate of dosage information omissions in our study is that the students obtained the medication histories the morning af-ter admission. This allowed time for other disciplines and departments to help with the reconciliation before the students obtained the medica-tion histories. Our rate of omitted medications may be higher because the students telephoned over 95% of the patients’ community pharmacies. Carter et al. did not state how often pharmacies or physician offices were contacted.The most significant limitation to our study was the inability to deter-mine whether the students’ medica-tion histories were 100% complete. There is not a standard mechanism to determine this, especially for non-prescription and natural products. It is also difficult to apply these results to the entire institution due to the sample population (inpatient inter-nal medicine service) and student availability (only 14–18 students are assigned to the institution an-nually). Lastly, preceptors are not assigned pharmacy students two to four months of the year; however, the students assigned have continued to provide this service when available.Conclusion Pharmacy students’ participation in obtaining medication histories improved the completeness and accuracy of patient medication records. References 1. La Verde S. Evaluation of drug history program. Hospitals. 1973; 47:106 passim. 2. Covington TR, Pfeiffer FG. The pharmacist-acquired medication history. Am J Hosp Pharm. 1972; 29:692-5.3. Wilson RS, Kabat HF. Pharmacist initi-ated patient drug histories. Am J Hosp Pharm. 1971; 28:49-53.4. Joint Commission. 2007 Hospital/Critical Access Hospital National Patient Safety Goals. /PatientSafety/NationalPatientSafety Goals/07_hap_cah_npsgs.htm (accessed 2008 Aug 27).5. Fujisaki BS, Farthing K, Marcus KB. Iden-tifying and resolving potential medica-tion errors in hospital admission orders. Paper presented at ASHP Midyear Clini-cal Meeting. Atlanta, GA; 2002 Dec 10.6. Roth KB, McCoy LK, Hill S et al. Achiev-ing patient safety through medication reconciliation: a pilot. Paper presented at ASHP Midyear Clinical Meeting. Las Vegas, NV; 2005 Dec 5.7. Padiyara RS, Rabi SM. Pharmacy students and reconciliation of medication upon hospital admission. Paper presented at ASHP Midyear Clinical Meeting. Ana-heim, CA; 2006 Dec 5.8. Mashni SM, Carroll WW. Medication reconciliation begins with pharmacy students in the emergency department. Paper presented at ASHP Midyear Clini-cal Meeting. Las Vegas, NV; 2007 Dec 4.9. Jungst DW, Gonzalez FJ. Medication histories and medication reconciliation utilizing pharmacy students: a pilot study. Paper presented at ASHP Midyear Clini-cal Meeting. Las Vegas, NV; 2005 Dec 8.10. Lessard S, DeYoung J, Vazzana N. Medi-cation discrepancies affecting senior patients at hospital admission. Am J Health-Syst Pharm. 2006; 63:740-3. 11. Carter MK, Allin DM, Scott LA et al. Pharmacist-acquired medication histo-ries in a university hospital emergency department. Am J Health-Syst Pharm. 2006; 63:2500-3.。