Students can improve medication reconciliation
July 1, 2008
Students can improve medication reconciliation
Students found omissions in histories
Hospitals often lack the time needed to obtain accurate medication histories from newly admitted patients, and this leads to errors.
Having pharmacists obtain medication histories might reduce errors, but it could also increase costs. One solution might be to train pharmacy students to obtain medication histories.
In a study that involved the use of pharmacy students, investigators found that fourth-year pharmacy students could enhance pharmaceutical care in a hospital medication reconciliation program by identifying omissions in original medication histories and notifying pharmacists, nurses, and physicians of problems.1
"The students found mistakes when something was improperly documented, such as a patient's prior-to-admission medication or a patient's allergies," says Rosalyn S. Padiyara, PharmD, CDE, an assistant professor in the department of pharmacy practice at Midwestern University Chicago's College of Pharmacy in Downers Grove, IL.
Padiyara created the study intervention based on her dual roles as a clinical pharmacist for medication reconciliation at a 300-bed, community hospital and her responsibility as a professor in overseeing pharmacy students.
"To fulfill both responsibilities, I asked myself how I could give the student a beneficial experience and also handle my responsibilities at the hospital," she explains. "I was the primary preceptor for the students, in charge of grading and assessing them, and I was hired to provide medication reconciliation for the hospital, along with another pharmacist, so I combined the two jobs together."
The first step was to find out how the hospital's medication reconciliation worked. Padiyara found that nurses, physicians, and residents were conducting the medication histories.
"I decided to look into the literature to see if there were ways to do it better," she adds. "That was nearly two years ago and although medication reconciliation was a hot topic at the time, there wasn't a huge amount of available.
Padiyara designed the study for six pharmacy students, who would be working at the hospital for six weeks. "Their rotation involved acute care in a hospital setting, so three would provide medication reconciliation, and three would gain experience in acute care, and then they switched experiences," Padiyara explains.
"Initially, what I'd do is have students go into a patient's room and perform the interview and then present all of the information to me," she says.
"Sometimes we found that getting hold of a patient's physician was difficult, so we developed a form where we could record all of the information gathered," Padiyara says.
The form provided documentation of which medications needed to be started, and it could be inserted in the patient's chart so the physician would see what had not been started and write orders for that, she explains.
Also, the pharmacy students assisted with verifying with the pharmacy, caregiver, or family members which medications the patients were on, Padiyara says, and confirming formulary status.
"In general the interview took about five to seven minutes," she says. "Depending on how many patients they had, they'd either page me or gather all of the information and discuss it all at one time."
Then the students would go back up to the floors to insert the form into the patient's chart that Padiyara had signed off on. These were for physicians to write orders for, if they deemed it necessary, Padiyara adds.
The students found mistakes made in previous medication histories since their own medication histories were used in the study to compare the pharmacy part of the intervention to the usual medication reconciliation process.
"This was something students did after the patient information was already documented in the chart, to assess what was left out and whether there was anything that could be added in order to reduce errors and ultimately enhance the care the patients received," Padiyara says.
Reference
- Padiyara RS, Rabi SM. Pharmacy students and reconciliation of medication upon hospital admission. Abstract presented at the 2006 Mid-Year Clinical Meeting of the American Society of Health-System Pharmacists; Anaheim, CA; Dec. 3-7, 2006.
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