Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students

Pharmacy Practice

  • Louise Deep1Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
  • Carl R. Schneider2School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
  • Rebekah Moles2School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
  • Asad E. Patanwala2School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
  • Linda L. Do2School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
  • Rosemary Burke3Sydney Local Health District, Sydney, NSW, Australia.
  • Jonathan Penm2School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.

Volume 19 Issue 3 Pages 1-6

DOI: 10.18549/PharmPract.2021.3.2471

Abstract

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.

Keywords

  • Medication Reconciliation
  • Students
  • Pharmacy
  • Professional Competence
  • Pharmaceutical Services
  • Medical History Taking
  • Hospitalization
  • Pharmacists
  • Workforce
  • Cross-Sectional Studies
  • Australia
Pharmacy Practice

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