Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students
Louise Deep1★, Carl R. Schneider2, Rebekah Moles2, Asad E. Patanwala2, Linda L. Do2, Rosemary Burke3, Jonathan Penm2★ Corresponding author
- 1Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- 2School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- 3Sydney Local Health District, Sydney, NSW, Australia.
CORRESPONDENCE
Louise Deep
Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Received: 24-06-2021; Accepted: 12-09-2021.
Volume 19, Issue 3 · pp. 2471 · PUBLISHED Jul-Sep 2021 · 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.
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Deep, L., Schneider, C. R., Moles, R., Patanwala, A. E., Do, L. L., Burke, R., & Penm, J. (2021). Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students. Pharmacy Practice, 19(3), 2471. https://doi.org/10.18549/PharmPract.2021.3.2471