Development of a Student-Led Ambulatory Medication Reconciliation Program at an Academic Institution

Abstract

Objectives:

To integrate fourth-year student pharmacists on advanced pharmacy practice experience (APPE) rotations within several different ambulatory clinics to perform medication reconciliations and enhance interdisciplinary practice.

Methods:

The study design was a descriptive, prospective multisite study among a variety of ambulatory care outpatient clinics. Student pharmacists were partnered with physicians to conduct medication reconciliations during clinic visits for 4 hours per week, with data collection from January 2016 to September 2016. This program originated from physician requests for additional pharmacy involvement and led to the development of a successful implementation strategy to involve student pharmacists in the medication reconciliation process.

Results:

Student pharmacists identified 537 medication discrepancies among 491 patients, including commission of medications (36%), documentation of previously omitted medications (27%), and incomplete patient allergy information (11%). Students spent an average of 10 minutes on each encounter.

Conclusion:

Documentation from this innovative program suggests improvement in medication reconciliation and enhanced patient care with limited time required of student pharmacists. A similar program could be developed and utilized at other clinical sites.

Keywords

medication reconciliation students transitions of care

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References

The Joint Commission. National patient safety goals: hospital accreditation program. https://www.jointcommission.org/assets/1/6/NPSG_Chapter_OME_Jan2017.pdf. Published 2017. Accessed May 21, 2017.

The Joint Commission. National patient safety goals: ambulatory health care accreditation program. http://www.jointcommission.org/assets/1/6/2016_NPSG_AHC.pdf. Published January 2016. Accessed January 25, 2016.

National Transitions of Care Coalition. Improving Transitions of Care; the vision of the national transitions of care coalition. http://www.ntocc.org/Portals/0/PolicyPaper.pdf. Updated September 2010. Accessed January 26, 2016.

Forster

Murff

Peterson

. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–167.

American College of Clinical Pharmacy, Kirwin

Canales

Bentley

. Process indicators of quality clinical pharmacy services during transitions of care. Pharmacotherapy. 2012;32(11):338–347.

Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree: “standards 2016”. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Published February 2, 2015. Accessed January 26, 2016.

McLaughlin

Amerine

Chen

. Early clinical experiences for second-year student pharmacists at an academic medical center. Am J Pharm Educ. 2015;79(9):139.

EHR Incentive Program. Eligible professional meaningful use menu set measures: medication reconciliation. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/7_Medication_Reconciliation.pdf. Updated May 2014. Accessed January 25, 2016.

Smith

Mosley

Lott

. Impact of pharmacy-led medication reconciliation on medication errors during transition in the hospital setting. Pharm Pract. 2015;13(4):634.

10.

Lancaster

Grgurich

. Impact of student pharmacists on the medication reconciliation process in high-risk hospitalized general medicine patients. Am J Pharm Educ. 2014;78(2): 34.

11.

Allison

Weigel

Holcroft

. Does electronic medication reconciliation at hospital discharge decrease prescription medication errors? Int J Health Care Qual Assur. 2015;28(6):564–573.

12.

Belda-rustarazo

Cantero-hinojosa

Salmeron-garcía

. Medication reconciliation at admission and discharge: an analysis of prevalence and associated risk factors. Int J Clin Pract. 2015;69(11):1268–1274.

13.

Budiman

Snodgrass

Chang

. Evaluation of pharmacist medication education and post discharge follow-up in reducing readmissions in patients with ST-segment elevation myocardial infarction (STEMI). Ann Pharmacother. 2015;50(2):118–124.

14.

Quality Measurement & Health Assessment Group. Accountable care organization 2012 program analysis - quality performance narrative measure specifications. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/downloads/ACO_QualityMeasures.pdf. Published 2011. Accessed January 27, 2016.

15.

Armor

Bulkley

Truong

Carter

. Assessing student pharmacists’ ability to identify drug-related problems in patient within a patient-centered medical home. Am J Pharm Educ. 2014;78(1):6.

16.

Ashjian

Salamin

Eschenburg

. Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer center. J Am Pharm Assoc. 2015;55(5):540–545.

17.

Andrus

Anderson

. A retrospective review of student pharmacist medication reconciliation activities in an outpatient family medicine center. Pharm Pract (Granada). 2015;13(1):518.