Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care

  • Autumn Stewart
  • Kevin J. Lynch
Keywords: Medication Reconciliation, Electronic Health Records, Medication Errors, Continuity of Patient Care, United States

Abstract

Objective: Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR).

Methods: Observational case series study of established patients from an urban, indigent care clinic. Medication reconciliation was conducted immediately prior to the physician visit at baseline and return visit. Main outcome measures included: frequency, types, and reasons for discrepancies, patient knowledge, and adherence.

Results: There was a 14.5% reduction in the number of patients with a discrepancy and the frequency of discrepancies was reduced by 7.3%. The rate of medication discrepancies in the chart was reduced by 31.3%. The most common type of discrepancy that persisted at follow up were medications listed on the chart that the patient stopped taking. Discrepancies were more likely to persist in Caucasian subjects when compared to African Americans.

Conclusion: While pharmacist led medication reconciliation appears effective at reducing the likelihood of a medication discrepancy in the EMR, challenges persist in maintaining this accuracy specifically as it relates to patient driven changes to the medication regimen.

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Author Biographies

Autumn Stewart

Assistant Professor of Pharmacy Practice

Division of Clinical, Social, and Administrative Sciences

Kevin J. Lynch
Medical Outcomes Specialist, Pfizer Medical

References

1. Chen D, Burns A. Summary and Recommendations of ASHP-APhA Medication Reconciliation Initiative Workgroup Meeting, February 12, 2007. Available at: http://www.ashp.org/s_ashp/docs/files/MedRec_ASHP_ APhA_ Wkgrp_MtgSummary.pdf (Accessed June 6, 2012).

2. American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). http://www.pharmacist.com/AM/Template.cfm?Section=Home2&CONTENTID=15496&TEMPLATE=/CM/ContentDisplay.cfm (Accessed March 3, 2010).

3. Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, Liss D, Noskin GA. Results of the Medications At Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med. 2010;25(5):441-447. doi: 10.1007/s11606-010-1256-6

4. Ketchum K, Grass CA, Padwojski A. Medication reconciliation: verifying medication orders and clarifying discrepancies should be standard practice. Am J Nurs. 2005;105(11):78-85.

5. Nester TM, Hale LS. Effectiveness of a pharmacist-acquired medication history in promoting patient safety. Am J Health Syst Pharm. 2002;59(22):2221-2225.

6. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J HealthSyst Pharm. 2004;61(16):1689-1695.

7. Varkey P, Cunningham J, O'Meara J, Bonacci R, Desai N, Sheeler R. Multidisciplinary approach to inpatient medication reconciliation in an academic setting. Am J Health Syst Pharm. 2007;64(8):850-854.

8. Bedell SE, Jabbour S, Goldberg R, Glaser H, Gobble S, Young-Xu Y, Graboys TB, Ravid S. Discrepancies in the use of medications. Arch Intern Med. 2000;160(14):2129-2134.

9. Johnson CM, Marcy TR, Harrison DL, Young RE, Stevens EL, Shadid J. Medication reconciliation in a community pharmacy setting. J Am Pharm Assoc (2003). 2010;50(4):523-526. doi: 10.1331/JAPhA.2010.09121

10. Stewart AL, Lynch KJ. Identifying discrepancies in electronic medical records through pharmacist medication reconciliation. J Am Pharm Assoc (2003). 2012;52(1):59-66. doi: 10.1331/JAPhA.2012.10123

11. Bayoumi I, Howard M, Holbrook AM, Schabort I. Interventions to Improve Medication Reconciliation in Primary Care. , Ann Pharmacother. 2009;43(10):1667-1675. doi: 10.1345/aph.1M059

12. Peyton L, Ramser K, Hamann G, Patel D, Kuhl D, Sprabery L, Steinhauer B. Evaluation of medication reconciliation in an ambulatory setting before and after pharmacist intervention. J Am Pharm Assoc (2003). 2010;50(4):490-495. doi: 10.1331/JAPhA.2010.09055

13. Bassi J, Lau F, Bardal S. Use of information technology in medication reconciliation: a scoping review. Ann Pharmacother. 2010;44(5):885-897. doi: 10.1345/aph.1M699

14. Nemeth LS, Wessell AM. Improving Medication Safety in Primary Care Using Electronic Health Records. J Patient Saf. 2010;6(4):238-243.

15. Morisky DE, Green LW, Levine DM. Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence. Med Care. 1986;24(1):67-74.

16. Orrico K. Sources and types of discrepancies between electronic medical records and actual outpatient medication use. J Manag Care Pharm. 2008;14(7):626-631.

17. Johnson RL, Roter D, Powe NR, Cooper LA. Patient Race/Ethnicity and Quality of Patient-Physician Communication During Medical Visits. Am J Public Health. 2004;94(12):2084-2090.
Published
2014-03-24
Section
Original Research