Abstract
Purpose
Medication errors are a leading cause of injury to hospitalized patients, and studies reveal that these errors occur most often at transitions of care. The objective of this study was to evaluate a pharmacist's impact on medication errors at the Veterans Affairs Medical Center (VAMC) through involvement in medication reconciliation on patient admission.
Methods
A retrospective, observational, single-center study was conducted to evaluate pharmacist-initiated medication reconciliation. Preprogram and postprogram data were compared. In both phases medical records were evaluated for discrepancies by comparing outpatient medications with inpatient medication orders. Inclusion criteria comprised patients with outpatient medications who were admitted to the VAMC for at least 72 hours. The primary outcome measure was the percentage of unreconciled medications. Secondary outcomes included cost savings to the VAMC and avoidance of potential adverse events.
Results
A total of 206 patients were included in the study. Patients in the postprogram group had a significantly lower percentage of unreconciled medications (P < 0.001). The most common type of discrepancy was omission of medications at admission, and the most common drug class for discrepancies was psychiatric medications. In the postprogram group, 21 medications were discontinued as a result of a pharmacist intervention, with a median cost savings of $36.58 (range, $1.10 to $2,311). An increase in the number of medications per patient was associated with an increase in unreconciled medications (coefficient of linear regression [R 2 ] = 0.31; P < 0.001). No adverse drug events (ADEs) were noted.
Conclusion
Pharmacists' involvement in medication reconciliation significantly reduces the number of unreconciled medications. In addition, this involvement may greatly improve patient safety and reduce the costs of medication errors and the occurrence of ADEs.
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