ABSTRACT
BACKGROUND: Because of the frequency of medication errors related to care transitions, patient-safety initiatives have recently focused on improving the patient medication list. Pharmacy student and technician participation in the medication-history process has been shown to improve the quality of medication histories. To improve patient care, a pharmacy-driven medication-history service utilizing a unique hybrid team of pharmacy students and technicians was launched at Inova Loudoun Hospital (ILH). OBJECTIVE: The objective of the service was to improve patient safety and therapy by providing the Best Possible Medication History (BPMH) for admitted acute-care patients. METHODS: Data for the medication-history service was collected for six months from July 2015 to January 2016. The service included pharmacy technicians and fourth-year pharmacy students using the BPMH approach to verify patients' allergies, medications, doses, and frequencies, and to ensure optimal documentation in the Electronic Health Record (EHR). Data on types and numbers of discrepancies and interventions were collected during the process. Readmission rates for the study group were calculated and compared to readmission rates for all patients. RESULTS: Out of 4,070 patients interviewed, 77.7% (3,162) had at least one discrepancy in their medication list. Per patient, the average number of medications was 7.47, with an average of 1.8 discrepancies. Pharmacy students identified more discrepancies per patient than pharmacy technicians, 2.3 versus 1.5, respectively. Readmission rates for patients interviewed by the medication-history team was lower than for all patients during the same period, as well as for all patients during the same period in the previous year. CONCLUSION: This pharmacy-driven medication-history service, staffed with pharmacy technicians and students using a structured BPMH approach, increased the accuracy of home-medication lists on patient admission. The service demonstrated a difference in the types of interventions provided by pharmacy students and technicians. Readmission rates were also lower for patients with completed BPMH.
