Study: Comparing pharmacists and nurses in med reconciliation

The US FDA approves 25 new drugs per year representing some 400 new formulations.

An article in Pharmacy Practice News last October, 2010 described a study conducted at the Medical Center of Aurora in Colorado that compared the accuracy and completeness of admission medication histories recorded by nurses and pharmacists respectively.

The study tracked 100 adults admitted to the emergency department over three months, who were able to respond to questions about their medications.  The ED nurse initially documented the patients home meds, apparently as part of the triage/assessment.  This was followed by an ED pharmacist interviewing all patients awaiting inpatient beds and updating the home med list originally collected.  On admission to the floor, a nurse was charged with reviewing the updated home medication list, interview the patient for a third time and document any changes.  Finally, the ED pharmacist would review all three iterations of the med history and follow up on any discrepancies by re-interviewing the patient or contacting the patient’s family, physician or community pharmacy for clarification when necessary.

In terms of the average number of meds documented per patient at each phase of admission, the ED nurse collected 3.87, the flor nurse 4.18 and the pharmacist 7.48 meds per patient.  The study found that omissions were the most common error and that vitamins and over the counter products were most often ommitted.  It also found that the pharmacist collected the most accurate med histories.

Several explanations for the results exist.  The initial med history is often collected in a highly stressful and fast paced environment where nurses are juggling many different tasks and patients are in an unfamiliar environment, often hurt.  Pharmacists are much more familiar with medications and can often tease information from patients by asking the right cqualifying questions about their medications than many nurses may be able to.  Like ED nurses, floor nurses are often multi-tasking, looking after multiple patients, and depending on the time of day may have multiple admissions to process at once, thus making it difficult to devote the time necessary to collect an accurate list of home meds.  On the other hand, nurses have more experience than pharmacists in working directly with patients and have more opportunity to develop a positive bedside manner and patient trust than do pharmacists.

The study’s authors concluded that incorporating pharmacists in the collection of the home med list, which is the basis for medication reconciliation to be initiated, improves the accuracy of information collected.  They recommended that additional training be provided to nurses in the collection of medication histories and that an environment of open communication exist between physicians, nurses and pharmacists.

I would add that in order to obtain the most accurate and complete medication histories, patients need to take a level of ownership over their medical information, including allergies and current medications.  Several tools exist to enable this ownership and I will discuss some of them in this forum in the coming weeks.  However, health-systems can also implement electronic systems that enable clinicians to collect and document more accurate medication histories.  An environment where all clinicians have access to and document in a longitudinal patient record is critical to the successful adoption of medication reconciliation.  The electronic system utilized by an organization should enable the completion of medication reconciliation tasks using a single source of truth (i.e., a single medication history and a single source of current medication information.

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2 Responses to Study: Comparing pharmacists and nurses in med reconciliation

  1. RXLogic says:

    Pharmacists are the medication experts but hospitals will continue to rely on nurses to collect medication histories to keep costs down.

  2. vora_P says:

    Surgeons do not like to do medication reconciliation because most of the time we have no holistic knowledge of patient. Their attending physician should be responsible for doing this.

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