Medication reconciliation in a rural trauma population

Area of Science:

• Trauma Care
• Patient Safety
• Clinical Pharmacy

Background:

• Hospitalized patients, especially trauma patients, are at high risk for medication errors due to healthcare provider preoccupation with critical injuries.
• Medication reconciliation on admission is a strategy to reduce medication errors and adverse drug events in this population.

Purpose of the Study:

• To assess the accuracy of medication histories obtained by initial healthcare providers for trauma patients.
• To compare this accuracy with a medication reconciliation process performed by a clinical pharmacist.
• To investigate the influence of trauma-specific factors on medication history accuracy.

Main Methods:

• Prospective enrollment of trauma patients at a Level I trauma center over 13 months.
• Medication reconciliation performed by a clinical pharmacist, including verification with external sources like pharmacies.
• Analysis of variables such as Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) score.

Main Results:

• Only 15% of medication histories were accurate as reconciled by the pharmacist; initial trauma team lists were inaccurate in 96% of cases.
• Patients with severe injuries (ISS > 15) or low GCS scores (< 13) demonstrated higher rates of medication list inaccuracies.
• Medication reconciliation was often delayed, with a median duration of 2 days, and 1 adverse drug event (hypoglycemia) was noted.

Conclusions:

• Admission medication histories for trauma patients are frequently inaccurate, posing a risk for adverse drug events.
• Clinical pharmacist-led medication reconciliation shows potential for improving safety but requires timely implementation.
• The study underscores the vulnerability of trauma patients to medication inaccuracies and the need for robust reconciliation processes.