Value of pharmacist medication interviews on optimizing the electronic medication reconciliation process.

Area of Science:

• Pharmacology
• Patient Safety
• Health Informatics

Background:

• Accurate medication histories are crucial for patient safety.
• Current methods like electronic medical record review (EMRR) may have limitations in capturing complete medication information.
• The impact of different medication history acquisition methods on medication safety requires further investigation.

Purpose of the Study:

• To compare the accuracy and clinical impact of pharmacist-obtained medication histories using EMRR alone versus a combination of direct patient interviews and EMRR.
• To evaluate the number of discrepancies, recommendations, and medication errors associated with each method.

Main Methods:

• An 18-week prospective study involving patients admitted to an Inpatient Medicine Service.
• Pharmacist-conducted medication reconciliation using EMRR within 48 hours of admission.
• Data collection through chart review to compare EMRR alone versus EMRR combined with patient interview.

Main Results:

• The combined interview and EMRR group identified significantly more discrepancies (986) than EMRR alone (513).
• More recommendations were generated in the combined group (260 vs. 97).
• Fewer medication errors were found with EMRR alone (55) compared to the combined group (134), with omitted medications being the most common error type.

Conclusions:

• Pharmacist-led medication interviews integrated with EMRR enhance the identification of potentially harmful medication discrepancies.
• This combined approach shows promise in preventing medication errors during hospital admissions.