Establishment and evaluation of pharmacist-managed admission medication history and reconciliation process for pediatric patients

This was a single-center, prospective, pilot study aiming to evaluate the impact of pharmacist involvement in the admission medication history and reconciliation process and to quantify discrepancies found by pharmacists when compared to information collected by other health care providers at a pediatric institution.

A pharmacist completed a thorough medication history and reconciled discrepancies with the medical team. Discrepancies included incorrect medication, dose, route, frequency; omitted information; missing medications; or any other inconsistencies outside of these categories. Information was documented in the electronic medical record via a standardized template, and pertinent discrepancies were communicated with the medical team.

Of the 100 medication histories included in the study, a total of 309 discrepancies were identified and corrected in the electronic medical record. The median length of time it took pharmacists to complete the medication history process was 15 minutes per patient (interquartile range, 10-20 minutes). Thirty discrepancies were determined as pertinent and were reported as intervened on and communicated to the medical team.

This study provides evidence that pharmacist-obtained admission medication histories and reconciliation have the potential to prevent potentially significant adverse drug reactions and have a positive impact on patient care.Index terms admission, history, medication, pharmacist, reconciliation.