Medication reconciliation in the emergency department performed by pharmacists

Patients are at risk of having their medication histories inaccurately documented while being admitted to an emergency department (ED). Allowing a pharmacist to access patient medication history is an effective way of reducing the number of errors. We sought to determine if having a pharmacist (as opposed to the admitting clinical team) verify patients' medication histories would result in fewer discrepancies in inpatient medication regimens. We performed a prospective cohort comparison study of adult ED patients admitted to general medicine floors for continuing care. In the intervention group, pharmacists in the ED performed a brief inquiry into the patients' medication history, a process called medication reconciliation. In the control group, the admitting clinical team conducted the medication reconciliation. Both groups received a second reconciliation by a trained pharmacy team and all discrepancies were recorded. Our cohort had 172 intervention and 172 control subjects. In the control group, 561 medication discrepancies were recorded while no medication discrepancies were observed in the intervention group. Having pharmacists consult with patients in the ED about their medication histories led to fewer discrepancies than when admitting clinical teams performed the same inquiry.