Pharmacist- versus physician-initiated admission medication reconciliation: impact on adverse drug events

• Published in: The American journal of geriatric pharmacotherapy Vol. 10; no. 4; p. 242
• Main Authors: Mergenhagen, Kari A, Blum, Sharon S, Kugler, Anne, Livote, Elayne E, Nebeker, Jonathan R, Ott, Michael C, Signor, Daniel, Sung, Soojin, Yeh, Jessica, Boockvar, Kenneth S
• Format: Journal Article
• Language: English
• Published: United States 01-08-2012
• Subjects: Academic Medical Centers; Aged; Aged, 80 and over; Clinical Competence; Cohort Studies; Electronic Health Records; Hospitals, Urban; Hospitals, Veterans; Humans; Inappropriate Prescribing - prevention & control; Male; Medication Reconciliation - methods; Middle Aged; Outcome Assessment (Health Care); Patient Admission; Pharmacists; Physicians; Prescription Drugs - administration & dosage; Prescription Drugs - adverse effects; United States; United States
• ISSN: 1876-7761
• DOI: 10.1016/j.amjopharm.2012.06.001

Medication reconciliation (MR) has proven to be a problematic task for many hospitals to accomplish. It is important to know the clinical impact of physician- versus pharmacist-initiated MR in the resource-limited hospital environment.
This quasi-experimental study took place from December 2005 to February 2006 at an urban US Veterans Affairs hospital. MR was implemented on 2 similar general medical units: one received physician-initiated MR and the other received pharmacist-initiated MR. Adverse drug events (ADEs) and a 72-hour medication-prescribing risk score were ascertained by research pharmacists for all admitted patients by structured record review. Multivariable models were tested for intervention effect, accounting for quasi-experimental design and clustered observations, and were adjusted for patient and encounter covariates.
Pharmacists completed the MR process in 102 admissions and physicians completed the process in 116 admissions. In completing the MR process, pharmacists documented statistically more admission medication changes than physicians (3.6 vs 0.8; P < 0.001). The adjusted odds of an ADE caused by an admission prescribing change with pharmacist-initiated MR compared with a physician-initiated MR were 1.04 with a 95% CI of 0.53 to 2.0. The adjusted odds of an ADE caused by an admission prescribing change that was a prescribing error with pharmacist-initiated MR compared with a physician-initiated MR were 0.38 with a confidence interval of 0.14 to 1.05. No difference was observed in 72-hour prescribing risk score (coefficient = 0.10; 95% CI, -0.54 to 0.75).
MR performed by pharmacists versus physicians was more comprehensive and was followed by lower odds of ADEs from admission prescribing errors but with similar odds of all types of ADEs. Further research is warranted to examine how MR tasks may be optimally divided among clinicians and the mechanisms by which MR affects the likelihood of subsequent ADEs.