Medication Histories Conducted by Nurses (RNs), Pharmacy Techs (CPhTs) & Pharmacists (RPhs)
Medication Histories Conducted by Nurses (RNs), Pharmacy Techs (CPhTs) & Pharmacists (RPhs)
Up to 50% of medication errors and 20% of adverse drug reactions (ADRs) in the hospital
 setting are estimated to be related to communication issues regarding patient medications at
 various transition points of care from admission to discharge. The Joint Commission (TJC)
 requires accurate and complete medication reconciliation occur at each transition point
 throughout hospitalization. Evidence from NQF demonstrates pharmacists (RPh) are the most
 effective medication management team leaders in the implementation of medication management
 practices and design of medication error reduction strategies; medication reconciliation is
 one of the five safety objectives pharmacists are recommended to lead. In addition, the
 Massachusetts Coalition for the Prevention of Medical Errors states strong evidence supports
 the use of pharmacy technicians (CPhT) in conjunction with pharmacists in completing accurate
 medication histories.

 WMC nurses (RN) currently are involved in the medication reconciliation process. In 2009, a
 Medication Use Evaluation (MUE) of Medication Reconciliation Accuracy found a 67% medication
 error rate on admission determined by comparing the nurse-obtained medication history to the
 pharmacist-obtained medication history. The number of home medications identified by the
 pharmacist compared to the nurse was 411 versus 312 (p<0.0001). The total percentage of
 medication errors prevented by the pharmacist was 66.2. Using the VA Healthcare Failure Mode
 Effects Analysis - HFMEA™ Hazard Scoring Matrix, 3 independent pharmacist reviewers found
 that 18% of patients interviewed had a score greater than 7, and 3 patients had a score of 12
 (major/probable), if the discrepancies would not have been identified and corrected by the
 pharmacist conducting the admission medication reconciliation audit. The same patients'
 discharge medication reconciliation and discharge medication lists were retrospectively
 reviewed for the MUE, and the total percentage of patients with medication errors on
 discharge was 43%.
Inclusion Criteria:

 -  Patients admitted as inpatients from the Emergency Department

 Exclusion Criteria:

 -  Prisoners (because the IRB does not have a prisoner representative)

 -  Patients not admitted as inpatients through the Emergency Department

 -  Patients admitted more than once during the study period