Medication reconciliation in the ED: Pharmacists can play a key role

Emergency department (ED) pharmacists can help hospitalsreconcile medications, according to a new study presented onTuesday.

Studies show that pharmacists take more accuratemedication history evaluations of patients than other healthcareproviders, so they would likely be able to identify "unspecified"medications (which may have been prescribed without the clinicianlisting a reason) that the patient is taking.

"Many emergency departments are increasing their use ofpharmacists, and hospital admission is a good time to assess theneed for all home medications," said Lucy Gizzi, PharmD,MUE/safety clinical specialist at West Virginia UniversityHospitals in Morgantown.

According to studies, Dr. Gizzi said, 60 percent of patients haveat least one discrepancy on their home medication list. Theseunspecified medications often lead to medical errors, adverseevents, and polypharmacy.

To track the unspecified medications that WVUH patientswere taking, Dr. Gizzi evaluated 300 patients aged 50 years andolder who were identified through a daily admission list.When patients taking unspecified medications were admitted, Dr.Gizzi went directly to the patients or caregivers and asked ifthey knew why they were taking the unspecified drug. In addition,Dr. Gizzi talked to the patients’ physicians and examined oldadmission records and electronic medical records.

A significant 38 percent of patients were taking at least oneunspecified medication.

The majority of those patients - 40 percent - were taking acid suppressants, andmany were taking unspecified selective serotonin reuptake inhibitors (SSRIs).

Dr. Gizzi is proposing that the industry takes medicalreconciliation a step further in the future by includingdrug-condition matching and listing reasons for why themedication was prescribed.

"This may improve reconciliation by the physician and wemay be able to prevent errors, adverse events, and polypharmacy,"Dr. Gizzi said.

ED pharmacists may be able to help with this matching andmedication history, but will likely not be able to take on thefull responsibility because of their other duties, Dr.Gizzi said.