Clinical Pharmacists Catch Medication Discrepancies More Often Than Nurses

Given a structured method for medication reconciliation (MR), clinical pharmacists identify more medication discrepancies (MDs) than nurses, according to research published online September 4, 2014, in the European Journal of Clinical Pharmacology.

For the study, a multifaceted team of researchers from Norway identified 201 patients aged 21 to 92 years who were admitted to the Department of Cardiology at the University Hospital of North Norway in the fall of 2012. Data was collected regarding the participants’ gender, age, previous medication history, and whether they were admitted from their home, another hospital, or a nursing home.

The 3 pharmacists and 3 nurses who participated in the study were trained by an independent pharmacist supervisor to perform MR in accordance with the standard Integrated Medicines Management guidelines. The patients were then randomly allocated to the clinical pharmacist performing MR group or the nurse performing MR group.

MDs were defined as discrepancies between the medication list from the handwritten medical chart at hospital admission and the medication list identified during the patient interview. Each MD was documented in patient records and acted upon by the responsible ward physician.

While performing MR, pharmacists spent an average of 22.9 minutes per patient, and the nurses spent 32.2 minutes per patient—a difference the researchers attributed to preparation and documentation times.

At the conclusion of the study, the pharmacists pointed out 235 MDs, with at least 1 MD identified in 78% of patients, while the nurses pointed out 222 MDs, with at least 1 MD identified in 84% of patients. Although both study groups reported “comitted drug” most often, the pharmacists identified significantly more “omitted drug” MDs than nurses.

The pharmacists and nurses spoke with responsible physicians regarding 65%and 59% of identified MDs, respectively. In those discussions, the responsible physicians agreed significantly more often with the MDs that pharmacists pointed out (59%) compared to those reported by nurses (44%). Most of the MDs that were not discussed were corrected via independent intervention, though more pharmacists performed these interventions than nurses.

“We show a small, but not statistical significant, difference between trained nurses and clinical pharmacists with regard to identifying MDs of clinical relevance in the medication list among patients admitted,” the authors concluded. “This finding is important, as MR is an essential task at hospital admissions to obtain a complete medication list. Consequently, health personnel who are involved in hospital admissions should be able to perform this task appropriately.”

The researchers noted that the decision on who should perform MR should not only be based on time availability, but also take into account the additional benefits that MR serves.

“The major benefit using clinical pharmacists to perform MR, in addition to time-savings and physician agreement, is that the MR serves as a first step to initiate a systematic medication therapy review with the identification of drug-related problems,” the authors wrote.