Impact of a Student Pharmacist Driven Medication History Service

Purpose:  This study describes the changes to the medical record and interventions performed as a result of student pharmacist participation in obtaining and documenting medication histories.

Methods:   This report describes student documentation of changes made to the Electronic Medical Record (EMR) and interventions accepted as a result of medication histories completed as part of an Advanced Pharmacy Practice Experience. Adult patients (> 18 years of age) admitted within 72 hours and being followed by a pharmacy student were included.  Exclusion criteria were the inability to speak English and admission directly from a nursing home.  Medication histories were obtained by a student pharmacist through patient interviews and pharmacy contacts.  Changes to the home medication list in EMR were evaluated.  Interventions were performed following discussion with the preceptor based at the institution.  Institutional Review Board approval was obtained.

Results: A total of 216 medication histories were completed.  The changes made to the home medication list were: 530 medications deleted, 626 medications added, and 692 instructions added or corrected, an average of 8.6 changes / patient.  The average time the student pharmacist spent interviewing the patient and contacting the patient’s pharmacy to obtain a medication history was approximately 17 +/- 6 minutes.  There were 76 interventions made to inpatient regimens.  

Conclusions:  This structured activity provides opportunity to enhance the student’s role in providing direct patient care resulting in benefit to patients and institutions.  Student roles can be structured based on the culture of care, pharmacy department and documentation standards of each institution.