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Purpose: Drug record discrepancies (DRDs) occur when the electronic medical record (EMR) medication list differs from the patient’s actual drug regimen. DRDs occur frequently in hemodialysis patients and are associated with increased incidence of medication-related problems (MRPs). The purpose of this project was to evaluate the role of student pharmacists in medication reconciliation to identify DRDs and MRPs in outpatient hemodialysis patients.
Methods: This pilot study was approved by the University of Pittsburgh Medical Center as a Quality Initiative project. It was performed in two phases, from Jan-Apr 2011, and then repeated from Mar-Apr 2012. Chronic hemodialysis patients at a single outpatient clinic were asked to participate by bringing in medications for review by student pharmacists. DRDs and MRPs were identified through patient interviews, medication reviews, EMR review, and conversations with clinic staff. Data are presented as median (range).
Results: Twenty-four patients participated in phase 1, and of these, 16 participated in phase 2 follow-up. A total of 87 DRDs were observed in 22/24 patients [2.5 (0-16)], and 38 MRPs were identified in 16/24 patients [1 (0-7)], compared with 80 DRDs in 14/16 patients [2 (0-16)] and 30 MRPs in 11/16 patients at follow-up [1.5 (0-5)]. The most common DRDs observed during phases 1 and 2 were ‘no longer taking a drug listed in the EMR (39/87)’ and ‘taking a drug not listed in the EMR (37/80)’, respectively. The most common MRP in both phases related to nonadherence, with 10/38 and 15/30 MRPs pertaining to patients not taking 1 or more prescribed drugs during phase 1 and 2, respectively.
Conclusion: Student pharmacists successfully identified DRDs and MRPs in the majority of patients interviewed. These results suggest that students participating in medication reconciliation activities can play a positive role in the identification of DRDs and MRPs in outpatient hemodialysis patients.