Class of 2007 Abstract / Objectives: Medication reconciliation is a formal process of obtaining a complete and accurate list of each patient’s current home medications. This process is done to prevent errors of omission, therapeutic duplication, dosing/frequency errors, or drug-drug/drug-disease interactions. As of January 1, 2006, University Medical Center (UMC) implemented a new, comprehensive medication reconciliation form which was intended to prevent medication-related discrepancies upon admission. The purpose of this study was to compare the percent of missing required prescription information upon hospital admission before and after the implementation of the medication reconciliation form. Methods: This study was an inferential retrospective chart review of patients admitted to UMC in Tucson, Arizona, between January 1, 2005 and August 1, 2006. While the overall goal was to measure the impact of a new medication reconciliation form on the completeness of a patient's medication history, the specific study objectives were to: (1) evaluate medication reconciliation form utilization and compliance and (2) compare the completeness of medication information upon hospital admission before and after the implementation of the comprehensive medication reconciliation form. Patients were included in the study if they were over 18 years of age and admitted to UMC at least once in 2005, and at least once between January 1, 2006 and August 1, 2006. The following patients were excluded: patients that were institutionalized in an assisted living facility or nursing home, admitted to the emergency room, intubated, transferred to the hospital from a nursing home or a long term care facility, and discharged from the hospital within 24 hours of admit. Two hundred and thirty-four patients, who met the inclusion criteria, were randomly selected from a UMC hospital census. The researchers reviewed each medical chart and recorded the physician-reported medication history, reason for admit, length of stay, and demographic information. Descriptive and inferential statistical analysis was completed using SPSS Version 11.0 (SPSS Inc., Chicago, IL). After collecting the data, counts were taken on missing prescription information, such as missing medication names, dose, route, and frequencies. If the collected data were normally distributed and were interval/ratio level data, a paired t- test was used for analysis. If the data were not normally distributed or were of nominal/ordinal level, a McNemar test was used. An a priori alpha level of 0.05 was used for all statistical tests. Results: A total of 234 patients were included in both the pre and post analysis. Approximately 53.8% of the sample was male. Fifty-one percent of the population was categorized as white in the patient’s chart. The average age at time of first admit was 50.3 years. Fifty-three percent of the population had a past medical history that included cardiovascular disease. Over 28% of the patients in the sample had diabetes and over 18% had pulmonary disease. The most common admit diagnoses for the population included shortness of breath, chest pain, and abdominal pain. Medication reconciliation forms were found in the chart 71.4% of the time. Of the 71.4% of the forms present in the patient’s medical chart, the form was utilized 66.6% of the time. The percentage of allergies recorded in the patient’s chart decreased from 89.3% before implementation of the form to 65.9% after implementation. This movement repeated itself with the recording of social history, which fell from 92.3% recorded before the form to 52.6% after implementation. Introduction of the new medication reconciliation form at UMC resulted in significantly fewer drug names missing, incorrect, or illegible from the patient’s medication history between pre and post (p=0.034), as well as a greater amount of medications recorded in the patient’s medication history (p=0.006). However, the use of the form did not result in significant differences between pre and post in the route, frequency, and dosing information being recorded. It also did not result in a significantly greater amount of non- prescription drugs recorded. Conclusions: The results of this study indicate the need for a systematic approach to ensure the process of obtaining accurate medication histories at the time of hospital admission. Utilization of a new comprehensive medication reconciliation form in this academic institution is far from optimal, and could have significant healthcare implications. Better methods of ensuring medication reconciliation at the time of hospital admission are needed.

Class of 2017 Abstract / Objectives: The purpose of this study is to demonstrate the effect of using advanced pharmacy practice experience (APPE) students in the collection of admission medication history at an academic teaching hospital prior to pharmacist review. Methods: The study is a retrospective, descriptive study. Using electronic medical records, the study looked at patients admitted to specific floors during a two-month period. The primary outcome was number of discrepancies found by the APPE students. The secondary outcome was the type of discrepancy found (omission, duplication, wrong dose, wrong frequency, wrong dosage form, and medications the subject no longer takes). Results: Over eight weeks, the APPE students identified 2,666 discrepancies, which equates to approximately 4.71 ± 4.76 discrepancies per patient. The majority of these discrepancies were identified as omissions of therapy (39.1%), followed by medications the patients were no longer taking (29.8%), and wrong dosing frequencies (18.1%). Conclusions: APPE students assisted the medication reconciliation process by identifying numerous medication discrepancies which may have prevented patient harm. APPE students are an underutilized resource and prove to be an asset to the healthcare team.

Background: Discrepancies in patient’s medication list can lead to medication errors which is a major cause of both morbidity and mortality today. The aim of the study was to examine the frequency of discrepancies in the Swedish prescription list “My saved prescriptions” regarding noncurrent treatment, incorrect dosages, double prescriptions, and missing prescriptions. Additionally, the purpose was to examine the type of source of information the patients used regarding their drug treatment.   Methods: Collection of data was conducted through interviews at three different pharmacies over a period of four weeks in Stockholm 2020. Patients 18 years or older with at least three prescribed drugs were asked to participate in the study.   Results: Of 157 patients, 74 patients were included. More than 70% of the patients had one or more discrepancies in their prescription list: a noncurrent, a duplicate or an incorrect dosage. 17.6% had at least one missing prescription. About half of the patients had a noncurrent prescription, which was the most common discrepancy among the patients. More than a third, 35.1%, of the patients used the prescription list as a source of information for their drug treatments. Furthermore, 31.1% of the patients used the drug packaging and 17.6% of them only used their memory. 10.8% of the patients used the medication list from healthcare.  Conclusions: The results suggest that discrepancies were quite common in the prescription list, which can increase the risk of medication errors for patients who use the prescription list as a source of information. The implementation of the Swedish National List (NLL) (launching in 2021) will provide the caregivers, pharmacies, and patients with access to the same information about patient’s prescribed drugs. NLL will hopefully reduce the risk of medication errors and it should lead to a reduced necessity of using several different sources for prescribed drugs.