Pharmacist involvement in a multidisciplinary inpatient medication education program.

The development of a multidisciplinary inpatient medication education program is described. A multidisciplinary group designed and implemented a medication education program with defined roles for both nurses and pharmacists. Nurses provided medication education to patients during each medication administration using specially designed assessment and teaching tools. The nursing staff submitted requests for pharmacist consultations for patients with complex medication regimens, who were admitted because of a drug-related problem or who required additional teaching as determined through the medication education assessment form. A complex medication regimen was defined as the administration of oral medication more than five different times per day, the start of at least 5 new medications that would be continued at discharge, or the prescribing of at least 10 medications to be taken daily that would be continued at discharge. Pharmacists provided education for 19% of admitted patients during a six-month period. As a result of pharmacists' interactions with prescribers and nurses, the number of medications was reduced in 12% of these patients, and the number of medication administrations each day was reduced in 19% of patients. In addition, for 33% of patients, pharmacists contacted the prescriber to make recommendations beyond the scope of the medication education program that optimized and simplified the patient's drug regimen. The development of a structured medication education program allowed patients to receive medication education throughout their hospitalization from both nurses and pharmacists. Pharmacists provided education for patients at highest risk for noncompliance or poor outcomes. Full implementation of a medication education program involving staff pharmacists is planned.