Ashley Sproul1, Carole Goodine2, David Moore3, Amy McLeod4, Jacqueline Gordon5, Jennifer Digby6, George Stoica7. 1. , BSc(Pharm), CDE, PharmD, is with Horizon Health Network, Saint John, New Brunswick, and Dalhousie University, Halifax, Nova Scotia. Since the time when this study was conducted, she has also joined the University of New Brunswick, Fredericton, New Brunswick. 2. , BSc(Pharm), ACPR, PharmD, is with the Horizon Health Network, Fredericton, New Brunswick, and Dalhousie University, Halifax, Nova Scotia. Since the time when this study was conducted, she has also joined the University of New Brunswick, Fredericton, New Brunswick. 3. , MMedSc, ART, is with the Horizon Health Network, Waterville, New Brunswick. 4. , RN, BN, ENCC, is with the Horizon Health Network, Waterville, New Brunswick. 5. , RN MN, is with the Horizon Health Network, Fredericton, New Brunswick. 6. , MD, is with the Horizon Health Network, Fredericton, New Brunswick. 7. , PhD, is with the Horizon Health Network, Saint John, New Brunswick.
Abstract
BACKGROUND: Medication reconciliation at transitions of care increases patient safety. Collection of an accurate best possible medication history (BPMH) on admission is a key step. National quality indicators are used as surrogate markers for BPMH quality, but no literature on their accuracy exists. Obtaining a high-quality BPMH is often labour- and resource-intensive. Pharmacy students are now being assigned to obtain BPMHs, as a cost-effective means to increase BPMH completion, despite limited information to support the quality of BPMHs obtained by students relative to other health care professionals. OBJECTIVES: To determine whether the national quality indicator of using more than one source to complete a BPMH is a true marker of quality and to assess whether BPMHs obtained by pharmacy students were of quality equal to those obtained by nurses. METHODS: This prospective trial compared BPMHs for the same group of patients collected by nurses and by trained pharmacy students in the emergency departments of 2 sites within a large health network over a 2-month period (July and August 2016). Discrepancies between the 2 versions were identified by a pharmacist, who determined which party (nurse, pharmacy student, or both) had made an error. A panel of experts reviewed the errors and ranked their severity. RESULTS: BPMHs were prepared for a total of 40 patients. Those prepared by nurses were more likely to contain an error than those prepared by pharmacy students (171 versus 43 errors, p = 0.006). There was a nonsignificant trend toward less severe errors in BPMHs completed by pharmacy students. There was no significant difference in the mean number of errors in relation to the specified quality indicator (mean of 2.7 errors for BPMHs prepared from 1 source versus 4.8 errors for BPMHs prepared from ≥ 2 sources, p = 0.08). CONCLUSIONS: The surrogate marker (number of BPMH sources) may not reflect BPMH quality. However, it appears that BPMHs prepared by pharmacy students had fewer errors and were of similar quality (in terms of clinically significant errors) relative to those prepared by nurses.
BACKGROUND: Medication reconciliation at transitions of care increases patient safety. Collection of an accurate best possible medication history (BPMH) on admission is a key step. National quality indicators are used as surrogate markers for BPMH quality, but no literature on their accuracy exists. Obtaining a high-quality BPMH is often labour- and resource-intensive. Pharmacy students are now being assigned to obtain BPMHs, as a cost-effective means to increase BPMH completion, despite limited information to support the quality of BPMHs obtained by students relative to other health care professionals. OBJECTIVES: To determine whether the national quality indicator of using more than one source to complete a BPMH is a true marker of quality and to assess whether BPMHs obtained by pharmacy students were of quality equal to those obtained by nurses. METHODS: This prospective trial compared BPMHs for the same group of patients collected by nurses and by trained pharmacy students in the emergency departments of 2 sites within a large health network over a 2-month period (July and August 2016). Discrepancies between the 2 versions were identified by a pharmacist, who determined which party (nurse, pharmacy student, or both) had made an error. A panel of experts reviewed the errors and ranked their severity. RESULTS: BPMHs were prepared for a total of 40 patients. Those prepared by nurses were more likely to contain an error than those prepared by pharmacy students (171 versus 43 errors, p = 0.006). There was a nonsignificant trend toward less severe errors in BPMHs completed by pharmacy students. There was no significant difference in the mean number of errors in relation to the specified quality indicator (mean of 2.7 errors for BPMHs prepared from 1 source versus 4.8 errors for BPMHs prepared from ≥ 2 sources, p = 0.08). CONCLUSIONS: The surrogate marker (number of BPMH sources) may not reflect BPMH quality. However, it appears that BPMHs prepared by pharmacy students had fewer errors and were of similar quality (in terms of clinically significant errors) relative to those prepared by nurses.
Entities:
Keywords:
best possible medication history; medication history; medication reconciliation; medication safety; nurses; pharmacy students; quality indicators
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