Evaluation of Pharmacist Involvement in Outpatient Transitions of Care
Approximately 20% of patients will experience an adverse event during the transition from hospital to home, with two thirds of the events due to medications. Medication reconciliation at transitions can minimize and/or eliminate the risk of medication errors by ensuring each patient's regimen is accurate and updated. Pharmacists are uniquely qualified to complete this task due to their expertise in assessing patients' medication profiles, identifying medication errors, and providing recommendations for resolution. Studies have consistently found that pharmacist involvement in medication reconciliation in the inpatient setting reduces medication errors. 4 However, few have examined the integration of a pharmacist in the outpatient setting, following a patient's discharge to home. UConn Health's academic hospital (JDH) utilizes trained pharmacy technicians to conduct comprehensive medication history taking. At discharge, medication reconciliation is performed by a physician, with any changes noted in the discharge summary. General Medicine Associates (GMA) is a primary care clinic within the UConn Health system that includes 49 general medicine providers, 34 of whom are medical residents, and a pharmacy team (faculty, residents, and students) While the facilities utilize separate medical records, providers have access to both. Our objective was to assess the impact of pharmacist involvement on the identification and resolution of medication discrepancies during post discharge follow up appointments at GMA. The institution's investigational review board (IRB) granted exemption to this project, as it was determined to be a quality improvement project.
Journal of General Internal Medicine