Impact of a Pharmacy-Led Medication History Program in the Emergency Center of a Large, Academic Hospital



Journal Title

Journal ISSN

Volume Title



PURPOSE: To evaluate the medication-related errors identified in medication histories completed by pharmacist extenders and pharmacists, compared to medication histories completed by emergency center providers, for patients admitted through the emergency center at a large, academic hospital.

METHODS: This 10-week pilot study used pharmacist extenders to complete medication histories on patients admitted from the emergency center. Pharmacist extenders were provided with standardized training to complete the histories and document within the patient’s electronic medical record (EMR). Emergency center providers completed medication histories for patients prior to admission and served as the control group. Pharmacist extenders and pharmacists served as the intervention group and completed medication histories for the same patients, but after the patient's status changed to admission status. The primary objective is to quantify the number of medication discrepancies captured on medication histories completed by pharmacist extenders and pharmacists compared to medication histories completed by emergency center providers. The secondary objectives included identifying types of errors and discrepancies captured by pharmacy students and pharmacists, cost impact on the institution, average time to complete a medication history by a pharmacy student, the number of errors by therapeutic class, and the types of errors by therapeutic class.

RESULTS: Pharmacist extenders captured 328 discrepancies (P<0.001, 95% CI: 2.41-3.36) on 113 medication histories. The majority of discrepancies captured were discontinued/not taking drug. The majority of discrepancies by therapeutic class were associated with analgesic medications.

CONCLUSION: Pharmacy involvement within the medication reconciliation process demonstrated positive outcomes.



Transitions of care, Medication reconciliation, Medication Safety, Medication Errors, Patient safety, Medication history