Johns Hopkins: Nurse-pharmacy medication reconciliation pays for itself

Investing time and money into a nurse-pharmacist team to reconcile patient medications can pay for itself, according to Johns Hopkins University of School of Medicine researchers.

Researchers studied more than 500 patients and found that nurse-pharmacy teamwork can help avoid medication discrepancies that otherwise would cause patient harm, according to the study published in the Journal of Hospital Medicine.

Patients often come into the hospital with more medications these days, but patients don't always remember the names or doses of the (prescription and over-the-counter) drugs they're taking, Johns Hopkins noted in a research announcement yesterday.

Nurses at the urban medical center developed a home medication list to be compared with drugs patients are taking at the hospital and at home after discharge. If a nurse couldn't get an accurate medical history at admission, for example, if patients couldn't remember their medications or had limited literacy skills, the nurse looked at electronic medical records from previous discharges or called the patient's family, primary care provider and pharmacist, when necessary.

From that information, the nurse determined whether the discrepancies were intentional (for example, if a physician purposely substituted a medication) or unintentional. In unintentional cases, the nurse notified the doctor to correct what could be a mistake.

Although gathering information for the medication list took about half an hour and cost roughly $32 per patient and about $114 to find one discrepancy that could cause harm, the hospital could save roughly $9,300 to treat each harmful event; so preventing one discrepancy in every 290 patient encounters would offset the intervention costs, Johns Hopkins said about the return on investment.

With chronic conditions on the rise and hospitals paying close attention to readmission rates, the program could avoid adverse drug interactions but also could free up physicians from reconciling medication duties.

"Many of our patients have limited literacy skills and we expect them to handle three, four or a dozen medications," Feldman says. "So it's not hard to imagine that getting accurate medication histories requires some detective work on our part."

That detective work averaged out to what researchers say could prevent more than 80 adverse events for every 290 patients admitted.

For more information:
- see the study abstract
- check out the research announcement

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