Impact of a patient risk scoring tool pilot on prioritization of pharmacy-conducted medication histories.

BACKGROUND: Approximately 50-70% of patients have at least one medication discrepancy in their initial medication history. These discrepancies can lead to errors on admission and discharge orders and have the potential to cause patient harm and incur added costs associated with increased length of stay and readmission rates. Several studies have demonstrated improved medication history accuracy with pharmacy-conducted services, but variations in practice exist due to challenges with workflow and resources.

OBJECTIVE: This study aims to assess the impact of implementing a patient risk scoring tool for the prioritization of medication history review by pharmacy staff.

METHODS: This quasi-experimental, single-center study was conducted at a 948-bed academic medical center as a pilot study with the medication history team which consists of pharmacists and technicians in the emergency department (ED). The endpoints assessed included pharmacy completion rate of patients in the high-risk category, overall pharmacy conducted medication history rate, and the proportion of medication discrepancies identified after reconciliation.

RESULTS: The number of medication histories completed by pharmacy (n=849) decreased by 5.7% in the post-intervention period (P=0.002). Between the pre- and post-intervention period, there were less low risk patients being captured by pharmacy (89.7% to 59.9%, respectively). There was also an increase in the number of medium-risk (Δ=25.4%) and high-risk patients (Δ=4.4%) being captured by pharmacy staff (P<0.017, α=0.017).

CONCLUSION: Use of a risk scoring tool allowed pharmacy staff to prioritize workflow and capture more high-risk patients.