In 2006, Joan Kramer, Pharm.D., Clinical Research Pharmacist, and Paula Hopkins, R.N., M.S.N., Clinical Nurse Specialist, of Wesley Medical Center in Wichita, Kansas, concluded their study, “Collaborative Pharmacist and Nurse Before/After Study to Evaluate Patient Safety Using Electronically Standardized Admission and Discharge Medication Reconciliation in a Tertiary Care Hospital,” which was funded through the Pharmacy/Nursing Partnership for Medication Safety Research Grant Program.

The study evaluated the feasibility and impact of a pharmacist- and nurse-conducted admission and discharge medication reconciliation documentation process that was collaborative, standardized, targeted and electronic-based. They conducted a prospective study with a baseline (Before) phase, followed by an intervention (After) phase on a 48-bed adult general medical unit. In the Before phase, admission medication histories and discharge medication counseling followed standard care processes. In the After phase, pharmacists obtained the patient medication history and collaborated with nurses, using an electronic admission and discharge process, to complete medication reconciliation documentation.

The study was groundbreaking in that technology was used to generate complete patient medication lists from admission through discharge. Patients received computer-generated, legible medication lists with dosing instructions at discharge.

“Patients who had their medications electronically reconciled reported a statistically significant greater understanding of what medications should be continued after discharge, how and when to take their medications and potential side effects,” says Kramer of the study’s findings, which have been submitted for publication in a future issue of the American Journal of Health-System Pharmacy. “We hope that other institutions will promote medication reconciliation utilizing the pharmacist-and-nurse collaboration model rather than relying on one discipline to complete the process.”

What’s next for Kramer and her team? “We hope to continue to study medication reconciliation as our institution pursues electronic, hospital-wide implementation,” she says. “We have a drug utilization evaluation scheduled for the last quarter of 2006 to review hospital-wide implementation!”