Pharmacist Utilization Needed for Home Medication Reconciliation

NOVEMBER 15, 2015
A patient enters the hospital with a previous history of taking medications at home for a chronic condition. Since most retail and mail-order pharmacies are not sharing patient data with hospitals, most of the reliable information on what medications the patient is taking at home comes from the patient or family members.

Different hospitals handle this scenario in different ways, but the norm seems to be that a desk clerk writes or enters these meds into a module that places responsibility on a physician who often decides to continue the home medications.

Unfortunately, some physicians are resistant to ensuring that the medication names, strengths, and directions are correct because they didn’t prescribe them in the first place. The hospital’s pharmacy does not want to take responsibility because its budget does not include managing patient home medications, and there is no way for it to recoup the pharmacist staffing cost.

The result is that home medications become a different sort of prescription. The prescription can be verbally given by the patient with no follow-up to see whether it is true or not, and a prescriber will sign off on it with little thought about its accuracy.
Essentially, the patient becomes the prescriber because no one will enforce the same laws on outpatient home medications, even though these medications are dispensed by the pharmacy if patients don’t bring their own.

I have read a lot of articles about patient safety and I have worked in several different health care settings where pharmacists are not being utilized because of the high personnel cost and the inability to justify it.

Why aren’t the medical errors that happen during the medication reconciliation process in the hospital setting enough to justify employing more pharmacists?
As soon as patients are admitted to a hospital, they are thrust into the category of the third leading cause of death in the United States. Some reports estimate that patient harm costs hospitals between $6 billion to $13 billion annually, though it is not as obvious as the cost of medications dispensed.

It’s time to make patient safety a priority and utilize pharmacists in the best way possible in the medication reconciliation and discharge processes. Relying solely on a patient is no different than allowing them to write their own prescriptions to fill.
It is baffling that medication reconciliation for home medications is not given the same scrutiny as in-patient medication orders.

Beth Lofgren, PharmD, BCPS
Beth Lofgren, PharmD, BCPS
Beth Lofgren, PharmD, BCPS, received her PharmD degree from the University of Tennessee at Memphis in 1999, after completing a BS at the University of Tennessee at Martin. She started her pharmacy career in retail and has practiced in home health, long-term care, and hospital pharmacy. She has also been blogging as the Blonde Pharmacist since 2004, focusing on education for peers and provider status for pharmacists.