Medication reconciliation is among many areas in which a pharmacist’s knowledge can be used in the health care system, providing patients with appropriate care by avoiding possible medication errors and drug interactions. Medication safety is at the forefront of patient safety.

As such, pharmacist involvement in transitions of care (TOC) helps mitigate 50% of medication errors, which translates to a 28% reduction in emergency department visits, 19% drop in hospital readmissions rates, and 67% decrease in adverse drug event-related hospital revisits.1

Nonprescription drugs, dietary supplements (DS), and OTC products are often overlooked by many health care providers.  The widespread use of OTC and DS are opportunities for pharmacists to not only educate patients, but also other health care members as to how these products fit into the overall health of patients.

The Consumer Healthcare Association reported that 81% of US adults use OTC medications for primary treatment of minor ailments. In addition, 93% prefer to treat their minor ailments with OTC medications before seeking professional care.2

In particular, their ease of access and patients’ awareness in maintaining good health show high utilization rates for those living in rural areas or low income communities, with 83% of adults in rural areas taking at least 1 oral DS and 29% using 5 or more.3 According to consumer-products analytics firm TABS, the escalating trend of vitamins, minerals, and supplements (VMS) steadily increased from 68% in 2010 to 77% in 2019, suggesting that VMS use is here to stay and has the potential to increase over time.4

Inclusion of DS and OTC products into patients’ medication profiles continue to be overlooked despite their prevalence. A study at Boston Medical Center revealed that only 60% of patients reported the use of dietary supplements, whereas 36% had documentation of such use on their admission profile. 

Rates diminished during admission to 20% of patients reporting use due to lack of inquiry whereas only 18% disclosed DS use to a prescriber.5 Absence of documentation can contribute to missing doses of supplements a patient may be taking to maintain their health. 

Diagnoses can be missed as well, such as a patient who takes valerian root, melatonin, and chamomile on a regular basis to treat their insomnia, anxiety, or pain. Although under-reported use of DS during the admission process was demonstrated, 48% of patients intend to continue using DS after hospital discharge.5 The data suggest that medication reconciliation is vital at all stages in the process of maintaining a current and appropriate medical history.

Pharmacist-led medication reconciliation was shown to have a tremendous impact on providing identification of DS and OTC documentation. According to Karaoui et al, 71.8% of all medication histories had a discrepancy, with dietary supplements the most common agents involved (27.7%).1

Nightingale et al showed an association between the use of DS/OTC products and the increased prevalence of excessive polypharmacy, defined as 4 or more unnecessary medications.6 Pharmacist involvement in each of these scenarios ensured DS and OTC products were documented and communicated to prescribers and other medical staff in a timely fashion.

TOC is the new frontier of clinical pharmacy involvement in the acute care setting.  A pharmacist’s role here is to obtain and verify the most accurate medication history of a patient and to optimize that therapy with the rest of the medical team, and nonprescription drugs are a key part of that. 

I believe the pharmacy world placed DS products specifically on the back burner in the early days of acute care treatment, but we have another opportunity to get it right now with TOC. Let us take this opportunity to perfect our medication reconciliation process and improve outcomes by asking every patient during each encounter with them about their DS and OTC use, with no exceptions. Only then can we have a complete medication history.

References
1. Karaoui LR et al. Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals. BMC Health Services Research, vol. 19, no. 493, 2019, pp. 1-9.
2. Fuji, Kevin T. The Importance of Reconciling Nonprescription Products. Home Healthcare Now, vol. 33, no. 3, 2015, pp. 175-176.
3. Shade MY et al. Analysis of Oral Dietary Supplement Use in Rural Older Adults. J Clin Nurs, vol. 28, 2019, pp. 1600-1606.
4. 12th Annual Vitamin Study. TABS Analytics. June 2019. Accessed June 2020.
5. Gardiner P et al. Medical reconciliation of dietary supplements: Don’t ask, don’t tell. Patient Education and Counseling, vol. 98, 2015, pp. 512-517.
6. Nightingale G et al. A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer. Journal of Geriatric Oncology, vol. 6, 2015, pp. 411-417.