Impact of Comprehensive Medication Reviews Completed by Pharmacy Students in a Complex Continuing Care Program: A Pilot Project

摘要

Background: Adults receiving a large number of medications are at increased risk for an adverse drug event and increased risk of admission to acute care. Adults with complex medical needs often require a complex drug regimen and benefit from regular review of medications to ensure safe medication use. Pharmacists and pharmacy students can play an important role in evaluating the appropriateness of medications and improving medication safety. Description: A step-wise, multidisciplinary procedure for completing a comprehensive medication review (CMR) was developed. The number of patients receiving this intervention was limited due to the amount of pharmacist time required to complete the CMR Action: A CMR role was developed for pharmacy students as part of a pilot project to increase the number of complex continuing care patients receiving this intervention. Pharmacy students were oriented to the process and followed a systematic approach to assessing each patient's medications. All suggestions were reviewed and cosigned by a clinical pharmacist prior to documentation and discussion with the physician. Evaluation: A retrospective audit was completed in order to determine the impact of the intervention. Three pharmacy students completed 47 CMRs over a total of 14 weeks resulting in 139 recommendations. Physicians implemented 77% of the recommendations. Of the accepted recommendations, 52% resulted in the discontinuation of a medication, while 40% resulted in the addition of a new order (optimization of an existing medication, new medication, monitoring test or consultation). Pharmacy student, pharmacist and physician satisfaction was found to be positive. Implications: The successful integration of pharmacy students into the CMR process for adults in a complex continuing care program may have important implications. It provides pharmacy students an opportunity to practice their skills and actively engage in providing meaningful patient care while helping pharmacists and physicians optimize drug therapy for patients.