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Should nurses or clinical pharmacists perform medication reconciliation? A randomized controlled trial

  • Clinical Trial
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Abstract

Purpose

To study differences in outcomes of medication reconciliation (MR) when performed by clinical pharmacists compared to nurses.

Methods

201 patients (21–92 years) admitted to the Department of Cardiology at the University Hospital of North Norway, autumn 2012, were randomized into a pharmacist group (PG) and a nurse group (NG). The nurses and the pharmacists were trained for performing the MR process by an independent clinical pharmacist. Medication discrepancies (MDs) were discussed with the physicians. Time spent during the MR was recorded. An independent expert group rated clinical relevance of the MDs retrospectively.

Results

At least one MD was identified in 78 % and 84 % of patients in PG and NG, respectively (P = 0.269) with a mean number of MDs per patient 3.1 (SD 2.1) and 2.8 (SD 2.2), respectively (P = 0.528). Mean time spent/patient on the MR process was 22.9 min (SD 11.6) in the PG and 32.2 min (SD 20.3) in the NG (P < 0,001). Physicians agreed significantly more often to act upon the MDs presented by pharmacists compared to nurses (P = 0.001). The expert group finally assessed 48 % and 49 % of the MDs to be of the clinical relevance in the PG and the NG, respectively.

Conclusions

By applying a structured method for MR, a small however not statistically significant difference in identified MDs between nurses and clinical pharmacists was revealed. The pharmacists spent significantly less time than the nurses, and physicians agreed significantly more often with the pharmacist that action should be taken on the MDs. This is important in the discussion of who to perform MR.

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Acknowledgement

We thank the personnel and patients at the Department of Cardiology at the University hospital of North Norway for all help and collaboration, especially the tree nurses that participated; Jeanette Robertsen, Jenny Vesterhus and Katrine Vollen. We thank MD Richard Slubowski for the help in validating the English-Norwegian translation of clinical relevance criteria and the expert group for rating clinical relevance. We thank Sykehusapotekene i Midt-Norge HF for teaching, help and collaboration regarding the IMM methodology and IMM tools.

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Hospital Pharmacy of North Norway Trust, PO 6147, Langnes, 9291, Tromsø, Norway

    Trine Aag & Beate Hennie Garcia

  2. Department of Pharmacy, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway

    Beate Hennie Garcia

  3. School of Pharmacy, The Faculty of Mathematics and Natural Sciences, PO 1068 Blindern, 0316, Oslo, Norway

    Kirsten K. Viktil

  4. Diakonhjemmet Hospital Pharmacy, PO 23 Vinderen, 0319, Oslo, Norway

    Kirsten K. Viktil

Authors
  1. Trine Aag
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  2. Beate Hennie Garcia
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  3. Kirsten K. Viktil
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Corresponding author

Correspondence to Beate Hennie Garcia.

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Aag, T., Garcia, B.H. & Viktil, K.K. Should nurses or clinical pharmacists perform medication reconciliation? A randomized controlled trial. Eur J Clin Pharmacol 70, 1325–1332 (2014). https://doi.org/10.1007/s00228-014-1741-7

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  • DOI: https://doi.org/10.1007/s00228-014-1741-7

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