Intake at the Hospital... in a Perfect World

Source: Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-429. [go to PubMed]

In a perfect world, a patient would be met by a pharmacist or a certified pharmacy technician asking them about their home medications at admission. The information, especially when a physician signs the blanket order to "restart home medications" with one click or swipe of the pen, would become as scrutinized as medications started in the hospital. I have been and will continue to be baffled at how no one wants to take ownership of home medications and in fact treat them as though they do not fall under the same protocols as the hospitals' orders. 

For example, I stumbled across a patient who had been admitted and had all home medications restarted on day 2. He had reported to intake that he took morphine 60 mg by mouth twice daily. The intake person chose morphine sulfate immediate release (MSIR) rather than the patient's actual MS Contin and the patient actually received the medication as immediate release for a couple of days. Another time I discovered intake had entered Lyrica for Lopressor, Isordil for Imdur and the common Lopressor for Toprol. We have confusion with Depakote ER vs EC and the list is really endless. Not only that, the patient could report they take anything they want, and it is not verified and a physician not really paying attention could restart all kinds of medications the patient has not ever taken.

Why aren't electronic records linked where hospital staff could see what the patient has taken in the past year regardless of where filled?

Why don't hospitals see the need for trained professionals to make sure home medications are entered correctly at patient admission?

Many medication errors and interactions can be found in home medication reconciliation. Personally, I feel a pharmacist or experienced certified pharmacy technician should be the ones to handle medication reconciliation, but with high salaries that pharmacists make and technician costs, the hospitals' financial leaders make the decision that since a pharmacist or tech isn't billing that time to medicare or another insurance, it is money loss EVEN THOUGH it results in better patient care and less mistakes and drug errors and increase in patient safety.

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