title: Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer center.
abstract: OBJECTIVE
  To determine the number of discrepancies and medication-related problems found as a result of pharmacy-led medication reconciliation involving introductory pharmacy practice experience (IPPE) students at a comprehensive cancer center.
  
  
  METHODS
  Outpatient infusion center of a National Cancer Institute (NCI)-designated and National Comprehensive Cancer Network (NCCN) cancer center.
  
  
  CONCLUSIONS
  Third-year IPPE students contacted and completed medication reconciliation for 510 hematology/oncology patients scheduled for infusion center appointments without a coupled provider visit. IPPE students discussed the findings of the medication reconciliations with their pharmacist preceptors, who updated the medication histories in the electronic medical record (EMR) and communicated with prescribers directly about identified medication-related problems. All medication reconciliation was documented using a standardized note template in the EMR.
  
  
  METHODS
  Number of medication discrepancies found, including medication additions, medication deletions, dose changes, and herbal product additions; medication-related problems-including drug-drug interactions, untreated indications (e.g., nausea, vomiting, pain, need for prophylactic medications), failure of patients to receive prescribed medications, and adverse drug reactions-were also documented.
  
  
  RESULTS
  Medication reconciliation was completed for 510 patients through the student pharmacist/pharmacist preceptor-led intervention during a 1-year period between January 1, 2013, and December 31, 2013. A total of 88% of patients had at least one discrepancy identified in their medication history and corrected in the EMR. In addition, 11.4% of patients had a medication-related problem identified.
  
  
  CONCLUSIONS
  Pharmacy-led medication reconciliation identified a large number of discrepancies among our hematology/oncology patients. This intervention allowed for correction of discrepancies in the EMR leading to improved accuracy of patient medication lists. In addition, it provided a valuable learning experience for student pharmacists.
authors.forename: Emily
authors.initials: E
authors.lastname: Ashjian
authors.forename: Louise B
authors.initials: LB
authors.lastname: Salamin
authors.forename: Katie
authors.initials: K
authors.lastname: Eschenburg
authors.forename: Shawna
authors.initials: S
authors.lastname: Kraft
authors.forename: Emily
authors.initials: E
authors.lastname: Mackler
mesh_terms: D000553:Ambulatory Care; D002173:Cancer Care Facilities; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D059065:Medication Reconciliation; D008824:Michigan; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D017060:Patient Satisfaction; D015397:Program Evaluation; D013339:Students, Pharmacy; D000078329:Workforce