title: Pharmacy collected medication histories in an observation unit.
abstract: BACKGROUND
  Clear processes to facilitate medication reconciliation in a hospital setting are still undefined. The observation unit allows for a high patient turnover rate, where obtaining accurate medication histories is critical.
  
  
  OBJECTIVE
  The objective of this study was to assess the ability of pharmacists and student pharmacists to identify discrepancies in medication histories obtained at triage in observation patients.
  
  
  METHODS
  Pharmacists and student pharmacists obtained a medication history for each patient placed in observation status. Patients were excluded if they were unable to provide a medication history and family, caregiver, or community pharmacy was also unable to provide the history. A comparison was made between triage and pharmacy collected medication histories to identify discrepancies.
  
  
  RESULTS
  A total of 501 medications histories were collected, accounting for 3213 medication records. There were 1176 (37%) matched medication records and 1467 discrepancies identified, including 808 (55%) omissions, 296 (20.2%) wrong frequency, 278 (19%) wrong dose, 51 (3.5%) discontinued, and 34 (2.3%) wrong medication. There was an average of 2.9 discrepancies per patient profile. In all, 76 (15%) of the profiles were matched. The median time to obtain a medication history was 4 min (range: 1-48 min).
  
  
  CONCLUSIONS
  Pharmacy collected medication histories in an observation unit identify discrepancies that can be reconciled by the interdisciplinary team.
authors.affiliation: Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA; The Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
authors.forename: Gabrielle L
authors.initials: GL
authors.lastname: Procopio
authors.affiliation: Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA; The Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Faley
authors.affiliation: Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA; The Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wynd
authors.affiliation: Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Finefrock
authors.affiliation: Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Feldman
keywords: Medication reconciliation; emergency medicine; medication history; observation; transitions of care