title: Pharmacy impact on medication reconciliation in the medical intensive care unit.
abstract: OBJECTIVE
  Pharmacy-driven medication history (MH) programs have been shown to reduce the number of serious or potentially life-threatening (S/PLT) medication discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs).
  
  
  METHODS
  MHs were repeated over a 6-week period. Demographics, number, and nature of MDs were documented. Discrepancy severity was graded using a previously published method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs.
  
  
  RESULTS
  Sixty-three MHs were repeated. Pharmacy MHs were less likely to contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001).
  
  
  CONCLUSIONS
  Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT MDs on admission and home medication lists were common in patients admitted to the medical ICU. Pharmacy-driven medication reconciliation (MR) reduced the number and frequency of these discrepancies. Further research is required to improve current MR procedures.
authors.affiliation: Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA, USA.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Wills
authors.affiliation: Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA.
authors.forename: William
authors.initials: W
authors.lastname: Darko
authors.affiliation: Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Seabury
authors.affiliation: Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA.
authors.forename: Luke A
authors.initials: LA
authors.lastname: Probst
authors.affiliation: Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Miller
authors.affiliation: Department of Pharmacy, Upstate University Hospital, Syracuse, New York, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Cwikla
keywords: Critical care; intensive care unit; medication reconciliation