Improving Medication History Processes: Raneem Alayoubi

Working at a hospital internship, a pharmacy student researcher discovered medication discrepancies in nearly 97% of Emergency Department patients’ records. She found ways to improve the process.   

Through the Summer Research Fellowship Program at Northeast Ohio Medical University, medicine or pharmacy students gain intensive training in research procedures by working (often side by side) with research mentors. In addition to these students, who are paid a stipend by NEOMED, other NEOMED students found funding on their own for summer 2019 internships or programs elsewhere in Ohio, as well as at institutions including the National Cancer Institute, the U.S. Food and Drug Administration and Harvard University.  

The Summer Research Fellowship Program culminates each year in an event called Poster Day. Below is a reflection by second-year College of Pharmacy student Raneem Alayoubi on her summer experience.

Last summer, I was fortunate enough to run a research study within the emergency department (ED) at Ascension Providence Rochester Hospital, located in Rochester Hills, Michigan, where I noticed a lack of pharmacy presence. I wanted to show the benefit of having a pharmacy representative, so I decided to look specifically at improving medication history upon admission — something that’s essential for patient care due to high medication error during the transition of care for patients.

From June 13 to Aug.2, I was able to collaboratively work with nurses, physicians, residents, pharmacists and other essential health care providers. During this time, I conducted patient interviews with all admitted patients seen within the ED and identified medication discrepancies, which were then quantified and placed into necessary categories. The same procedure was performed on the secondary outcome of allergy discrepancies and patients were encouraged to have their medications filled during discharge with the “Meds to Beds” service to ensure medication adherence and affordability.

Patient compliance, drug, dose, dosage form, frequency and last dose were all documented variables in my research study. Allergies and reactions were also documented and updated via an electronic records system (ERS). When necessary, physicians and pharmacies were called to verify medication. If needed, patient counseling was completed during the interview and documented. The information obtained by interview was then compared to the home medications listed on the ERS.

In total, I was able to see 479 patients and was amazed to discover that 96.87% of these patients had a medication discrepancy of either omission (we did not have one of their current medication documented in our ERS), wrong dose, wrong frequency, or they were no longer taking a medication we had documented. In addition, 17.33% of patients had allergy discrepancies, such as a missing allergy note or an allergic reaction.

When I broke down the data further, I was able to conclude the main medication issue was with the omission of drugs, and patients were not always aware of the medication they were taking and needed me to call their pharmacies or doctors. Of these omitted drugs, 700 of the missing drugs were cardiac medications — medications that are oftentimes vital to the patient’s health.

By having pharmacy representatives within the ED, and by spending time with our patients, we can provide better overall care and ensure the safety of our patients by helping health care providers correctly diagnosis patients and ensure the correct medications are given during their hospital stay and even into discharge. Not only was my research conclusive with safer patient outcomes; an anonymous survey  was sent out to the hospital’s ED nurses and physicians via email showed that 100% of the responding healthcare professionals found this service to help with overall patient care and productivity.

I was unsure of what to expect at the beginning of my summer, but this was an experience that will stick with me for the rest of my life. Not only did I learn how to interact with patients or how to work with a team, I learned how to provide a beneficial service to our patients — the ultimate goal. This summer, my research helped confirm that this branch of pharmacy is exactly where I want to be upon graduation and I could not have done this without the help and endless support of my mentors: Lindsay Schwalbach, Pharm.D., director of pharmacy services; Glenn Garwood, director of clinical operations: emergency, urgent care, security, occupational health; and Patrick Milostan, nurse manager: emergency services and clinical decisions units.

I’m so grateful to work for an organization that not only believes in me but holds the same values — to put the patient first in every situation. I want to encourage anyone reading this that if you have an idea to improve healthcare, run with it. Health care is always evolving, and your voice can be what changes our future for the better. I plan on returning to the ED next summer and continue to push for an interprofessional setting to provide the best patient care possible.

— Raneem Alayoubi, a second-year College of Pharmacy student, contributed this reflection.