Matt Kressl, PharmD, BCPS

1. The Evolution and Outcomes
of Pharmacist Medication
History Services
Matt Kresl Pharm.D BCPS
Clinical Pharmacy Manager
Abbott Northwestern Hospital
Innovation Summit – September 26th 2015

2. Disclosure
• There are no conflicts of interest or relevant
financial interests in making this presentation
and have indicated that my presentation does
not include discussion of an unlabeled use of a
commercial product, or an investigational use
not yet approved for any purpose.
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3. Objectives
• Describe the challenges of accurate
medication history taking in admitted
inpatients
• Review additional services pharmacists offer
beyond list acquisition
• Understand the data on process and outcome
improvements with medication history
services
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4. Patient Story #1
• 94 y/o M admitted through ED with emesis,
headache and weakness
• Arrived via ambulance
• Lives in assisted living
• Hospitalist unclear on cause – EMS information
non-contributory
• Pharmacist asked to review medications in ED
• Poor historian given condition at time of interview
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5. Patient Story #1
• Pharmacist calls home pharmacy
• Pharmacist calls assisted living facility
• Convinces RN to go into patients room to
obtain medications
• Found “medications strewn all across home
including empty Tylenol PM and Aleve PM”
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6. Patient Story # 1
• Patient diagnosed with anticholinergic OD and
treated
• Patient discharged back to assisted living with
RN administered medications
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7. Abbott’s Story
• Emergency Department (2011)
• Hospitalist Consult Service (2013)
• MDRs (2014)
• Integrated Pharmacist Delivery Model (2015)
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8. Process -More Than Just a List
• Why pharmacy staff?
–Experience and training
–Outlined processes
–Focus and attention
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9. Process – Pharmacy Staff Note
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10. Process – Pharmacist Navigator
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11. PRN Services –Collaboration with Other
Services
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12. PRN Services – Referral to Outpatient
Pharmacist
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13. PRN Services – Tracking Mechanisms
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14. PRN Services – IDP Note Placement
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15. The Data – What Do We Know?
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1. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized
patients. JAMA 1997;277(4):307-11.
2. Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs
http://www.ahrq.gov/qual/aderia/aderia.htm
3. Steven B. Meisel, PharmD at the Joint Commission/Institute for Safe Medication
Practices Medication Reconciliation Conference, Nov. 14, 2005.

16. The Data – What Do We Know?
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17. Patient Story # 2
• 25 y/o F admitted with abdominal pain
• ED MD asks about medication use with patient
during workup
• Patient self –reports taking ‘no additional
medications’
• Pharmacist enters room and asks about
medication use
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18. Patient Case # 2
• Asks about over-the-counter and herbal
products (not discussed prior)
• Patient states she is taking 10 grams/day PO
acetaminophen for last 2 + weeks
• Patient admitted and treated for chronic
acetaminophen overdose
• Patient education on appropriate OTC use
completed
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19. References
• Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in
hospitalized patients. JAMA 1997;277(4):307-11.
• Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs
http://www.ahrq.gov/qual/aderia/aderia.htm
• Steven B. Meisel, PharmD at the Joint Commission/Institute for Safe
Medication Practices Medication Reconciliation Conference, Nov. 14, 2005.
• The Institute for Healthcare Improvement. Protecting 5 million lives from harm.
http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1.
Accessed September 14, 2015
• American Society of Health-System Pharmacists. ASHP Medication Reconciliation
(Med Rec) Toolkit.
http://www.ashp.org/menu/PracticePolicy/ResourceCenters/PatientSafety/ASHPM
edicationReconciliationToolkit_1.aspx. Accessed September 14, 2015.
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20. Contact Information
Matt Kresl PharmD BCPS
800 E. 28th Street - Mail Route 11321
Minneapolis, MN 55407-3799
Phone: 612-863-8333
Fax: 612-863-3799
matt.kresl@allina.com
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