Background: Studies, particularly the MARQUIS trial, have demonstrated the value of pharmacist-led medicine reconciliation. At our institution, we partnered with the College of Pharmacy to implement, revise, and grow a novel hospitalist-led transitions of care pharmacy student rotation. Pharmacy students work directly with attending hospitalists to address admission medication reconciliation errors and collaborate in the transitions between outpatient and inpatient care.
Purpose: In this innovations abstract, we describe how we implemented a novel Hospitalist-led transitions of care Pharmacy Student rotation, improve patient care, and provide valuable educational experiences.
Description: The Hospitalist Division in the Department of Medicine at the University of Florida (UF) completed two cycles and are currently in the third cycle of a Transitions of Care Pharmacy/Hospitalist rotation in partnership with the UF School of Pharmacy. In this six-week rotation, a 4th year pharmacy student works with the admitting Hospitalists to identify medication errors and clarify any discrepancies across patients’ pharmacies and other facilities. In Cycle 1 (Fall of 2020-Spring 2021), pharmacy students worked with Hospitalist attendings on the transition of outpatient care to inpatient management. The pharmacy student would complete a medicine reconciliation at admission, and document it in a note in the EMR. The admitting Hospitalist would then review and verify it. Students were also expected to help research and answer clinical pharmacology questions, present a journal club article, and present a patient case discussion. Feedback was conducted at midpoint and at the end of the rotation. Feedback from the students were generally positive with highlights being the value of interprofessional collaboration, the unique educational insights provided by having an attending hospitalist, and the motivation provided by engaging in clinically valuable activities. Similarly, feedback from hospitalist attendings were also positive with highlights being the opportunity to teach, the clinical value provided by students, and the students’ motivation to obtain accurate reconciliations. Students added value by calling patient families and pharmacies to coordinate medication lists in complicated patient presentations. We grew the rotation based on student feedback. Originally envisioned as an in person clinical rotation, the first cycle occurred during the COVID pandemic, and had to be implemented as a telemedicine rotation for student safety. In Cycle 2 (Fall 2021- Spring 2022), the rotation returned to being in person, and was expanded to more students, with students also helping with discharge medications and identifying social barriers to safe discharges in collaboration with case management. This expanded curriculum was again very successful, with students describing it as one of their most valuable rotations.
Conclusions: Although studies clearly demonstrate that pharmacy led medication reconciliation leads to higher value care, not all institutions have a multidisciplinary approach to transitions of care. Fortunately, at academic centers, an innovative solution would be to implement a hospitalist led pharmacy student rotation. This type of rotation provides a unique educational perspective for the students to be involved in patient care, allows hospital medicine faculty to engage in interprofessional education, and most importantly adds value by improving patient care.