Improving immunosuppression drug accuracy through pharmacy-directed medication reconciliation

Background: Accurate immunosuppression is key to reducing donor-specific antibodies, acute rejection, drug toxicity, and prolonging graft survival. Pharmacydirected medication reconciliation has shown improved drug compliance, but has not been studied in post-transplant patients. Methods: A prospective, randomized cohort study of adult post-kidney transplant patients was conducted and analyzed using statistical process control. 100 patient medication lists (10 medication lists per sample) from the electronic medical record (EMR) were cross-validated through patient and pharmacy interviews to determine baseline medication list error rates. High risk medications were defined as including immunosuppressants, anticoagulants, antiarrhythmics, insulins, opioids, or benzodiazepines. The intervention was a dedicated pharmacist who was randomly assigned to perform medication reconciliation exclusive of transplant team care. These 100 intervention samples were then cross-validated with the same methodology to determine accuracy of EMR medication lists post-intervention. Results: Compared to the baseline samples, the pharmacy-directed intervention resulted in a reduction of EMR medication list errors of high risk post-transplant medications from an average of 7.3 per sample (Phase 1;73%) to 0.09 per sample (Phase 2;0.9%)(Figure). Upper and lower control limits showed marked reduction in variation from sample to sample in the number of medication errors identified post-intervention (Phase 2). Two special cause tests (1 and 2) show that the chances of this finding occurring by chance alone is less than 0.03%. Conclusion: Pharmacist-directed medication reconciliation post-transplant significantly decreases the number of high risk medication errors, including immunosuppressives. Further studies are needed to evaluate the impact of reducing these errors. (Figure Presented) .