Medication Reconciliation Using Pharmacy Techs in the ED
Medication Reconciliation Using Pharmacy Techs in the ED
Background The collection of a complete, verified medication history is essential to patient safety. The involvement of clinical pharmacists has been shown to improve the completeness and accuracy of medication histories; however, to our knowledge, involvement of pharmacy technicians has not been studied.
Objective Our aim was to determine whether verification of medication histories by pharmacy technicians in the emergency department (ED) would result in fewer errors in inpatient medication regimens compared to verification by the admitting physician team.
Methods We performed a prospective cohort study of adult ED patients admitted for continuing care. In the intervention group, medication reconciliation was performed by pharmacy technicians in the ED before the creation of physician admitting orders. In the control group, pharmacy technicians conducted their history taking later, after admission. Initial admitting orders were then compared to the pharmacy technicians' medication reconciliation taken before admission (intervention group) or after admission (control group). Medication discrepancies were classified and determined to be justified or unjustified. Unjustified discrepancies were rated for harm potential.
Results In our cohort of 113 intervention and 75 control subjects, the mean age was 55 years (standard deviation [SD] 16 years); 96 patients (51%) were male. In the intervention group, 566 changes to home medications were observed on admission; 352 (62%) were unjustified. Among controls, 406 changes to home medications were observed; 228 (56%) were unjustified. This difference was not statistically significant (p = 0.0586). The rate of unjustified medication changes per patient was likewise not significantly different (3.14 [SD 2.98] in interventions vs. 3.17 [SD 2.81] in controls; p = 0.9570). The rate of medical errors did not differ between study groups, nor did severity ratings of unjustified changes.
Conclusions Medication reconciliation by pharmacy technicians in the ED did not lead to a significant reduction in unjustified medication discrepancies.
Unintentional medication discrepancies on hospital admission are common, occurring in up to 67% of inpatients. Such discrepancies include interruption of regularly used medications, inconsistent dosing or frequency of a home medications, and provision of incorrect medications that differ from those normally prescribed. A proportion of these medication discrepancies represent errors that have the potential to cause patient harm. As a result, the Joint Commission has made medication reconciliation an important element of its National Patient Safety Goals for hospital accreditation since 2004. Medication reconciliation is the process of systematically identifying the medications a patient is taking at home and comparing them with newly ordered medications in the hospital.
The collection of a complete, verified medication history is essential to the process of medication reconciliation and the prevention of unintentional medication discrepancies. However, obtaining an accurate medication history can be challenging, especially for patients admitted from the emergency department (ED). In these cases, existing difficulties are compounded by extra handoffs, the involvement of multiple health professionals, and transfer of patient care to several different areas of the hospital.
It has been shown that formal medication reconciliation in the ED by a clinical pharmacist before patient transfer reduces prescribing errors compared to standard history taking by junior specialty house staff on the receiving ward. Few studies have evaluated the extent to which pharmacy technicians, who represent a much lower cost to hospitals, can perform in a similar capacity. Likewise, no study has qualitatively examined the ability of pharmacy technicians to reduce medication errors of significant vs. insignificant severity.
In this study, our primary objective was to determine whether verification of medication histories by pharmacy technicians in the ED improved medication reconciliation. We hypothesized that patients whose medication histories were verified by pharmacy technicians in the ED would have fewer errors in their initial inpatient medication regimen compared to patients whose home medications were verified by the admitting physician team, and that these errors would be of lower clinical significance. We also sought to identify and describe the information sources utilized in formal history taking by pharmacy technicians in the ED.
Abstract and Introduction
Abstract
Background The collection of a complete, verified medication history is essential to patient safety. The involvement of clinical pharmacists has been shown to improve the completeness and accuracy of medication histories; however, to our knowledge, involvement of pharmacy technicians has not been studied.
Objective Our aim was to determine whether verification of medication histories by pharmacy technicians in the emergency department (ED) would result in fewer errors in inpatient medication regimens compared to verification by the admitting physician team.
Methods We performed a prospective cohort study of adult ED patients admitted for continuing care. In the intervention group, medication reconciliation was performed by pharmacy technicians in the ED before the creation of physician admitting orders. In the control group, pharmacy technicians conducted their history taking later, after admission. Initial admitting orders were then compared to the pharmacy technicians' medication reconciliation taken before admission (intervention group) or after admission (control group). Medication discrepancies were classified and determined to be justified or unjustified. Unjustified discrepancies were rated for harm potential.
Results In our cohort of 113 intervention and 75 control subjects, the mean age was 55 years (standard deviation [SD] 16 years); 96 patients (51%) were male. In the intervention group, 566 changes to home medications were observed on admission; 352 (62%) were unjustified. Among controls, 406 changes to home medications were observed; 228 (56%) were unjustified. This difference was not statistically significant (p = 0.0586). The rate of unjustified medication changes per patient was likewise not significantly different (3.14 [SD 2.98] in interventions vs. 3.17 [SD 2.81] in controls; p = 0.9570). The rate of medical errors did not differ between study groups, nor did severity ratings of unjustified changes.
Conclusions Medication reconciliation by pharmacy technicians in the ED did not lead to a significant reduction in unjustified medication discrepancies.
Introduction
Unintentional medication discrepancies on hospital admission are common, occurring in up to 67% of inpatients. Such discrepancies include interruption of regularly used medications, inconsistent dosing or frequency of a home medications, and provision of incorrect medications that differ from those normally prescribed. A proportion of these medication discrepancies represent errors that have the potential to cause patient harm. As a result, the Joint Commission has made medication reconciliation an important element of its National Patient Safety Goals for hospital accreditation since 2004. Medication reconciliation is the process of systematically identifying the medications a patient is taking at home and comparing them with newly ordered medications in the hospital.
The collection of a complete, verified medication history is essential to the process of medication reconciliation and the prevention of unintentional medication discrepancies. However, obtaining an accurate medication history can be challenging, especially for patients admitted from the emergency department (ED). In these cases, existing difficulties are compounded by extra handoffs, the involvement of multiple health professionals, and transfer of patient care to several different areas of the hospital.
It has been shown that formal medication reconciliation in the ED by a clinical pharmacist before patient transfer reduces prescribing errors compared to standard history taking by junior specialty house staff on the receiving ward. Few studies have evaluated the extent to which pharmacy technicians, who represent a much lower cost to hospitals, can perform in a similar capacity. Likewise, no study has qualitatively examined the ability of pharmacy technicians to reduce medication errors of significant vs. insignificant severity.
In this study, our primary objective was to determine whether verification of medication histories by pharmacy technicians in the ED improved medication reconciliation. We hypothesized that patients whose medication histories were verified by pharmacy technicians in the ED would have fewer errors in their initial inpatient medication regimen compared to patients whose home medications were verified by the admitting physician team, and that these errors would be of lower clinical significance. We also sought to identify and describe the information sources utilized in formal history taking by pharmacy technicians in the ED.