Effect of Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital Admissions of Elderly Adults: A Multicenter Study

Abstract

Pharmacy-based medication reconciliation leads to a substantial reduction in medication discrepancies in acutely admitted elderly adults.

Expanded Roles for Pharmacy Technicians in the Medication Reconciliation Process: A Qualitative Review

“…First, pharmacy technicians identified medication discrepancies in approximately 25% to 50% of patients, illustrating the widespread problem of medication history inaccuracy. 14,19,21,23,25 Second, many studies reported that it took 15 to 30 minutes per patient for pharmacy technicians to collect a medication history. 14,15,[23][24][25] This estimate is consistent with past reports, 11 further demonstrating that medication reconciliation is a resource-intensive activity.…”

“…They were not included in this review because they focused on workflow process measures, 26 such as whether all the medications listed had a name, dose, and frequency, or contained limited information on how the quality of the pharmacy technician's work was assessed. [27][28][29] Considering all reports of pharmacy technician engagement, several best practices emerged: (a) creating a standardized process for collection of the medication history and defining a specific patient populations, 14,15,21,24,25,27,28 (b) choosing pharmacy technicians with past experience in hospital and community pharmacy settings as well as those who demonstrate good interpersonal, communication, and problem-solving skills, 16,17,25,27 (c) having pharmacy technicians who are dedicated to medication reconciliation efforts, 16,17,[27][28][29] (d) educating the hospital staff regarding the new process and how it may impact and improve their current workflows as well as patient safety, 24,28 and (e) establishing an internal training program for technicians in these roles led by pharmacists and/or experienced pharmacy technicians. Training programs generally included an education component (either didactic or through background reading and discussion), training on how to complete medication reconciliation or compile a BPMH, observation of a medication reconciliation interview completed by a pharmacist or pharmacy technician, practice or completion of a medication reconciliation interview while being observed, and finally a competency assessment.…”

“…In the Netherlands, for example, pharmacy technicians are trained in medication preparation, dispensing, patient education, and medication reconciliation. 21 In Denmark, pharmacy technicians receive 3 years of formal education that includes both a didactic and experiential component, and they are allowed to complete select medication interventions while collecting the BPMH. 24 Differences in health care systems also impact access to information.…”

“…Training programs generally included an education component (either didactic or through background reading and discussion), training on how to complete medication reconciliation or compile a BPMH, observation of a medication reconciliation interview completed by a pharmacist or pharmacy technician, practice or completion of a medication reconciliation interview while being observed, and finally a competency assessment. [14][15][16][17]21,24,25,[27][28][29] Some programs have also incorporated quality assurance audits and observed interviews that take place throughout the year. 27 One study identified did not demonstrate a decrease in the rate of unjustified medication discrepancies among patients who had their medications verified before admission by a pharmacy technician as compared to the admitting team.…”

“…The study concluded that a pharmacy-based medication reconciliation program reduced medication discrepancies in acutely admitted elderly patients. 21 The final study evaluated whether verification of medication histories by pharmacy technicians in the ED could decrease errors in initial inpatient medication regimens at an academic medical center (University of North Carolina Hospitals, Chapel Hill, NC). Hospital admission orders were compared to a pharmacy technician-obtained medication histories that were collected before admission (intervention) or after admission (control) and the discrepancies were classified as justified or unjustified.…”