Improving best possible medication history with vulnerable patients at an urban safety net academic hospital using pharmacy technicians

Abstract

BackgroundBest possible medication history (BPMH) enhances the care of safety net patients, especially those with limited English proficiency and limited health literacy who are most vulnerable to medication error during the hospital admission process. Our large urban academic safety net centre faced numerous barriers to achieve BPMH among hospitalised patients including communication barriers that increase the time and complexity of eliciting BPMH, frequent provider turnover at our training institution and lack of an electronic health record (EHR) medication reconciliation tool to facilitate BPMH collection and monitoring.DesignLeveraging opportunities afforded by the US federal incentive EHR programme, our multidisciplinary team designed an EHR-facilitated medication reconciliation programme by which pharmacy technicians engaged newly admitted patients and their caregivers at the bedside to develop and electronically document the BPMH.StrategyPrior to this intervention, pharmacy technicians had no role in BPMH. Providers collected home medications documented on paper notes without a consistent methodology. With each plan–do–study–act (PDSA) cycle since the programme began, the goal was to increase the per cent of BPMH completed by a pharmacy technician. Individual PDSA cycles targeted either the pharmacy technicians by expanding their pool of eligible patients or provider engagement with the pharmacy technician workflow.ResultsBy optimising not only the health information technology platform but also the operational processes, the programme achieved a nearly 80% generation of BPMH completed by a highly trained pharmacy technician, surpassing its intended goal of 50% BPMH completion by a pharmacy technician on admission.ConclusionAn EHR-facilitated tool improved BPMH at an urban academic safety net hospital using pharmacy technicians.

Medications and patient safety in the trauma setting: a systematic review

“…Several other factors were attributed to these inaccuracies such as poorly informed patients, multiple pharmacy use by a single patient, medication samples obtained from physician’s offices, mail order prescriptions, Internet prescriptions, the number of medications, age of 65 or older, and emergent admission [18, 19]. These data from trauma patients are consistent with reported rates in general medical patients [3–8, 15, 16, 21, 26].…”

“…Various strategies have been reported to improve accuracy of medication reconciliation including using pharmacists and pharmacy technicians, additional training, creation of mandatory sections of the electronic medical record (EMR), or using checklists to conduct the process [4, 13, 15, 27]. Some of these interventions, such as hard stops in the EMR, however, may not apply to trauma patients as they might interfere with the emergent care of trauma patients.…”

“…Hiring additional pharmacy technicians and pharmacists with 24-h a day, 7-day a week coverage is an expensive solution that may not apply to all facilities. Even with addition of expert staff, the process still remains very time consuming because it requires validating a patient’s medications with their various pharmacies and physicians for true accuracy, and therefore, addition of staff alone may not be enough in a trauma setting [13, 15]. Pharmacists in the Miller et al study took on average 3 days post-trauma (range 1–8 days) to complete the medication reconciliation, with a median duration of 2 days [18].…”

“…In the general medication reconciliation literature, it took pharmacy technicians on average 23 min to provide a complete medication reconciliation in a study of over 11,000 non-trauma patients. However, these were completed in only 21% of patients before admission orders were placed [15]. If this same evaluation was applied to trauma patients, this percentage would most likely be even lower given the acuity of care.…”

“…Medication reconciliation involves obtaining an accurate list of medications, including dosage, route of intake, frequency, and adherence and then updating the medical record with these medications [11]. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated medication reconciliation throughout the continuum of healthcare in their 2006 National Patient Safety Goals, but it can be difficult, time-consuming, inaccurate, and costly [12–15]. An admission medication reconciliation requires time—on average 58.4 min with a cooperative patient—and costs a minimum of $55.91 per patient for a pharmacist to complete [13].…”