Medication reconciliation is crucial for patient safety. Patients are often uncertain of the medications they are taking and physicians may not have time to take thorough medication histories. A pharmacy technician (PT), by conducting structured patient interviews and calling outpatient pharmacies, would be a new means by which to obtain important information on patients’ medication histories, information that may improve safety of inpatient medication ordering. The purpose of our study was to quantify discrepancies between different sources of medication history and to compare potential adverse drug events (PADEs) before and after a PT’s information was available to providers.
For each patient on a hospital medicine service, a PT conducted a patient interview for medication history and obtained a medication list from the outpatient pharmacy. We quantified discrepancies between the provider’s History and Physical (which was always written without access to the PT’s information and is thus a unique source of information), the pharmacy data, and the patient’s medication history per the PT’s interview. Discrepancies were categorized as omissions, dose discrepancies (DDs), or frequency discrepancies (FDs). Information from the PT was not available at all to providers for the patients in the pre‐intervention group, but was available to providers for the patients in the post‐intervention group after the H&P had been written; we looked at admission orders to compare the number and severity of PADEs between the two groups.
Compared to the pharmacy, the H&P omitted 26.6% of medications, 13.4% of medications had DDs, and 5.7% of medications had FDs. Compared to the PT’s patient interview, the H&P omitted 13.6% of medications, 10.6% of medications had DDs, and 8.2% of medications had FDs. Compared to the pharmacy, the PT’s patient interview omitted 21.0% of medications, 6.7% of medications had DDs, and 8.9% of medications had FDs. Once PT information was available to providers, the percentage of patients with PADEs decreased (83% to 59%, p=0.04), there was a trend towards reduction in total number of PADEs (47 to 35, p=0.07), and overall severity of PADEs decreased (p=0.09; number of serious PADEs: 5 to 0).
There are many discrepancies among all three information sources, demonstrating that no one source sufficiently captures all medication information. The PT adds important new information, as both the pharmacy data and the patient interview are quite different from the H&P. Finally, the PT appears to improve the safety of medication ordering upon admission. The PT might be worth pursuing as a novel means by which to achieve better medication management.
To cite this abstract:Waraich A, Beuningen A, Eakin M, Record J. A New Role for Pharmacy Technicians in Medication History Taking and Management. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 87. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/a-new-role-for-pharmacy-technicians-in-medication-history-taking-and-management/. Accessed May 21, 2019.