Use of Pharmacy Technicians to Reconcile Patients’
Ryan D. Michels, Pharm.D. and Steven Meisel, Pharm.D.
Fairview Southdale Hospital
The problem of ensuring that patients appropriately continue
on their home medications upon admission to the hospital is
one that has long challenged health-care professionals. This
is especially concerning the surgical population since surgeons
are typically not the original prescribers of the drug therapy
and are often unfamiliar with the drugs and doses. Considerable
time and effort is associated with clarification of inaccurate/incomplete
orders, which results in pharmacy and nursing staff dissatisfaction.
To reduce potential adverse events by at least 80% and improve
staff satisfaction, we implemented a pilot program utilizing
pharmacy technicians for transitioning outpatient medications
to active inpatient orders.
Prior to technician involvement, a hospital policy was instituted
that prohibited the use of blanket orders, such as "continue
home medications," and a specialized order form was created
that serves as both a place to record medication histories
and for physician ordering of home medications. Pharmacy technicians
were then deployed in the surgical admissions area. Their
primary responsibility was to record complete medication histories,
including medication name, dose, route, frequency, and any
special instructions onto the ordering form. The majority
(~75%) of patients were telephoned 1-2 days before surgery,
with the remaining patients seen in a face-to-face interview
immediately prior to their procedure. The medication histories
were reviewed by a clinical pharmacist who identified and
resolved any concerns or discrepancies. The completed order
form was then placed in the chart for the surgeon to review
and decide whether or not to continue each medication during
the hospital admission.
After three months of technician presence in the surgical
admissions department, the number of order errors per patient
decreased from 1.5 to 0.26 (a reduction of 82.7%) and the
number of errors per order decreased from 0.25 to 0.04 (a
reduction of 84.0%). Staff satisfaction was assessed using
anonymous evaluation forms that were distributed before technician
involvement and again four months into the project. Global
pharmacy and nursing staff satisfaction increased from 1.7
to 3.4 (100%) and 2.0 to 2.8 (40%), respectively. Staff consistently
felt that the process was safer, more accurate, and more efficient.
Anecdotal feedback suggests that surgeons are pleased with
the improvements and also that the job satisfaction of the
technicians involved has increased.
Using pharmacy technicians for obtaining medication histories
in the surgical admissions department has exceeded our goal
of reducing potential adverse drug events by 80%. Based on
this reduction and overall improvement in staff satisfaction,
hospital administration has authorized the pilot program be
made permanent. We are currently developing plans to expand
this model to other areas of the hospital where patients are
admitted through other portals, such as the emergency department,
as well as other hospitals within this health system.