Use of Pharmacy Technicians to Reconcile Patients’ Home Medications

Ryan D. Michels, Pharm.D. and Steven Meisel, Pharm.D.

Fairview Southdale Hospital

Edina, Minnesota

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.