Bilingual Pharmacy Technician Medication Reconciliation at Hospital Admission Reduces Omissions of Prescribed Medications
Kim Luong-Schwab, Pharm.D., BCPS, Lara Gillian, Pharm.D., Ronald A. Floyd, Pharm.D., FCCP, BCPS, Blair Frater, Pharm.D., Elaine Levy, Pharm.D.
Sharp Chula Vista Medical Center, Chula Vista, and Sharp Mary Birch Hospital for Women, San Diego, California.
Having an accurate and comprehensive medication history in the medical record on admission directly impacts patient care. The purpose of this study was to implement and evaluate a systematic process to reconcile patients’ medications on hospital admission. One necessary step in accomplishing this was to clearly communicate with the large segment of patients who use Spanish as their primary language.
The standard of practice for medication history collection on admission had relied solely on physicians and nurses who are overburdened. Patients who are Spanish speaking frequently receive care from non-Spanish speaking providers. A medication history form was developed and pharmacy technicians bilingual in English and Spanish were trained in using it to obtain comprehensive medication histories. Physician, nurse and pharmacy technician medication reconciliation discrepancy rates were compared. In addition, changes made in medication orders after placement of the technician medication history in the chart were tracked.
Between August 2005 and March 2006, 478 patients were enrolled; 152 patients met inclusion criteria and agreed to participate in the study. Three hundred twenty six patients were excluded for: use of fewer than 4 medications, 137; on 23 hour hold, 31; having a complete and legibly written medication list or medication bottles, 53; and refused participation, 105. Within 24 hours of admission, a trained pharmacy technician interviewed the patient, obtained the approval of the supervising pharmacist, and then placed the completed medication history form in the medical record. Medical records of all eligible patients were reviewed by a pharmacy resident for demographic data collection, quantification of medications that should have been listed on the admission medication history and discrepancies among the providers of medication histories.
The average patient was 68 years old and, of the 152 patients, 86 were female. About 55% of patients listed English as their primary language, 41% listed Spanish, and the rest listedTagalog. Overall, the average total number of medications identified (ATNOMI) did not differ between unit nurses and emergency department nurses, 3.9 and 5.1, respectively. The ATNOMI, likewise, did not differ among physicians, pharmacy technicians and the pharmacist comparator at 6.7, 7.6 and 7.8, respectively. The difference between the nursing groups and the physician and pharmacy groups was statistically significant. Differences between the average numbers of reconciled medications among the provider groups followed the same pattern and were also statistically significant. Another method used to determine if the information generated by the pharmacy technician was useful was to track medications ordered by the physician based on this history. The average number of medications added by the physician after the pharmacy technician medication history sheet was available was 1.4 which was a statistically significant difference from zero.
Medication errors on admission, predominantly errors of omission, can be reduced with the implementation of a structured medication reconciliation process using bilingual pharmacy technicians.
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