A Prospective Cohort Study of Medication Reconciliation Using Pharmacy Technicians in the Emergency Department to Reduce Medication Errors among Admitted Patients

Cater, Sarah Wallace; Luzum, Matthew; Serra, Allison E.; Arasaratnam, Meredith H.; Travers, Debbie; Martin, Ian B.K.; Wei, Trent; Brice, Jane H.

doi:10.1016/j.jemermed.2014.09.065

Cited by 24 publications

(41 citation statements)

References 15 publications

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“…study showing that pharmacists and pharmacy technicians were both equally effective in eliciting the best possible medication histories at hospital transitions. In the contrary, a recent prospective cohort study comparing pharmacy technicians with admitting physicians did not show a significant reduction in unintentional medication discrepancies.…”

Section: Discussionmentioning

confidence: 71%

Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis

2016

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Summary What is known and objective Medication reconciliation is recognized as an important tool for the prevention of medication discrepancies and subsequent patient harm at care transitions. However, there is inconclusive evidence as to the impact of medication reconciliation at hospital transitions overall, as well as pharmacy‐led medication reconciliation services. This review sought to evaluate the impact of pharmacy‐led medication reconciliation interventions on medication discrepancies at hospital transitions and to categorize these interventions as single transition interventions or multiple transitions interventions. Methods PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO databases, inclusive from inception to December 2014, were searched. Included studies were published studies in English that compared the effectiveness of pharmacy‐led medication reconciliation interventions to usual care and that aimed to assess medication discrepancies at hospital transitions. ‘Usual care’ was defined as any care where targeted medication reconciliation was not undertaken as an intervention, or if an intervention was conducted, it was not provided by a pharmacist/pharmacy technician. Results and discussion Nineteen studies which involved a total of 15 525 adult patients were included. Eleven studies were randomized controlled trials. Overall, pharmacy‐led medication reconciliation intervention usually revealed a trend towards reduction in medication discrepancies, compared with usual care. Seventeen studies involving 18 medication reconciliation interventions targeting the various transitions (admission, 9; discharge, 4; and multiple transitions, 5) were included in the meta‐analysis. Compared with usual care, single medication reconciliation interventions at transitions in care (either admission or discharge) showed a significant reduction of 66% in patients with medication discrepancies (RR 0·34; 95% CI: 0·23–0·50) in favour of the intervention. There was no difference between groups for interventions targeting multiple transitions (RR 0·88; 95% CI: 0·77–1·02). Subgroup analyses confined to RCTs showed that there were no differences for target of transition (admission vs. discharge), type of intervention (multifaceted intervention vs. medication reconciliation) and setting (single centre vs. multicentre), nor pharmacists vs. pharmacy technicians (non‐RCTs only). Importantly, medication discrepancies of higher clinical impact were more easily identified through pharmacy‐led interventions than with usual care. What is new and conclusion Pharmacy‐led medication reconciliation interventions were found to be an effective strategy to reduce medication discrepancies, and had a greater impact when conducted at either admission or discharge but were less effective during multiple transitions in care. Further studies that are designed to assess the impact of the involvement of pharmacy technicians in medication reconciliation are also needed.

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Section: Discussionmentioning

confidence: 71%

Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis

2016

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“…Consequently, organizations such as the World Health Organization and the Joint Commission support pharmacists in lead roles during the medication reconciliation processes 7,8. In addition, studies have shown that under pharmacist supervision, medication histories obtained by pharmacy technicians are significantly more accurate than those collected by other healthcare professionals 6,9,10,11…”

Section: Introductionmentioning

confidence: 99%

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

Kraus

Sen

Murphy

et al. 2017

Pharm Pract (Granada)

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Objectives:To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations.Methods:A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05.Results:Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours.Conclusion:A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

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“…Pharmacy technicians and other support personnel can help obtain and organize relevant patient data for assessment by the clinical pharmacist in both direct patient care and population health initiatives. Many examples involving pharmacy technicians in the medication reconciliation process exist, 34,35,58,59,[63][64][65][66][67][68][69][70][71] and successful examples are available in a wide range of practices and settings, including emergency departments, 59,[63][64][65][66]72 pediatrics, 67 geriatrics, 68 hemodialysis units, 69 mental health, 70 and academic medical centers 58 and in preoperative screenings. 71 Medication histories from certified technicians are at least as accurate as medication histories from other members of the health care team.…”

Section: Assessment Of the Patientmentioning

confidence: 99%

“…This includes using a set of criteria that tracks adherence to care standards, which subsequently helps identify high-risk patients who might benefit from pharmacy services, 33,43,73,74 and collecting designated laboratory data for pharmacist review. 48,72,74 Other population health initiatives include reviewing adherence data and quality measure performance. 47…”

Section: Assessment Of the Patientmentioning

confidence: 99%

Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care

Borchert

Phillips

Bastin

et al. 2018

J Am Coll Clin Pharm

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Changes to the U.S. health care landscape have increased the focus on the quality and use of alternative payment models, with a growing focus on value. As health care costs continue to rise, clinical pharmacists will increasingly engage in roles to expand the breadth and depth of clinical services in providing comprehensive medication management (CMM) to improve patient outcomes. The roles of pharmacy technicians and other support personnel must evolve to meet the needs created by this practice change and allow pharmacists to focus their services on activities that use their expertise to improve medication outcomes. Support personnel, including pharmacy technicians, should be identified to assist with clinical pharmacy tasks on the basis of their skills. To ensure competence, support personnel should be adequately trained and (if applicable) certified. Moreover, support personnel should be optimally incorporated into appropriate components of the clinical pharmacist's process of care to expand the reach and depth of clinical pharmacy services. When supervised by the pharmacist or others as defined in state practice acts, support personnel may be able to assist in the clinical pharmacist's provision of CMM. Finally, research should be conducted and disseminated on the utility and outcomes achieved using support personnel in the clinical pharmacist's process of care.

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A Prospective Cohort Study of Medication Reconciliation Using Pharmacy Technicians in the Emergency Department to Reduce Medication Errors among Admitted Patients

Cited by 24 publications

References 15 publications

Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis

Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care

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