Expanded Roles for Pharmacy Technicians in the Medication Reconciliation Process: A Qualitative Review

Abstract

A ccording to the Institute of Medicine, the average hospitalized patient experiences at least one medication error per day.1 It is further estimated that 67% of admitted patients have at least one error in their medication history, with 11% to 59% of those classified as clinically important.2 At a cost of $2,595 to $4,685 per adverse drug event (ADEs), the total costs attributable to ADEs have been estimated to exceed $5 million annually for a typical teaching hospital. 3Findings from these studies as well as others have led the health care community, professional organizations, and regulatory entities to demand more structured processes for comparing medication histories and resolving discrepancies during care transitions. [4][5][6] A key component to medication reconciliation is the creation of the best possible medication history (BPMH). The BPMH uses information gathered from the community pharmacy, medical record, structured ABSTRACT Background: Collection of a complete and accurate medication history is an essential component of the medication reconciliation process. The role of pharmacy technicians in supporting medication reconciliation has been the subject of recent interest. Purpose: The purpose of this article is to review the existing literature on pharmacy technician involvement in the medication reconciliation process and to summarize outcomes on the quality and accuracy of pharmacy technician-collected medication histories. Method: A literature review was conducted using MEDLINE and Academic Search Premier (1948( -April 2015. Results: Sixteen papers were identified, with 12 containing a formal evaluation of outcomes. Three were purely descriptive, and 9 compared the pharmacy technician's performance to pharmacists, nurses, physicians, and/or interdisciplinary teams. Studies used a variety of endpoints, but they demonstrated similar or improved outcomes by engaging pharmacy technicians. Evidence demonstrates that trained pharmacy technicians are able to gather medication histories with similar completeness and accuracy to other health care professionals. Conclusion:The use of pharmacy technicians may be a viable strategy for developing and expanding medication reconciliation processes with appropriate supervision. Future efforts should focus on evaluating the impact of expanded roles for pharmacy technicians in the health care system; assessing the need for standardization of pharmacy technician education, training, and certification; and obtaining clarification from state pharmacy boards regarding these expanded roles.

Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study

“…This finding underlines the importance of a dedicated training programme for pharmacy technicians on how to obtain a BPMH which includes practical elements such as role-playing exercises, as stated in other studies. 25 33 Our findings suggest that for some pharmacy technicians, direct patient interaction may be too close and that not all pharmacy technicians may be equally willing and apt to deal with these challenges. This is an aspect that should be considered when recruiting pharmacy technicians for these tasks.…”

“…Choosing pharmacy technicians who demonstrate good interpersonal, communication and problem-solving skills has been identified as one of the best practices when engaging pharmacy technicians in medication reconciliation efforts. 25 The situation for pharmacy technicians in our study is different when they are interviewing elective patients at admission, who are generally stable and not in urgent need for medical care. In this case, the neutral space of the admission booth may convey a sense of distance and better control of the situation.…”

“…Evidence from numerous studies demonstrates that trained pharmacy technicians are able to gather medication histories with similar completeness and accuracy to other healthcare professionals. 25 26 One study found that, compared with non-pharmacy personnel, pharmacy technicians had an absolute risk reduction of 50% in medication history errors. 27 A three-arm randomised controlled study found that when adding a best possible medication history (BPMH) by either pharmacy technicians or pharmacists to usual care processes, errors in the admission history were reduced by over 80%.…”

Perceived roles of independent community pharmacists and pharmacy technicians in patient referrals to community resources: A Study from the Medication Safety Research Network of Indiana (Rx‐SafeNet)

“…As pharmacist roles have expanded into direct patient care services, optimizing the utilization of pharmacy technicians and other support staff has been a commonly cited consideration . Available literature demonstrates the positive impact on patient care and safety when incorporating community pharmacy technicians into more direct patient care processes, and a recent white paper outlines “best practices” for engaging these personnel in ways which support pharmacist provision of patient care services . Examples of these best practices include ensuring appropriate certification and training of support staff and incorporating support staff into appropriate parts of the PCPP.…”

Comparison of pharmacy technicians’ and doctors’ medication transcribing errors at hospital discharge

“…Hospital pharmacy technicians often work on wards to support clinical pharmacists, and their roles in the UK have expanded with the final accuracy checking of dispensed prescriptions, and completion and documentation of medication histories,6 where their accuracy in completing medication histories has been reported as effective as pharmacists and other healthcare professionals 7 8…”