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Medication Reconciliation in the Emergency Department: Technician Expansion

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A Catholic healthcare ministry serving Ohio and Kentucky

Objectives

• Describe the implementation of a pharmacy technician into the medication reconciliation process

• Present data on the technician interventions and expansion of emergency medicine pharmacy services

• List the preparation process for the med rec technician

ED Pharmacy Services

• October 2013, clinical pharmacists began providing services in the ED on second shift for 7 day coverage of the department

• Drug information; therapy recommendations; participate in emergency responses; medication reconciliation; operations support

• Medication reconciliation technician began as a pilot project in February 2014

• New job description and responsibilities as part of Technician Career Ladder• Hours of coverage 8am -1:30pm; then 2pm-4:30pm for CC support

• APPE students began rotations in the ED starting April 2014• 1-2 students monthly on rotations• Integrated into activities with pharmacist supervision on second shift

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ED Technician Process• Identify patients to be admitted from the ED

• Interview and discuss home medications with patient• Use family, pharmacies, ECFs, PCPs, etc. as needed

• Identify correct drug, dose, route and frequency as well as last dose taken if able

• Obtain or confirm outpatient pharmacy

• Clarify allergies*

• Enter Med Rec i-vent into Epic for review by pharmacist 4

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Expansion of Pharmacy Services Project

• This project was designed to review the impact provided by these additional personnel in newly expanded roles within the ED as well as to see how their support can impact the services provided by the ED pharmacists themselves

• Review project from January 2014 through April 2014

• Data compiled and project submitted as abstract for a poster at ASHP Midyear 2014

• “Impact of pharmacy extenders on providing emergency medicine pharmacy services”

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Methods of project

• Interventions titled as “medication reconciliation” were reviewed during a time period that included ED services provided by the pharmacists alone, the pharmacists and technicians, and the pharmacists, technicians, and a student

• The types of interventions made by the pharmacist in addition to “medication reconciliation” were also reviewed for this time period to determine if the additional support allowed the pharmacist to redirect their attention to other clinical interventions

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Additional RPh Interventions

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Non-Medication Reconciliation Interventions(Performed by Pharmacist)

• Code/Trauma

• Antibiotic stewardship

• Recommend dose change

• Recommend drug initiation

• Recommend drug discontinuation

• Patient counseling

• Recommend drug therapy change

• Pharmacy consult

• Allergy clarification

• PK evaluation

• Drug therapy evaluation

• Drug-drug interaction evaluation

• Drug information

• Other

Project Results

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Month Pharmacy Personnel

Medication ReconciliationInterventions

Non-MedicationReconciliation Interventions

Total Interventions

January Pharmacist 186 30 216

February Pharmacist, technician

279 40 319

March Pharmacist, technician

291 43 334

April Pharmacist, technician,

student

500 64 564

Additional Quality Project

  Total-July 2014 Avg per dayTime spent in ED (h) 79 4.6Number of patients 131 7.7

Avg number of meds per patient 11.4 n/aOmitted medications 304 17.9

Wrong strength 93 5.5Wrong dosage form 45 2.6Wrong instructions 102 6.0Duplicate meds 19 1.1D/c medications 111 6.5

Correct med history 7 0.4Unable to complete 3 0.2

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Technician interventions

Additional Quality Project

  Total-July 2014 Avg per dayTime spent in ED (h) 76.5 5.1Number of patients 91 6.1

Avg number of meds per patient 11.6 n/aOmitted medications 117 7.8

Wrong strength 30 2Wrong dosage form 0 0Wrong instructions 25 1.7Duplicate meds 2 0.1D/c medications 95 6.3

Correct med history 13 0.9Unable to complete 0 0

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Student interventions

Technician Preparation

• Provided a technician specific binder• Discusses step-by-step the med rec process: How to…What needs to be

collected…etc.• Includes screen shots of Carepath to assist with direction• Contact information for local pharmacies, home health agencies, ECFs, and

PCPs

• Trained in real-time on a collaborative care unit• Observed pharmacist perform medication history initially• Transition to technician performing med history with pharmacist observation• When comfortable technician to perform med history on own

• Playground version of Carepath available to work through patient profile—not indicative of live environment for making changes

• Techs training techs12

Questions?

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