Orlando, Fla.—Emergency department (ED) pharmacy technicians from several hospitals received praise at the American Society of Health-System Pharmacists 2013 Midyear Clinical Meeting for conducting medication reconciliations with up to 96% accuracy. The studies found that pharmacy technicians were able to detect a substantial number of errors included in ED nurse-obtained medication histories, heading off costly and harmful adverse events.

“Our program has been so successful that our technicians are often called to floors to obtain home medication lists for direct admissions,” said Colleen Teevan, PharmD, an ED clinical pharmacist at The Hospital of Central Connecticut (THOCC), in New Britain (poster 5-148).

Dr. Teevan said the 22,000 patients admitted annually through THOCC’s ED more than justified hiring seven pharmacy technicians to provide around-the-clock medication reconciliation services and an ED pharmacist to verify the accuracy of their work. Between late 2012, when the program was launched, and late 2013, the pharmacy technicians conducted more than 25,000 ED medication reconciliations, averaging roughly 250 per week. Documentation from the ED pharmacist who approved each list demonstrated that technians were accurate 96% of the time.

That number stands in contrast to the 66% accuracy rate for medication lists gathered by other ED health care providers at THOCC, noted Dr. Teevan.

“Having technicians document home medications using a structured approach ensures the same level of quality and completeness for every patient,” she said, referring to a checklist used by the ED pharmacy technicians (see sidebar below) that has helped standardize the medication reconciliation process. “Practically nothing is missed, even during busy times, and the admitting team can rely on the quality of information they are receiving.”

Nearly $1 Million Saved

An ED pharmacy technician at St. Vincent’s Medical Center-Riverside, in Jacksonville, Fla., also has been scrupulous in detecting and correcting errors in nurse-obtained medication histories, helping avoid nearly $1 million in annual adverse event–related costs (poster 5-202).

Katherine Kamataris, PharmD, an emergency medicine pharmacist at St. Vincent’s Medical Center-Riverside, and her colleagues reviewed medical records from 300 patients admitted through the hospital’s ED between October 2012 and February 2013, after the pharmacy technician-conducted medication reconciliation service was initiated in June 2012. Patients included had been interviewed by a nurse at ED presentation as well as by a technician at the time of hospital admission, Dr. Kamataris noted. ED admissions outside of the specific technician’s 40-hour workweek were not included.

According to Dr. Kamataris, the pharmacy technician found and corrected 981 discrepancies in 70.7% (212 of 300) of medication histories compiled by nurses during the study period. (The Table presents the types of errors found.)

Table. Frequency of Errors in Nurse Medication Lists at St. Vincent’s Medical Center
Category of Discrepancy Discrepancies
(N = 981)
Patients With Particular Discrepancy Type, %
(N = 300)
Omitted medication 267 42.0
Omitted frequency 212 46.2
Omitted dose 157 47.6
Discontinued medication 117 31.1
Incorrect frequency 89 30.2
Incorrect dose 67 22.6
Omitted route 50 10.4
Incorrect formulation 12 5.2
Incorrect drug 9 3.8
PRN with no indication 1 0.5
PRN, as needed

Nurses were most likely to err in documenting cardiovascular medications, she reported, with 52% of all cardiovascular drug entries in nurse histories containing one or more inaccuracies. Nurse-obtained history entries contained errors for the following additional drug types: pain relievers and muscle relaxants, 38.2%; gastrointestinal medications, 27.8%; anxiolytics, sedatives and hypnotics, 19.3%; and psychiatric medications, 13.2%.

Because the study only included ED-admitted patients interviewed by both the pharmacy technician and nurses, Dr. Kamataris estimated the number of errors nurses made in their medication lists over 12 months is closer to 14,700. Based on a conservative assumption that 3% of those errors would have resulted in an adverse event, she said pharmacy technicians helped avoid an estimated $962,543 in error-related treatment costs.

“Given how helpful the [pharmacy technician] medication reconciliation program has been in increasing patient safety and avoiding costs, we believe it would be beneficial to include the service for all admissions,” Dr. Kamataris said.

Techs Versus Nurses

Pharmacy technicians at Morton Plant Hospital, in Clearwater, Fla., have proven vastly more accurate than nurses in documenting use of high-risk antiplatelet and anticoagulant medications, according to Coleen Hart, PharmD, formerly a postgraduate year 1 pharmacy resident there (poster 3-073).

Dr. Hart reviewed 150 medication lists created by ED nurses between November 2011 and February 2012, and the same number of technician-conducted admission medication reconciliations, checking them both against clinician notes and hospital pharmacy prescriptions.

She found that, in recording the last time patients had been administered an anticoagulant or antiplatelet, nurses were accurate only 13% of the time, whereas pharmacy technicians were correct in 76% of cases in their medication reconciliations (P<0.001).

The potential consequences of such errors could be dire, Dr. Hart noted. “If a patient were to have a scheduled or unscheduled surgical procedure too soon after they received their anticoagulant and it had not been clearly documented, they could potentially have a serious or life-threatening bleed,” she said.

Dr. Hart added that the results of the study were all the more surprising, given the fact that pharmacy technicians were often asked to do medication histories on the more complicated patients. “As a result, we might expect that the technician group would make more errors,” she said. “However, the [overall] data actually showed the opposite. Despite having more complicated patients, 88% of the time the technician group had completely accurate medication histories vs. only 57% of the time by nurses” (Figure).

Figure. Accuracy of medication lists obtained by pharmacy technicians

Nurses Welcomed the Help

Dr. Hart’s report had the potential to anger ED nurses, who may have felt the results questioned the quality of their work. However, a survey Dr. Hart distributed to 27 of the ED nurses suggested otherwise. “All of the nurses said they would be happy if [pharmacy technicians] conducted every ED medication reconciliation and that it would leave them with more time to attend to other duties.”

Caryl Ann Mannino, BSN, RN, the director of Professional Practice/Magnet Project Director at Our Lady of Lourdes Memorial Hospital, in Binghamton, N.Y., is an expert on the role of nurses in the medication reconciliation process. She said her hospital has not formally compared the accuracy of nurse- and technician-conducted medication histories but, “from anecdotal comments and incidental medical record reviews,” there are more omissions, wrong doses and wrong frequencies in medication histories collected by nurses.”

Those errors are not surprising, Ms. Mannino noted. “Nurses are constantly interrupted, have multiple foci and are often multi-tasking, whereas a [medication reconciliation technician] is focused on this one task—[medication reconciliation],” she said. Such technicians “have the time to contact external sources such as retail pharmacies and provider offices, while nurses most often rely on information provided by patients or [in their] records.”

A Technician’s Med Rec Checklist

From The Hospital of Central Connecticut
  1. Introduce yourself as a pharmacy staff member and inquire as to the reason for the patient’s visit
  2. Ask about and record allergies and reactions to:
    • Medications
    • Foods
    • Other
  3. Record patient’s preferred pharmacy
  4. Record name of patient’s primary care physician (PCP); communicate PCP’s name to admitting department
  5. Obtain and record patient’s height and weight
  6. Obtain medication history from any external pharmacies used.
  7. Obtain patient’s medication list and last doses. Ask specifically about:
    • Prescription medications
    • Blood thinners (dabigatran [Pradaxa, Boehringer Ingelheim], rivaroxaban [Xarelto, Janssen], warfarin, aspirin)
    • Eye drops
    • Pain relievers
    • Patches
    • Inhalers
    • Creams or ointments
    • Any recent antibiotics
    • Sleep aids
    • Insulin or other injectables
    • Vitamins, supplements, or herbal medications
    • Anything taken once a week or once a month
    • Over-the-counter medications
    • Medication pumps (internal/external)
  8. Call pharmacy/nursing home/etc., as needed for clarification
  9. Communicate any issues to providers

None of the researchers reported any relevant financial conflicts of interest.