Comparison of pharmacy technician versus nurse obtained medication histories in the emergency department Marija Markovic, Pharm.D. PGY-1 Pharmacy Practice.

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Presentation transcript:

Comparison of pharmacy technician versus nurse obtained medication histories in the emergency department Marija Markovic, Pharm.D. PGY-1 Pharmacy Practice Resident Monmouth Medical Center Long Branch, New Jersey

Introduction The emergency department (ED) environment creates numerous challenges in obtaining an accurate medication history1 Critically ill patients, high turnover Nurses - multiple patients, tasks, interruptions Patient characteristics Poor medication histories lead to poor medication reconciliations2 Adverse drug events Increased lengths of stay Discharge confusion Australas Emerg Nurs J. 2014; 17:167-75. Eur J Intern Med. 2013; 24:530-5.

Background 2008 - ASHP statement supports pharmacy services in ED3 Studies show pharmacy technicians may be more effective than nurses and physicians (and comparable to pharmacists) at performing accurate and complete medication histories4,5,6 April 2015 - Monmouth Medical Center hired a pharmacy technician to obtain detailed medication histories in emergency department patients Am J Health Syst Pharm. 2008; 65:2380-83 P&T. 2015; 40(1):56-61. Ann Pharmacother. 2009; 43:868-74. Can J Hosp Pharm. 2010; 63(5):359-65.

Study Objectives Primary Objective Compare the error rate of the pharmacy technician to nursing staff Secondary Objectives Categorize discrepancies by type Categorize discrepancies by therapeutic drug class Describe the ED pharmacy technician workflow

Methods Compare pharmacy technician to ED nurse Retrospective chart review by PGY-1 pharmacy resident 50 patients; July – October 2015 Compare pharmacy technician to ED pharmacist Real-time observation and intervention by ED pharmacist 50 patients; March 2016 ED workflow description Observation and staff interview by PGY-1 pharmacy resident

Methods Approved by the institutional review board Inclusion criteria At least 18 years old Taking at least one medication Exclusion criteria Psychiatric emergency screening service (PESS) Incomplete electronic documentation Admitted to ED outside of pharmacy technician work shift Statistical analysis Continuous data: Student’s t-test Categorical data: Fischer’s exact test

Methods Data collection All data was recorded without identifiers Discrepancy category: Missing or additional medications Duplicates Wrong or missing doses Wrong or missing frequencies Wrong or missing formulations Therapeutic drug class: 12 distinct categories plus “other”

Results Table 1. Baseline characteristics RN-PT PT-RPh P-value Total medications 474 521 N/A Medications per patient, mean (+SD) 9 (4.0) 10 (7.1) 0.416 Mean age, years (+SD) 66 (15.9) 61 (14.6) 0.154 Males, n (%) 22 (44) 20 (40) 0.840 Admitted to hospital from ED, n (%) 35 (70) 0.0046 PT = pharmacy technician, RPh = pharmacist, RN = nurse

Results Table 2. Number of medications and errors RN-PT PT-RPh P-value Total medications* 474 521 N/A Number of histories with error, n (%) 50 (100) 18 (36) < 0.0001 Medications with error, n (%) 408 (86) 30 (5.6) < 0.0001 *Number of medications in final medication list PT = pharmacy technician, RPh = pharmacist, RN = nurse

Results RN-PT: n=502 PT-RPh: n=30 13.3% 16.7% 63.3% 17.9% 17.9% 21.7% Number of errors

Results Table 3. Errors by therapeutic drug class Cardiovascular RN-PT PT-RPh Cardiovascular 100 (24.5)* 2 (6.7) Vitamins 75 (18.4) 4 (13.3) Neurologic/psychiatric 57 (14.0) 6 (20.0) Gastrointestinal 51 (12.5) 11 (36.7) Pain 40 (9.8) 1 (3.3) Diabetes 21 (5.1) Other 16 (3.9) Antibiotic/antiviral 13 (3.2) Immune 10 (2.5) 3 (10.0) Ophthalmic 9 (2.2) Asthma/COPD 6 (1.5) Endocrine Topical 4 (1.0) TOTAL 408 30 *Expressed as n(%) PT = pharmacy technician, RPh = pharmacist, RN = nurse

Discussion This study revealed medication histories performed by the pharmacy technician were more accurate than those done by ED nurses Technician 94.4% accuracy; nurse 14.0% (p < 0.0001) Significant difference (p=0.0046) in number of patients admitted to hospital between the two groups PT-Rph - later data set May reflect technician’s growing experience in targeting patients more likely to be admitted Limitations Small sample size Different study designs between the two comparator groups

Future Directions Our pharmacy technician currently only sees approximately 17% of ED patients per shift Average time to complete medication history ~24 minutes Wide variability Staff education Electronic databases

Conclusion ED pharmacy technician obtained medication histories have less errors than those obtained by ED nurses.

Acknowledgements Scott Mathis, Pharm.D Hoytin Lee Ghin, Pharm.D., BCPS Michelle Gardiner, Pharm.D., CGP Ashley O’Keefe

References Scott BM, Considine J, Botti M. Medication errors in ED: do patient characteristics and the environment influence the nature and frequency of medication errors? Australas Emerg Nurs J. 2014; 17:167-75. Quelennec B, Beretz L, Paya D, et al. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013; 24:530-5. ASHP Statement on Pharmacy Services to the Emergency Department. Am J Health Syst Pharm. 2008; 65:2380-83 Hart C, Price C, Graziose G, et al. A program using pharmacy technicians to collect medication histories in the emergency department. P&T. 2015; 40(1):56-61. van den Bemt P, van den Broek S, van Nunen AK, et al. Medication reconciliation performed by pharmacy technicians at the time of preoperative screening. Ann Pharmacother. 2009; 43:868-74. Johnston R, Saulnier L, Gould O. Best possible medication history in the emergency department: comparing pharmacy technicians and pharmacists. Can J Hosp Pharm. 2010; 63(5):359-65.

Questions? Marija Markovic, Pharm.D. PGY-1 Pharmacy Practice Resident 17 Questions? Marija Markovic, Pharm.D. PGY-1 Pharmacy Practice Resident Monmouth Medical Center, Long Branch NJ