1. 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

2. 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:
Eur J Intern Med. 2013; 24:530-5.

3. 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 Monmouth Medical Center hired a pharmacy technician to obtain detailed medication histories in emergency department patients
Am J Health Syst Pharm. 2008; 65:
P&T. 2015; 40(1):56-61.
Ann Pharmacother. 2009; 43:
Can J Hosp Pharm. 2010; 63(5):

4. 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

5. 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

6. 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

7. 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”

8. 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

9. 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)
<
Medications with error, n (%)
408 (86)
30 (5.6)
 <
*Number of medications in final medication list
PT = pharmacy technician, RPh = pharmacist, RN = nurse

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

11. 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

12. 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 < )
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

13. 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

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

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

16. 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:
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:
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:
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):

17. Questions? Marija Markovic, Pharm.D. PGY-1 Pharmacy Practice Resident17
Questions?
Marija Markovic, Pharm.D.
PGY-1 Pharmacy Practice Resident
Monmouth Medical Center, Long Branch NJ