Utilizing Pharmacy Technicians for Medication Reconciliation. Kristy Malacos, MS, CPhT Magruder Hospital Port Clinton, OH Pharmacy Systems, Inc.

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1 Utilizing Pharmacy Technicians for Medication Reconciliation Kristy Malacos, MS, CPhT Magruder Hospital Port Clinton, OH Pharmacy Systems, Inc.

2 Magruder Hospital Located on the shores of Lake Erie in Port Clinton 25 bed critical access Went live with Cerner in 2010

3 Introduction Medication Reconciliation Joint Commission ASHP CMS Patient Safety Physician satisfaction

4 Old Model ED Nurse Med/Surg Nurse Physician Admission Reconciliation

5 Initiating Change In December 2013 began to examine med rec process Understood that nursing alone cannot complete thorough, accurate medication history Began utilizing pharmacy technician to first investigate if/what errors were occurring in current model

6 Old Med Rec Examples

7 Common Errors Frequency of Administration (once daily vs. twice daily) Strength Incomplete History or information obtained Formulation of Drug (ex. metoprolol succinate vs. metoprolol tartrate) Duplicate/Inappropriate Therapy

8 New Model ED Nurse Med/Surg Nurse Physician Admission Rec Physician Discharge Rec Pharmacy Med Rec

9 Nursing Education Don t enter meds that don t have a strength If patient is unsure of strength, pick the med without a strength and then enter in comments patient is unsure of dose

10 Nursing Education

11 Nursing Education Don t free text When you free text a dosage: ex. Half tab, this does not translate through into the system

12 Nursing Education Don t complete medications unless you re sure the patient is not taking the medication Complete medications for therapies finished (antibiotic, pain meds, etc.) Cancel/DC meds with new dosages

13 Pharmacy Med Rec Process Certified Pharmacy Technician Reviews patient census for new admissions Review profiles of new admits for documented medications Collects data and modifies medication history as needed Pharmacist Verifies any CPhT changes Informs physician of any drug interactions or allergies Utilizes medication information for patient counseling

14 CPhT Med Rec Process PCP Medication Lists External Rx History Calling the Pharmacy

15 Technician Med Rec Process External Rx History

16 RpH Med Rec Process Verify what technician has modified Documented in spreadsheet Research potential interactions noted by CPhT and informs physician Gather information to use for patient education and counseling Answer any questions remaining during counseling process

17 Pharmacist Med Rec Process

18 Results Pharmacy technicians frequently identified inaccurately documented medication histories. Frequency of dosing and strength of medication were the most noticed issues of those observed

19 Percentage of Profiles with Errors Prior to Med Rec January February March April May June July August September

20 Results Technicians were able to communicate questions to pharmacists, who could then discuss these concerns with the patient directly This increased counseling percentages while improving the medication reconciliation program simultaneously.

21 Pharmacist Counseling Involving pharmacists with med rec increased counseling percentages by increasing involvement with patient medication issues Inpatients Allpatients

22 HCAHPS

23 HCAHPS

24 Next Steps Continue to monitor the number of patient profiles reconciled which contain an error after nursing medication history Educate nurses individually when errors are documented Continue to monitor HCAHPS

25 Conclusions Pharmacy technicians can provide an effective addition for the medication reconciliation process. Nursing education is essential. Involving pharmacists can help increase counseling percentages by increasing involvement with patient medication issues.

26 Lessons Learned Nursing education is constant, ongoing, and essential. The patient is not the most reliable source of information. Use physician medication lists, pharmacies, and external Rx histories when possible. No matter how small, pharmacy involvement is crucial for med rec success.