Technician Medication Reconciliation in Primary Care Is An Overlooked Opportunity

Advancing the Roles of All Pharmacy Team Members Has Shown to Reduce Errors and Improve Patient Safety.

In the United States, medication errors lead to harm for an estimated 1.3 million individuals each year.¹ For this reason, medication reconciliation (MR) is an important safety measure. In fact, MR became a Joint Commission 2013 National Patient Safety Goal (NPSG.03.06.01); this goal was designed to promote medication safety and was originally announced by the Joint Commission in 2004.

The MR process has traditionally been reserved for pharmacists, nurses, and providers. However, time constraints, an increased demand for health care resources, and the expanded roles of pharmacists have made pharmacy technicians ideal candidates to provide these services.^2-3 Pharmacy technician—directed MR can potentially reduce errors, helps patients maintain continuity of care, and enables other members of the health care team to perform important clinical services, all at a relatively low cost. Additionally, results from research have shown that properly trained and supervised pharmacy technicians are able to complete MR as accurately as pharmacists.⁴

To date, most research on pharmacy technician MR has been conducted in emergency departments and preoperative settings. Despite current lack of data on the use of technician-centered MR in primary care, MR remains important in this setting. Between 70% and 95% of clinical records include inaccurate medication lists,^5-7 and approximately 20% to 30% of all ambulatory patients experience an adverse drug event annually.⁸

At the Boise VA Medical Center, a pilot program evaluated a pharmacy technician—directed MR process in the primary care setting from February to April 2015. After completing a pharmacist-driven training period, the pharmacy technician contacted patients via telephone to conduct MR 24 to 72 hours before their clinic appointment with a primary care provider. The encounter was documented in the electronic medical record with an updated medication list and notes on any discrepancies in the patient’s medical record for the provider to view prior to the patient’s appointment. Pharmacist oversight was provided via review to identify whether medication-related issues needed to be brought to the attention of the provider.

Following completion of the pharmacy technician—directed MR pilot, a retrospective chart review was done to identify the number of resolved discrepancies. The pharmacy technician had identified 837 discrepancies, 712 of which were considered to be of minor clinical significance and unlikely to affect patient safety and 109 of which were of moderate clinical significance; these discrepancies consisted of patients who were self-adjusting or discontinuing medications used to treat blood pressure, asthma/chronic obstructive pulmonary disease, depression, psychiatric symptoms, and diabetes. Finally, 16 discrepancies were of major clinical significance; these cases included patients who were taking medications for which anaphylaxis was listed as the allergic reaction, as well as cases in which an allergy had no reaction listed but was anaphylaxis per patient report. Additional findings that fall into this category were instances of caregivers giving the wrong dose of warfarin to a patient that resulted in the patient’s having a supratherapeutic international normalized ratio, a patient’s self-discontinuation of critical medication (clopidogrel) without provider consent, and provider unawareness of medication changes from a patient’s hospital discharges or external providers. Chart review identified resolution of 64% (70) of moderate discrepancies and 81% (13) of major discrepancies.

Ultimately, the pharmacy technician—directed MR process helped avoid a number of errors, improved patient care, and ultimately decreased cost to the health care system. These experiences highlight the opportunities available to technicians to improve the accuracy and completeness of MR in the primary care setting.

LeAnn Bolster, CPhT is a pharmacy technician at the Boise VA Medical Center in

Idaho and is the former director and chair of technician affairs for the Idaho Society of Health-System Pharmacists.

Megan Koyle, PharmD, BCPS, BCACP, is a teleprimary care clinical pharmacy specialist at the Phoenix VA Health Care System in Arizona.

References

• Hayes K. Medication errors more than double. AARP website. Published July 24, 2017. aarp.org/health/drugs-supplements/info-2017/medication-errors-rise-fd.html. Accessed November 25, 2018.
• Smith M, Bates DW, Bodenheimer TS. Pharmacists belong in accountable care organizations and integrated care teams. Health Aff (Millwood). 2013;32(11):1963-1970. doi: 10.1377/hlthaff.2013.0542.
• Shane R. Advancing technician roles: an essential step in pharmacy prac­tice model reform. Am J Health-Syst Pharm. 2011;68(19):1834-1835. doi: 10.2146/ajhp110445.
• 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):359-365.
• Bedell SE, Jabbour S, Goldberg R, et al. Discrepancies in the use of medications: their extent and predictors in an outpatient practice. Arch Intern Med. 2000;160(14):2129-34.
• Kaboli PJ, McClimon BJ, Hoth AB, Barnett MJ. Assessing the accuracy of computerized medication histories. Am J Manag Care. 2004;10(11; pt 2):872-877.
• Nassaralla CL, Naessens JM, Hunt VL, et al. Medication reconciliation in ambulatory care: attempts at improvement. Qual Saf Health Care. 2009;18(5):402-407. doi: 10.1136/qshc.2007.024513.
• Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348(16):1556-1564. doi: 10.1056/NEJMsa020703.