Best Possible Medication History in the Emergency Department: DISCUSSION
To the authors’ knowledge, this study is the first randomized trial directly comparing medication histories obtained by pharmacists with those obtained by pharmacy technicians. Previous studies have examined medication reconciliation and the role of the pharmacy technician in both preoperative and hemodialysis clinics and have obtained favourable results. However, the role of the pharmacy technician in the emergency department, although increasing in popularity, is not as well studied. The results obtained here confirm the hypothesis that in the emergency department, well-trained pharmacy technicians can obtain a BPMH with as much accuracy and completeness as pharmacists.
The process of medication reconciliation is a responsibility shared among the members of the health care team. Using the best skill mix for this task is of great importance, and it is vital to take advantage of the knowledge, skills, and abilities of all groups involved to properly allocate and utilize resources. That being said, the results reported here have the potential to benefit various members of the health care team who are involved in performing medication reconciliation. The involvement of pharmacy technicians in innovative and nontraditional roles can ultimately improve their job satisfaction and aid in retention of staff. Delegation of this task allows for enhanced facilitation of the pharmacist’s responsibilities, which can ultimately increase the time available to the pharmacist for providing more in-depth clinical services and resolving drug therapy problems. This, in turn, will increase pharmacists’ job satisfaction and facilitate human resources management through improved recruitment and retention of staff. With additional team members involved in the medication reconciliation process, it should be possible to provide this service more consistently, which will contribute to improved patient safety through avoidance of adverse drug events. viagra plus
One notable finding was the difference in duration of interviews conducted by pharmacists and technicians. Although the total time recorded for each interview was approximate, interviews conducted by technicians were significantly shorter than those completed by pharmacists (7.96 versus 9.24 min). This difference might be explained by the fact that pharmacists often spend time inquiring about clinical issues. At least 2 other studies have examined the time taken by pharmacy technicians to complete a BPMH, reporting an average of 17 min for hemodialysis patients7 and an average of 12 min for medical patients. If the BPMH obtained by a technician is accurate and complete, as shown by the results reported here, more time is freed up for the pharmacist to assess and resolve clinical medication-related problems. In addition, although we anticipated that it might take the technicians longer to complete their interviews with patients, we have shown that the benefit of a technician’s assistance can be achieved without any requirement for additional time.
We believe that all staff involved in medication reconciliation could benefit from a training program similar to that used to train the technicians in this study. A systematic approach to obtaining the BPMH is essential to the success of medication reconciliation. Leung and others used a 2-week period to train technicians in a hemodialysis clinic to obtain a BPMH. The training consisted of interview training, observation, and practice under the direct supervision of a pharmacist. During the assessment phase of their study, these authors found that pharmacists agreed on 98.1% of the orders identified by technicians during their interviews with 99 patients, and they concluded that an adequately trained technician was capable of interviewing patients to create a BPMH. In another study at the same institution, a similar 7-day training program was used, and the authors identified 775 discrepancies among 326 medical patients from interviews conducted by pharmacy tech- nicians. Small and others pilot-tested a structured admission medication reconciliation education and certification program for hospital pharmacists. Although they did not perform any statistical analyses, these authors concluded that participants who used a “trigger sheet”, such as that used in our study, had higher accuracy scores in the certification phase than those who did not (88.1% versus 67.1%). The training and certification program used in our study was a modified version of that used by Small and others. It will be used in our institution for future training of pharmacy staff members.