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Publication Date

5-2021

Keywords

oregon; portland; newport; ppmc

Disciplines

Pharmacy and Pharmaceutical Sciences

Abstract

Background

• The yearly joint commission National Patient Safety Goals for 2020 and 2021 stress the importance of using medications safely which includes an emphasis on medication reconciliation and decreasing medication discrepancies. 1,2 o Pharmacy Medication History Technicians (MHTs) work as an integral part of the medication reconciliation process to gather complete medication histories o The goal of medication reconciliation is to decrease medication discrepancies  decreased medication related adverse events  improve patient outcomes • Pharmacist run medication reconciliation programs have shown decreased medication errors by over 80% when compared to standard medication reconciliation performed by nurses or other healthcare providers. 3 • Cost of a preventable adverse drug event (ADE) is between $4,800 10,375 per event. 5 • Each documented medication history is valued at $642 • Large tertiary medical center MHT expansion: o Adds two additional MHTs to the already existing team of four MHTs o Funded by medical center hospitalists group o Goal of capturing a larger proportion of medication histories in additional settings • Many studies have assessed the impact of the implementation of a MHT program, however there is a lack of knowledge when it comes to the effect of adding additional MHT to an existing program.

Purpose

• This study aims to evaluate the impact of the addition of two MHTs to an already existing program as well as evaluate how outside factors ( i.e. quantity of medications, verification of methadone dose) involved in the medication reconciliation process effect productivity metrics.

Objectives

• Primary Objectives: o Determine the number of medication histories completed and the number of opportunities missed o Identify the percent of time medication histories are complete within 12 and 24 hours of the patient being set for admission o Evaluate the accuracy of medication histories completed by medication history technicians • Secondary Objectives: o Identify effect of predetermined factors such as quantity of medications and availability of MARs on the number of medication histories completed by medication history technicians o Calculate the cost savings associated with technician completed medication histories compared to hospitalist completed medication histories o Calculate the cost savings associated with number of medication histories completed o Evaluate provider satisfaction with medication history technician program and medication history service

Methodology

• IRB status: Approved; Study2020000877 • Study design: Prospective/Retrospective chart review • Study timeline: Pre expansion; November 2020 April 2021 (6 Months) • Inclusion criteria: Patient’s admitted through the emergency department • Exclusion criteria: Patients that do not meet the inclusion criteria • Patients will be screened for eligibility via EPIC data analysis admissions data and intervention (I vent) documentation • Productivity factors will be documented using I vent documentation with custom dotphrases in EPIC • Pharmacists: • Number of corrections made by RPh • Technicians: • Medication administration record (MAR) faxed • Quantity of medications on medication list • Methadone verification needed • Discrepancies of note • Provider satisfaction will be determined through a Microsoft forms survey

Discussion

• January Findings: o Most completed = Friday/Saturday o Most missed = Tuesday/Saturday o The busiest shift seems to be MHT2 from 1730 0000 this is also when most med hxs are missed o 33.8% of medication histories missed were when there were no MHT present (111 out of 328) o Turnaround time on completed med hxs was on average 2.5 hours shorter when MHT were completing the medication histories vs. providers o All average and median turnaround times are within the preferred 24 hour timeframe • Study Limitations: o No post expansion data analysis due to time constraints and expansion go live date o Limited productivity factor data collection due to time constraints and expansion go live date o Productivity factor data: Implementation of a new dotphrase that is different from what the MHT were trained to use may result in inconsistent documentation in I vents o Turnaround time analysis uses different start times depending on the admission scenario  ED to DC  IP bed requested + med hx  Med hx + IP bed requested o Due to scheduling challenges, there may or may not be MHT overlap for the entire time from 1330 1730


Preliminary Conclusions

• A much higher percentage of medication histories were missed when MHTs were not present in the ED • The presence of MHTs noticeably reduced the turnaround time of medication histories completed • On average, if a medication history was completed it was completed within the 24 hour preferred timeframe • The additional MHT coverage as a part of the expansion will help to capture more medication histories • Future direction: o Post expansion data analysis o 24 hour MHT coverage

Specialty/Research Institute

Pharmacy

Specialty/Research Institute

Graduate Medical Education

Conference / Event Name

Academic Achievement Day, 2021

Location

Providence Newberg Medical Center

Evaluation of Medication History Technician (MHT) Expansion at a Large Tertiary Medical Center

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