1. A Catholic healthcare ministry serving Ohio and Kentucky
Medication Reconciliation in the Emergency Department: Technician Expansion
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subtitle
A Catholic healthcare ministry serving Ohio and Kentucky

2. Objectives
Describe the implementation of a pharmacy technician into the medication reconciliation process
Present data on the technician interventions and expansion of emergency medicine pharmacy services
List the preparation process for the med rec technician

3. ED Pharmacy Services
October 2013, clinical pharmacists began providing services in the ED on second shift for 7 day coverage of the department
Drug information; therapy recommendations; participate in emergency responses; medication reconciliation; operations support
Medication reconciliation technician began as a pilot project in February 2014
New job description and responsibilities as part of Technician Career Ladder
Hours of coverage  8am -1:30pm; then 2pm-4:30pm for CC support
APPE students began rotations in the ED starting April 2014
1-2 students monthly on rotations
Integrated into activities with pharmacist supervision on second shift
-2 clinical pharmacists; 7 on 7 off schedule; second shift when a majority of admissions take place and traumas etc present; many ED pharmacist provide some sort of second shift coverage with varying hours
-Emergency responses=codes, traumas, strokes, MI, OD etc
-CC=collaborative care
-Technician schedule modified to prevent overlap with pharmacist/student coverage

4. ED Technician Process Identify patients to be admitted from the ED
Interview and discuss home medications with patient
Use family, pharmacies, ECFs, PCPs, etc. as needed
Identify correct drug, dose, route and frequency as well as last dose taken if able
Obtain or confirm outpatient pharmacy
Clarify allergies*
Enter Med Rec i-vent into Epic for review by pharmacist
Talk about what you do when a medication list in EPIC does not match up and an example of what you might “flag” for removal.

6. Expansion of Pharmacy Services Project
This project was designed to review the impact provided by these additional personnel in newly expanded roles within the ED as well as to see how their support can impact the services provided by the ED pharmacists themselves
Review project from January 2014 through April 2014
Data compiled and project submitted as abstract for a poster at ASHP Midyear 2014
“Impact of pharmacy extenders on providing emergency medicine pharmacy services”

7. Methods of project
Interventions titled as “medication reconciliation” were reviewed during a time period that included ED services provided by the pharmacists alone, the pharmacists and technicians, and the pharmacists, technicians, and a student
The types of interventions made by the pharmacist in addition to “medication reconciliation” were also reviewed for this time period to determine if the additional support allowed the pharmacist to redirect their attention to other clinical interventions

8. Additional RPh Interventions
Non-Medication Reconciliation Interventions
(Performed by Pharmacist)
Code/Trauma
Antibiotic stewardship
Recommend dose change
Recommend drug initiation
Recommend drug discontinuation
Patient counseling
Recommend drug therapy change
Pharmacy consult
Allergy clarification
PK evaluation
Drug therapy evaluation
Drug-drug interaction evaluation
Drug information
Other

9. Medication Reconciliation Reconciliation Interventions
Project Results
Month
Pharmacy Personnel
Medication Reconciliation
Interventions
Non-Medication
Reconciliation Interventions
Total Interventions
January
Pharmacist
186 30
216
February
Pharmacist, technician
279 40
319
March
291 43
334
April
Pharmacist, technician, student
500 64
564

10. Additional Quality Project
Total-July 2014
Avg per day
Time spent in ED (h) 79
4.6
Number of patients
131
7.7
Avg number of meds per patient
11.4
n/a
Omitted medications
304
17.9
Wrong strength 93
5.5
Wrong dosage form 45
2.6
Wrong instructions
102
6.0
Duplicate meds 19
1.1
D/c medications
111
6.5
Correct med history 7
0.4
Unable to complete 3
0.2
Omitted medications-meds that patient was taking that had been left off the med list
Wrong strength-self explanatory
Wrong dosage form- ER vs IR etc
Wrong instructions-self explanatory
Duplicate meds- self explanatory (meds themselves, not classes)
D/c meds-meds the patient no longer is taking but is still on the med list, removed from list at med rec
Technician interventions

11. Additional Quality Project
Total-July 2014
Avg per day
Time spent in ED (h)
76.5
5.1
Number of patients 91
6.1
Avg number of meds per patient
11.6
n/a
Omitted medications
117
7.8
Wrong strength 30 2
Wrong dosage form
Wrong instructions 25
1.7
Duplicate meds
0.1
D/c medications 95
6.3
Correct med history 13
0.9
Unable to complete
Additional Quality Project Student?
-Some reasons students numbers aren’t as high as techs in some areaschanges were self-reported (subjective); students are not solely occupied with med rec—discussing patients, researching drug information questions, observing procedures, observing emergency situations, projects
Omitted medications-meds that patient was taking that had been left off the med list
Wrong strength-self explanatory
Wrong dosage form- ER vs IR etc
Wrong instructions-self explanatory
Duplicate meds- self explanatory (meds themselves, not classes)
D/c meds-meds the patient no longer is taking but is still on the med list, removed from list at med rec
Student interventions

12. Technician Preparation
Provided a technician specific binder
Discusses step-by-step the med rec process: How to…What needs to be collected…etc.
Includes screen shots of Carepath to assist with direction
Contact information for local pharmacies, home health agencies, ECFs, and PCPs
Trained in real-time on a collaborative care unit
Observed pharmacist perform medication history initially
Transition to technician performing med history with pharmacist observation
When comfortable technician to perform med history on own
Playground version of Carepath available to work through patient profile—not indicative of live environment for making changes
Techs training techs
Does each tech have own binder or one to share?

13. Questions?