Medication Reconciliation in the Emergency Department: Technician Expansion subtitle A Catholic healthcare ministry serving Ohio and Kentucky 1 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 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 3 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 4 5 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” 6 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 7 Additional RPh Interventions Non-Medication Reconciliation Interventions (Performed by Pharmacist) • Code/Trauma • Pharmacy consult • Antibiotic stewardship • Allergy clarification • Recommend dose change • PK evaluation • Drug therapy evaluation • Recommend drug initiation • Drug-drug interaction evaluation Recommend drug discontinuation • Drug information • Patient counseling • Other • Recommend drug therapy change • 8 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 Pharmacist, technician 291 43 334 April Pharmacist, technician, student 500 64 564 9 Additional Quality Project Time spent in ED (h) Number of patients Avg number of meds per patient Omitted medications Wrong strength Wrong dosage form Wrong instructions Duplicate meds D/c medications Correct med history Unable to complete Total-July 2014 79 131 11.4 304 93 45 102 19 111 7 3 Avg per day 4.6 7.7 n/a 17.9 5.5 2.6 6.0 1.1 6.5 0.4 0.2 Technician interventions 10 Additional Quality Project Time spent in ED (h) Number of patients Total-July 2014 76.5 91 Avg per day 5.1 6.1 Avg number of meds per patient Omitted medications Wrong strength Wrong dosage form Wrong instructions Duplicate meds D/c medications Correct med history Unable to complete 11.6 117 30 0 25 2 95 13 0 n/a 7.8 2 0 1.7 0.1 6.3 0.9 0 Student interventions 11 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 12 Questions? 13