Improving best possible medication history with vulnerable patients at an urban safety net academic hospital using pharmacy technicians

Abstract

Background: Best possible medication history (BPMH) enhances the care of safety net patients, especially those with limited English proficiency and limited health literacy who are most vulnerable to medication error during the hospital admission process. Our large urban academic safety net centre faced numerous barriers to achieve BPMH among hospitalised patients including communication barriers that increase the time and complexity of eliciting BPMH, frequent provider turnover at our training institution and lack of an electronic health record (EHR) medication reconciliation tool to facilitate BPMH collection and monitoring.

Design: Leveraging opportunities afforded by the US federal incentive EHR programme, our multidisciplinary team designed an EHR-facilitated medication reconciliation programme by which pharmacy technicians engaged newly admitted patients and their caregivers at the bedside to develop and electronically document the BPMH.

Strategy: Prior to this intervention, pharmacy technicians had no role in BPMH. Providers collected home medications documented on paper notes without a consistent methodology. With each plan-do-study-act (PDSA) cycle since the programme began, the goal was to increase the per cent of BPMH completed by a pharmacy technician. Individual PDSA cycles targeted either the pharmacy technicians by expanding their pool of eligible patients or provider engagement with the pharmacy technician workflow.

Results: By optimising not only the health information technology platform but also the operational processes, the programme achieved a nearly 80% generation of BPMH completed by a highly trained pharmacy technician, surpassing its intended goal of 50% BPMH completion by a pharmacy technician on admission.

Conclusion: An EHR-facilitated tool improved BPMH at an urban academic safety net hospital using pharmacy technicians.

Keywords: medication reconciliation; pharmacy technicians; safety net hospitals; vulnerable populations.

Figure 1

Final best possible medication history (BPMH) protocol design after multiple plan–do–study–act at an academic urban safety net hospital. EHR, electronic health record.