Up to three billion medications are prescribed per year in the United States, states the FDA’s Drug Safety and Availability “Safe Use Fact Sheet.” The Fact Sheet adds, “The Institute of Medicine (IOM) estimates that at least 1.5 million preventable adverse drug events occur within the healthcare system each year.” Fortunately, medication reconciliation procedures are becoming increasingly embraced across the continuum of healthcare in order to significantly reduce the frequency of adverse drug events (ADEs).
Medication Reconciliation was recognized as a priority in healthcare when the Joint Commission (then called the Joint Commission on Accreditation of Healthcare Organizations) made it one of its National Patient Safety Goals in 2005. The revised edition of this goal—NPSG 03.06.01—was issued in July 2011.
The American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) created a panel in 2007 to come up with a coherent definition of medication reconciliation:
“Medication reconciliation is the comprehensive evaluation of a patient’s medication regimen any time there is a change in therapy in an effort to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions, as well as to observe compliance and adherence patterns. This process should include a comparison of the existing and previous medication regimens and should occur at every transition of care in which new medications are ordered, existing orders are rewritten or adjusted, or if the patient has added nonprescription medications to [his or her] self-care.”
[Source: “Improving Care Transitions: Optimizing Medication Reconciliation” by the American Pharmacists Association & American Society of Health-System Pharmacists (March 2012) https://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspx]
The Pharmacy Technician’s Role
“It has been shown that the pharmacy technician can be an integral part of contributing to patient safety by performing medication reconciliation,” states Mark D. Levitz, MA, CPhT, RPhT in his Pharmacy Times article “Medication Reconciliation: The Role of the Pharmacy Technician” (August 9, 2013). Levitz, who has been a pharmacy technician for more than 10 years, serves as Inova Alexandria Hospital’s medication reconciliation technician. He explains that it is the pharmacy technician’s role to develop a list of current medications taken by emergency room patients, as well as others, such as admitted patients that have congestive heart failure.
Developing this list is a comprehensive procedure and involves such steps as interviewing the patient, making phone calls to community pharmacies, family physicians and other relevant healthcare settings/professionals, verifying the lists and vials patients have on their person, and more. “To be complete and useful to the physicians, this list should include the drug, dose, frequency, and any special circumstances under which the drug in taken,” says Levitz. Thus, pharmacy technicians must rely on their knowledge of dosages, multiple names of the same drug, critical medications, etc.
The entire medication reconciliation process is a collaborative process between pharmacy techs and other healthcare professionals including nurses, physicians and hospital directors. The list of current medications is compared to a list of newly prescribed medications and clinical decisions are made to prevent adverse drug events. Communicating the new list to patients and their caregiver is also a key step.
In 2009, it was discovered that in 50% or more cases there were errors among medication lists at Inova Alexandria’s Emergency Department, says Levitz. However, the rate of error decreased to less than 5% after two years of initiating the medication reconciliation program at the hospital.
Another example of pharmacy technicians participating in the medication reconciliation process is at Northwest Medical Center in Tucson, Arizona. Pharmacist Scott Hall, Pharm.D, was an intern at the medical center at the time it initiated a pilot project to have pharmacy technicians compare medication lists recorded by nurses with lists of ordered prescriptions. Hall said two years into the project observed benefits included the significant avoidance of potential errors (such as missed medications), and freeing up time for nurses and physicians to engage in other care activities.
“Deploying pharmacy technicians on a project like this is a great utilization of existing resources,” said Hall (in his Case Study “Medication Reconciliation by Pharmacy Technicians, Student Interns,” Pharmacy Practice Model Initiative). “They have knowledge and are able to get trained on the necessary tools needed to conduct these medication reconciliations. The technicians in our pharmacy who were approached to participate were very excited about going out and seeing patients and working on this project.”