Medication Histories Conducted by Nurses (RNs), Pharmacy Techs (CPhTs) & Pharmacists (RPhs)

Study Description

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Brief Summary:

Up to 50% of medication errors and 20% of adverse drug reactions (ADRs) in the hospital setting are estimated to be related to communication issues regarding patient medications at various transition points of care from admission to discharge. The Joint Commission (TJC) requires accurate and complete medication reconciliation occur at each transition point throughout hospitalization. Evidence from NQF demonstrates pharmacists (RPh) are the most effective medication management team leaders in the implementation of medication management practices and design of medication error reduction strategies; medication reconciliation is one of the five safety objectives pharmacists are recommended to lead. In addition, the Massachusetts Coalition for the Prevention of Medical Errors states strong evidence supports the use of pharmacy technicians (CPhT) in conjunction with pharmacists in completing accurate medication histories.

WMC nurses (RN) currently are involved in the medication reconciliation process. In 2009, a Medication Use Evaluation (MUE) of Medication Reconciliation Accuracy found a 67% medication error rate on admission determined by comparing the nurse-obtained medication history to the pharmacist-obtained medication history. The number of home medications identified by the pharmacist compared to the nurse was 411 versus 312 (p<0.0001). The total percentage of medication errors prevented by the pharmacist was 66.2. Using the VA Healthcare Failure Mode Effects Analysis - HFMEA™ Hazard Scoring Matrix, 3 independent pharmacist reviewers found that 18% of patients interviewed had a score greater than 7, and 3 patients had a score of 12 (major/probable), if the discrepancies would not have been identified and corrected by the pharmacist conducting the admission medication reconciliation audit. The same patients' discharge medication reconciliation and discharge medication lists were retrospectively reviewed for the MUE, and the total percentage of patients with medication errors on discharge was 43%.

Condition or disease	Intervention/treatment	Phase
Medication Reconciliation; Emergency Department	Other: Medication reconciliation completed by a RN, CPhT, or RPh	Not Applicable

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	153 participants
Intervention Model:	Single Group Assignment
Masking:	Single (Care Provider)
Primary Purpose:	Health Services Research
Official Title:	Electronic Patient Triage Development and Implementation Involving Nurse (RN), Pharmacy Technician (CPhT), and Pharmacist (RPh) Obtained Medication Histories in the Emergency Department (ED)and Impact on Medication Reconciliation
Study Start Date :	February 2010
Actual Primary Completion Date :	April 2010
Actual Study Completion Date :	May 2011

Arms and Interventions

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Intervention Details:

Other: Medication reconciliation completed by a RN, CPhT, or RPh
To determine which patients benefit the most from medication histories obtained by the RN, CPhT, or RPh. Patients will be admitted as inpatients through the ED with medication histories finalized electronically by the RN at the admitting unit.
Other Names:
• Medication Reconciliation
• Pharmacist
• Nurse
• Certified Pharmacy Technician
• Emergency Department
• ED

Outcome Measures

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. To determine which patients benefit most from medication histories obtained by the RN, CPhT, or RPh based on accuracy (% complete disease states, allergy documentation and description, vaccination documentation, medication documentation) [ Time Frame: 5 months ]

Eligibility Criteria

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Ages Eligible for Study:	Child, Adult, Senior
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Patients admitted as inpatients from the Emergency Department

Exclusion Criteria:

• Prisoners (because the IRB does not have a prisoner representative)
• Patients not admitted as inpatients through the Emergency Department
• Patients admitted more than once during the study period

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, Kansas
Wesley Medical Center
Wichita, Kansas, United States, 67214

Sponsors and Collaborators

Wesley Medical Center

Cardinal Health Foundation

Investigators

Principal Investigator:	Joan S Kramer, PharmD	Wesley Medical Center

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Joan Kramer, Clinical Research Pharmacist, Wesley Medical Center
ClinicalTrials.gov Identifier:	NCT01065675 History of Changes
Other Study ID Numbers:	09-068
First Posted:	February 9, 2010
Last Update Posted:	December 28, 2012
Last Verified:	December 2012

Keywords provided by Joan Kramer, Wesley Medical Center:

Medication Reconciliation; Emergency Department; Nurse	Pharmacist; Certified Pharmacy Technician; Medication reconciliation: inpatients admitted from the ED

Additional relevant MeSH terms:

Emergencies; Disease Attributes; Pathologic Processes