Medication reconciliation has always been a problematic process for a variety of reasons. Patients visit multiple providers and pharmacies and they may take over the counter and herbal medications unbeknownst to their providers. An accurate medication history requires a number of tools and adequate time to complete.
The CHI Health Pharmacy Service Line presented a proposal for a pharmacy-led medication history program conducted by pharmacy technicians to the CHI Health Executive Leadership. Four Nebraska CHI Hospitals received approval to implement the program, including CHI St Francis in Grand Island, Nebraska. The effort began in February 2016.
The team implemented a pharmacy-led medication history program using pharmacy medication history technicians to ensure an accurate medication history list at the time of the patients hospital admission. The ultimate goal was to have the pharmacy own the medication history process from beginning to end.
CHI St Francis hired four medication history technicians dedicated to obtaining medication histories from patients at the time of admission. The initial primary focus for these technicians are patients who were admitted to the hospital, via surgery, Emergency Departments or direct admits. The medication technicians are based on (or near) the floors as well as the Emergency Department, and are available via wireless phones. The nurse is to contact the medication technician to get the process started. Patients and their family members are interviewed as the current medication list is reviewed. This may involve the patient’s pharmacy, provider office, nursing home and hospital lists.
The top priority is an accurate home medication list, including indication for the medication. The list includes the drug name, but also the strength, dose, route, frequency and time/date last taken. For controlled substances, the tech also works to assess if a patient is doctor or pharmacy ‘shopping’ by accessing NeHII.
Lessons learned include:
- There is a need for good, two-way communication with provider offices
- There was an initial need to education staff on the value the medication history technicians provide to nursing staff
- Timely notification when the patient was admitted was challenging
- Multiple admissions often take place at the same time, which is challenging
- Adding staff to coordinate this medication reconciliation project was necessary
“We are very excited about this pilot program and gains made thus far. Our ultimate goal is to have the pharmacy provide support to the medication reconciliation process. The Nebraska Health Information Initiative (NeHII) is valuable as both a starting point and a validation because they use more than one source. They have been a wonderful resource for us as we have implemented this process. As workflow and efficiency allows, we hope to expand to include pre-surgical and planned admissions. Our goal is all medication lists will be reviewed by a pharmacist before being reviewed by a provider,” stated Doug Richling, Pharmacy Director at CHI St Francis Health, Grand Island, Nebraska.
“Many hospitals do not include indications for medications on the home medication list or the list for sending to the Skilled Nursing Facility (SNF), home health agency or assisted living facility. Medication indications are a requirement for SNFs, and it is the right thing to do for patients going home with no services. Patients and families not knowing their medications and why they are to take them are at higher risk for readmission. This seems so simple and yet is so very challenging. The work being done at CHI St Francis is truly a model of quality improvement and their team should be commended for their efforts,” stated Paula Sitzman, RN, BSN; Quality Improvement Advisor with Great Plains QIN.