Article Text
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.
- medication reconciliation
- vulnerable populations
- safety net hospitals
- pharmacy technicians
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Footnotes
Contributors SS was responsible for the literature review, data analysis and manuscript writing. DES was responsible for the literature review, project design, project implementation, data monitoring and analysis, and manuscript writing. SG was responsible for the project design, project implementation and manuscript writing. NR was responsible for the data analysis and manuscript writing.
Funding Research reported in this publication was supported by AHRQ Grants 1K08HS022561 and P30HS023558 and the National Center for Advancing Translational Sciences of the NIH under Award Number KL2TR000143.
Disclaimer The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of AHRQ or the NIH.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.