Description of a Pharmacy Technician and Student Intern-Driven Medication Reconciliation Process and Evaluation of Medical Provider Acceptance of Recommendations to Reorder Critical Medications

Abstract

OBJECTIVES: To describe a pharmacy technician and student intern-driven medication reconciliation process and to evaluate medical provider acceptance of recommendations to reorder critical medications. METHODS: Patients admitted to Northwest Medical Center had medication histories taken on admission. A specially trained pharmacy technician or student intern reviewed these histories, with emphasis placed on critical medications as defined by the Pharmacy and Therapeutics Committee. Recommendations to re-order these critical medications were made to medical providers. All patients, excluding those under 18 years of age or current enrollment in the prison system, admitted during the months of May-June 2010 were reviewed for acceptance of critical medication recommendations through information recorded in the pharmacy electronic medical record system. RESULTS: One hundred seventy-eight (178) recommendations were made on 132 patients requiring recommendations. All medical providers accepted 102 (57%, p-value=0.008) of the recommendations made. Hospitalists were more likely than physician specialists or surgeons to accept recommendations made (62.5%, p-value<0.001). Recommendations made regarding thyroid products were accepted the greatest majority of the time (82.1%, p-value<0.001); antidepressants (54.8%, p-value=0.321), anticonvulsants (63.2%, p-value=0.194), and medications classified as other (55.6%, p-value=0.480) were also accepted a majority of the time. Vitamin K antagonists did not have recommendations accepted a majority of the time (31.8%, p-value=0.034). CONCLUSION: Medical providers accepted a majority of recommendations to reorder critical medications made by pharmacy technicians or student interns.