When a patient is brought into an exam room at a physician's office, they typically begin with a 5-minute “rooming” process where the nursing staff must obtain vital signs and laboratory tests, identify the patient’s main concern, administer vaccines, run electrocardiograms or other clinically relevant tasks as directed by providers.
Because physicians try to care for as many patients as possible each day, nursing staff only have enough time to ask a patient if anything on their medication list has changed. A medication history is also obtained, but with limited time, these histories are not always complete or accurate. Accurate medication histories are an essential part of ensuring patient safety by reducing the risk of medication errors that could lead to adverse events, duplications or errors.
During a 14-day pilot project, a certified pharmacy technician was placed in the office at Coastal Family Medicine, an NHRMC Physician Group practice. The primary role of the pharmacy technician was to collect and document accurate medication lists.
The goal of this project was to pilot a Shared Care Technician (SCT) in the physician office to complete medication histories. The primary objective was completion of 12 medication histories per day by the SCT. Secondary objectives included filling more new prescriptions at the NHRMC Outpatient Pharmacy and determining the number and type of SCT completed interventions.
During the 14-day pilot project, the SCT identified 501 medication list discrepancies (incorrect dose, incorrect frequency, medication on list in error, medication omitted from list in error, etc.). The most common reasons for discrepancy were a patient was not taking a prescribed medication or the patient was taking a medication that was absent from the list.
In addition, the SCT documented the completion of 385 interventions. The most common interventions were completion of medication histories, notifying providers of patient requests for refills and identifying and resolving medication access barriers.
Hospitals often use pharmacy technicians to complete medication histories, but this practice is fairly new to the physician office. The results of this pilot project can be used within our health system and other health systems seeking to expand the role of their pharmacy technicians. The standard work developed during this project will be available for other clinics within the NHRMC system to establish a workflow for a SCT within their ambulatory practice. Utilization of knowledge gained through this project would be beneficial for other health systems in improving the accuracy of medication histories for patients across the variety of care.
“Now that we have successfully completed the pilot, we are looking for a way to incorporate the Shared Care Technician into the workflow at Coastal Family Medicine with additional responsibilities related to new services,” said Lisa Edgerton, a pharmacist at NHRMC. “Potentially, this concept could be expanded to other outpatient clinics.”
The Shared Care Pharmacy Technician Event at New Hanover Regional Medical Center earned a Bronze Touchstone Award from Atrium Health, which has a services agreement with NHRMC. The Touchstone Award was one of seven earned by NHRMC in 2018. The awards will be presented Wednesday, July 25 at the Charlotte Convention Center.
- Lindsay Thompson, PharmD
- Elizabeth Kyle, PharmD
- Lisa Edgerton, PharmD
- Tufan Nardali, PharmD