Clinical trial NCT01065675: Medication Histories Conducted by Nurses (RNs), Pharmacy Techs (CPhTs) & Pharmacists (RPhs)
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 type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Medication Reconciliation
Emergency Department
Keywords: Medication Reconciliation
Emergency Department
Nurse
Pharmacist
Certified Pharmacy Technician
Medication reconciliation: inpatients admitted from the ED
Lead sponsor: Wesley Medical Center
Sponsor class: OTHER
Collaborators: name: Cardinal Health
First posted: 2010-02-09
Enrollment: 153
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

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%.


Eligibility 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

Primary outcomes:
measure: 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)
timeFrame: 5 months
Secondary outcomes:
Other outcomes:
Locations:
city: Wichita
country: United States
facility: Wesley Medical Center
state: Kansas
Study officials:
affiliation: Wesley Medical Center
name: Joan S Kramer, PharmD
role: PRINCIPAL_INVESTIGATOR
References: