Background: With growing importance placed on patient safety, it has become necessary to elevate past processes and rethink rolls for experienced healthcare professionals. One of the primary goals identified by The Joint Commission is to “maintain and communicate accurate patient medication information” to “safely prescribe medications in the future” [1]. This task is often complicated by a variety of factors, such as polypharmacy, medication changes by specialists, and compliance issues, increasing the risk for costly adverse medication errors in hospitalized patients. Previous studies using history technicians to collect the best possible medication history (BPMH) have demonstrated a positive impact on accuracy [2-4] but few studies have evaluated hospital-wide coverage from a fully developed program. Considering the size and reach of our hospital, it would be beneficial to measure to what degree a Medication History Technician (MHT) program reduces home medication errors and the financial impact on this error reduction on a large scale.
Methods: For this prospective analysis, MHTs were utilized to obtain the BPMH on patients at least 18-years-old; there was no gender, ethnic background, or health status exclusions. Medication histories were obtained in our emergency department (ED), all general medical rooms, and our Coronary Care ICU. Prescheduled surgery or catheterization patients as well as long-term specialty care and behavioral health units were excluded from this study. The BPMH was obtained via interview of patient/caregiver(s), transferring hospital documentation, EHR review, patient’s pharmacies, and/or provider’s office. Omission, commission, and dose/frequency errors were recorded. A progress note went into the patient chart, listing time of last dose, any medication assistance the patient receives, and reports of possible noncompliance.
Results: The anticipated number for the study was originally 1400 over four weeks but zealous recruitment estimates and financial restrictions placed by our institution ended the study at 7 weeks with 832 BPMH completed. Prior to implementation, nursing staff within our hospital performed a BPMH less than 50% of the time spending an average of 5.7 minutes on a medication history (1.2 minutes in ED and 8.0 minutes in other locations). We found that MHTs spent an average of 37.1 minutes interviewing, verifying, and documenting and utilized advanced sources on 94% of patient. An average of 6.93 potential errors corrected per patient were identified with 82% of patients having an omission error, 59% with a commission error, and 50% with an error in dosing/frequency. Identifying these errors resulted in a cost avoidance estimation of $192.03 per patient resulting in $1,400,000 per year in net savings to our 499 bed moderate-sized not-for-profit hospital.
Conclusions: A BPMH completed prior to admission medication reconciliation is considered to be the gold standard. Collecting a BPMH requires training and time; allotting 15-30 minutes from start to finish is suggested per recommendations from the MARQUIS Implementation Manual [5]. Our MHT model reassigned the medication history process throughout the hospital, resulting in significant avoidance of potential errors and produced more accurate medication histories. In addition, nurses, pharmacists, and providers were allowed to devote more attention and time to other aspects of patient care. Our institution found expansion of the MHT program to be a cost-effective approach while ensuring patient safety.