“Most medication errors that occur at hospital admission originate in medication histories,” says Arsany Gadallah, PharmD, MBA. “Although several studies show a significant increase in medication history accuracy when collected by on-site pharmacy technicians, a study my colleagues and I conducted was the first to examine the impact of dedicated virtual medical history technicians.”

The virtual medication history technician program, Dr. Gadallah explains, assists in meeting the resource and labor demands of obtaining medication histories within large healthcare systems. “In the Ascension Seton network, for example, medication histories are conducted through HIPAA-compliant video conferencing equipment rather than through in-person interviews,” he notes. “Under the supervision of a pharmacist, this technology enables pharmacy technicians to complete medication histories from a remote central location. In this way, the technicians can observe multiple emergency departments (EDs) at once, interview patients via videoconferencing, and document completed medication histories in electronic medical records.”

Once a physician enters an admission order at a participating site, Dr. Gadallah continues, the transfer system signals to technicians that a new patient is to be admitted. Technicians then contact the ED staff to move the videoconferencing equipment into the patient’s room for medication history collection.

Virtual Technicians Had Lower Incompletion Rates

For a paper published in the International Journal of Clinical Pharmacy, Dr. Gadallah and colleagues conducted a multicenter, retrospective study aimed at assessing the impact of taking a medication history virtually by pharmacy technicians on medication reconciliation accuracy in comparison with other clinicians. The study team performed a retrospective chart review of patients older than 18 who were directly admitted from the ED between January 1, 2019 and August 31, 2019. They identified, quantified, and categorized unintentional discrepancies by comparing medication histories with reconciled medication orders at admission.

Among 208 patients, 190 unintentional discrepancies were identified. “Compared with physicians, nursing staff, pharmacists, advanced practice registered nurses, and physician assistants, virtual pharmacy technicians showed a significantly lower discrepancy and medication history incompletion rate,” Dr. Gadallah says. “Incomplete and inaccurate medication histories could have significant ramifications on patient safety, and therefore, it is important to reinforce training for obtaining accurate and complete medication histories. This finding also highlights the advantage of dedicating a well-trained, supervised clinician group for obtaining medication histories.”

In both groups, the most frequent type of unintentional medication discrepancy was omission, followed by incorrect drug entries, such as incorrect drug name, strength, dose, and/or frequency, Dr. Gadallah notes (Table). “With respect to secondary endpoints, there were no significant differences,” he adds. “Hospital length of stay, hospital readmissions, and ED visits at both 30- and 90-days post-discharge were similar in both groups.”

Thorough Education & Training Is Critical

Dr. Gadallah and colleagues believe the study shows promising data on the use of telepharmacy in obtaining accurate medication histories. “Although both national and international quality and safety organizations identify pharmacists as the ‘gold standard’ for obtaining medication histories, resources and time constraints can make it impractical for large hospitals and healthcare systems to dedicate pharmacists for this role,” Dr. Gadallah says. “This study hopefully serves as an invitation for pharmacists to advocate for the expansion of telepharmacy services and the involvement of pharmacy technicians in obtaining medication histories. It is crucial for physicians and pharmacy leaders to provide thorough education and training on conducting accurate medication reconciliation at their institutions.”

The study team concurs that future prospective evaluation is needed to assess the accuracy and efficiency of the technician-driven virtual medication history program across other healthcare systems. “With more prospective data, leveraging communication technologies to expand and facilitate pharmacy technician involvement in the medication reconciliation process could positively impact global medical practice,” Dr. Gadallah says.