More than one-third of patients have medication errors upon admission, most commonly as a result of inaccurate medication histories. Hospitals can improve the accuracy of medication histories by having a subset of staff specialize in the process.
Read on to learn how to deploy medication history experts at your organization.
Specialization can improve quality and efficiency
Nurses are often asked to be a "jack of all trades" by taking on a long list of responsibilities. Yet, a basic economic principle is that specialization leads to greater efficiency.
For example, Shouldice Hospital, a Canadian specialty hospital solely focused on repairing hernias, operates twice as fast, at half the cost, with significantly better outcomes, than a typical hospital that performs hernia repair.
The first step in transferring work to specialized team members is to identify work that would benefit from specialization. Leaders should consider specializing work that is complex, completed by many caregivers (but only as a small portion of each of their jobs), and contributes to delays in care if not completed quickly and accurately.
Patient medication histories often inaccurate
While there are numerous patient care responsibilities that could be improved through specialization, leaders should consider inpatient medication reconciliation as a potential starting point.
The pie graphs below show that more than one-third of patients experience medication order errors upon admission, 85% of which are the result of inaccurate medication histories. Because medication reconciliation is complex work that can lead to errors if not performed accurately, it represents a strong opportunity to improve care quality through specialization.
Transfer medication reconciliation to the experts
At Fairview Ridges Hospital, pharmacists own the full medication reconciliation process in the Emergency Department (ED). A pharmacist in the ED collects medication lists, enters the lists into the EMR, and reconciles medications prior to physician review.
While this may seem costly, leaders at Fairview report much lower than average total pharmacy costs. Because of their expert knowledge, Fairview's pharmacists can keep drug costs low by recommending less-expensive substitutes as they review patients' medications. Even though pharmacy labor costs are at the 78th percentile, Fairview’s overall pharmacy costs are at the 11th percentile.
Deploy non-pharmacist med history experts in the ED
In addition to pharmacists, leaders should consider other individuals to fill the role of medication history specialist.
Vassar Brothers Medical Center dedicates two nurses exclusively to collecting medication histories in the ED during peak hours. After the nurse collects a patient's medication history and enters it into the EMR, a physician verifies it. Since deploying this model, 99% of patients admitted through Vassar's ED now have a complete medication history that includes their home medications.
St. Mary's Medical Center implemented a similar model using pharmacy technicians as medication history experts in the ED. St. Mary's equips the medication history technicians with "cheat sheets" to ensure they gather the Best Possible Medication History—a complete list of medications collected by systematically interviewing the patient and consulting other data sources such as the patient's family, retail pharmacy, and primary care physician.
Once the medication history technician enters the information into the EMR, a physician verifies the history. In less than one year after introducing the medication history technician role, the percentage of patients admitted through the ED with the Best Possible Medication History at St. Mary’s nearly doubled, from 45% to 82%.
Resources for Implementing a Medication History Expert
Learn more about how St. Mary's improved medication history accuracy by downloading a job description of their medication history technician role and the full medication history interview script.