Comparison of the Medication History Process at Two Emergency Departments in a Multi-Campus Health Care System
Purpose: The results of a study comparing the accuracy of medication histories obtained by pharmacy technicians against those obtained by nurses in an emergency department setting are described.
Methods: Patient census reports were reviewed to generate a list of patients who met the study criteria. A single pharmacist investigator interviewed a randomly selected subset of patients meeting the criteria. The pharmacist reviewed the medication history recorded in the electronic medical record and compared the record with information obtained from the patient or patient representative. Where discrepancies existed, the patient’s pharmacy and/or prescribing physician were queried for clarification. The discrepancies assessed include missing doses, missing frequencies, incorrect doses, incorrect frequencies, medications listed that the patient does not currently take, and medications the patient takes that were omitted from the record. The primary outcome is the number of discrepancies between nurse- and technician-obtained medication histories. Statistical significance was assessed via two-tailed t-tests. The secondary outcomes assessed include timeliness, cost of staff time involved, and physician satisfaction.
Results: The total number of errors was greater among nurseobtained histories vs. technician-obtained (111 vs. 77, p=NS). Likewise the number of errors involving prescription medications was greater with nurse- vs. technician-obtained histories (83 vs. 39, p=NS). Conversely, errors involving over-the-counter products were fewer when nurses obtained the histories vs. technicians (28 vs. 38, p=NS).
Conclusion: While statistical superiority was not achieved, the present study determined that technician-obtained medication histories are at least as accurate as those obtained by nurses, and take less time to complete. There is also a higher level of perceived satisfaction among providers with the technician model, particularly with regard to timeliness.
Shaun W. Phillips, Chad Norkus, Angela Green