Transcript Pharmacy Technicians Role Expanding within Hospitals

DISCLAIMER
We are speaking today in an individual capacity and not
as employees of Alberta Health Services.
The views and opinions presented are entirely our own.
They do no necessarily reflect the views of Alberta
Health Services; Nor should they be construed as an
official explanation or interpretation.
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Expanding Scope of Practice
Technicians Performing
BPMH
Foothills Hospital
Calgary, AB
Hospitalist and Primary Care
Network (PCN) Patients
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Introduction
• Kristi Fauth – Started at FMC in July of 2006
• Mindy Kohar– Started at FMC in December of 2003
The Expanded Role in ED
• Two technicians and two pharmacists were chosen to pilot
this new role and it has been ongoing since October of
2009.
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General Info About Our
Site
933 beds currently at FMC.
There is a new tower being built that includes
an ICU expansion. Upon Completion, there will
be 1026 beds. Following
this there will also be a
pharmacy expansion.
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General info about our
pharmacy department
 Within our department we have a large team of
pharmacists, technicians and assistants. All of which
perform duties in/out of the main pharmacy providing
service to the entire site
 Clinical Pharmacist Activities include:
ED, Palliative, Oncology, ICU, CV-ICU, Cardiology,
Nephrology/transplant, Med Teaching Unit and
Hospitalists
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General info about our
pharmacy department
 Technician Responsibilities
Order Entry
Unit Dose delivery system
Oncology
Fill patient specific orders
Non sterile & sterile manufacturing
Tech Check Tech is in place at our site when filling refills,
delivering unit dose and in sterile & non sterile
manufacturing
 Assistant Responsibilities
Narcotics, Deliveries, Packaging, Re-stock Code Trays,
Wardstock and Inventory management
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BPMH
• Data from research show that 53% of patients have at least
ONE medication discrepancy upon admission.3
• 22-27% of those medication discrepancies had potential for
harm.3
• Best Possible Medication History (BPMH) is a process
where steps are taken to retrieve the most current, accurate
information of the patients home medications. Including
what medications they have taken in the recent past
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BPMH
• Because one source of information may not be completely up
to date we consult as many sources as possible
We have learned how to use Netcare however it may not list
all current meds and may not include any OTC products
• Sources of Medication Information
-Netcare
- Community Pharmacy
-Chart
- SCM/Prev. Hosp Recs
-Centricity
- Blister Packs/Vials
-Nursing Home MAR
-Interview
-MD Office
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Why BPMH?
• Physicians are usually not familiar with the patient and often do not
have access to the complete medical record. As a result, they are
not familiar with the patient’s medications, medical history, or
allergies
• The ED is known to be a particularly high-risk environment with
frequent medication errors1
• Ultimate Goal of BPMH: To compile the most accurate up to
date pt medication list
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BEST POSSIBLE MEDICATION HISTORY
Date:______________________________________
Name:_________________________________ PHN/ULI:________________________
FMC Loc:___________________ Pharmacy:_____________________ Phone:________________
Health Issue:_________________________________________
Medication
Strength
Frequency
Metoprolol 25mg
50mg
Bid
Hold/dc
SCM
Comments
X
Pt stopped taking last wk
Eye/ear drops: Y/N
Pain: Y/N
Vitamins: Y/N
Cold/Flu/Allergies: Y/N
Topical: Y/N
Herbals: Y/N
Bowels: Y/N
Sleep: Y/N
Heartburn: Y/N
Information sources:
_X_ EMS records
_X_ Pharmacy list
___ Family recall
___ Family Physician
_X_ Hospital records
_X_ Netcare
___ MAR from a facility
_X_ Patient recall
___ Vials
___ Blister pack
___ Other:___________________
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Medication Reconciliation
What is Med Rec?
A process of identifying the most accurate list of all medications a
patient is taking, including: Name – Dose – Frequency – Route.
Identifying any discrepancies and reporting them to a pharmacist.
Med Rec Involves:
• Start - Performing a BPMH
• Comparing the BPMH to a patient’s current medication orders in
hospital. In the hospital we have Computer Prescriber Order
Entry with a program called Sunrise Clinical Manager (SCM) for all
physicians orders
• To finish - Reconciling discrepancies with the medical team
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MED REC
• Primary goals of Med Rec process;
• To prevent/recognize/manage medication discrepancies.
• To Provide seamless care, from admission to discharge.The
ED lacks the ability for direct follow-up, and thus adverse
interactions between medications prescribed in the ED may
go unnoticed by the providers2
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Valuable Skills for this
Role
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



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Knowledge and Experience with medications
Independence within the workplace
Professional Confidence as a Technician
Communication / Conversation Skills
Organizational Skills
Multi Tasking
Ability to learn: data retrieval skills, resource searching,
computer programs
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Training
 Our Clinical Practice leader supplied us with a Med Rec
training Manual that is currently being used to train
Residents and Pharmacists
 Literature Searches - research into other hospitals who
have implemented med rec.
 Week 1 – Observed our CPL & Pharmacist
 Week 2 & 3 - We were performing the duties while being
supervised by our CPL & Pharmacist
 Week 4 – Fully trained and comfortable performing the
necessary duties
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Technicians in ED
 We were fortunate enough to receive an office in the
Emergency department. Two technicians and two
pharmacists rotate through shifts, currently Mon-Fri.
This office makes us easily accessible for any staff
members on the unit to find us with any concerns
regarding patients, missing medications or stock
 Professional Interactions
Physicians, Nurses, Respiratory Therapists, Echo
Cardiologists, and Porters
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Technicians in ED
 Patient Selection – New admissions and admitted
Hospitalist and Primary Care Network (PCN) patients
 We have the ability to look at all new pts first thing in the
morning to prioritize our day. We work on the newest
admits first - it is beneficial for the Nurses and
physicians if we can provide the current med list ASAP
 We see and average of 8 pts per day
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Technicians in ED
Hospitalist pts are decided by the complexity of their health
conditions and medication history. Usually COPD, CHF, falls,
UTI, pneumonia etc.
PCN pts have community physicians that are part of a
PCN group. They will flag on admittance and be assigned to
this service
Hospitalist patients total approx 160 - PCN patients total approx 40
Physicians and Nurses also make requests for pts outside these groups
depending on the circumstance
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A Day In The Life Of A Med Rec
Tech
 START
 Log on to SCM and prioritize our patients in the list and
print off their current admission orders
 Print out NETCARE for the patient medication profile
 Contact Community Pharmacy and have them fax the
medication profile for the last 6 months
 Access patient chart for any medication information
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A Day In The Life Of …
Write up the BPMH form with all of the collected patient
information
 Patient Interview is then performed. The patient is
asked about their prescription medications and any OTC
products they take. If family is present they can be
interviewed as well
 Contact other sources of information if needed - Ex:
Eye Clinic, Southern Alberta Clinic (SAC), other
hospitals, family members
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A Day In The Life Of …
Med Rec - Compare the medication
information between home medications and
what is currently ordered in the hospital.
Consult with Pharmacist
 FINISH
 The pharmacist will make their recommendation to the
physician on any changes if needed
The time it takes to see a single patient varies, on
average it will take approximately ½hr to 1hr per pt
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Other Duties
 Liaison between main Pharmacy and ED
 Inventory Control
 Suggestions on Increases and Decreases in
floorstock quota, additions and deletions of floorstock
meds
 H1N1 Pandemic Planning Support, stocked antivirals.
 Issues regarding medications for patients – missing /
delayed meds
 Modified Narcotic / Floorstock Order Forms
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NEW Duties
• As of the end of April we have started preparing
discharge printouts for our specific group of pts
• From ED the patient is transferred to a unit. When they
are ready for discharge they will receive a printout of
their scheduled meds
• If we are not busy in ED we will call the pharmacists on
the unit to see if we can assist them
• Also started scanning and saving all our BPMH info onto
a protected drive for any repeat patients
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The Experience
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Positive feedback from staff and patients
Beneficial for both departments
Job satisfaction
Providing seamless care
Future possibilities……..
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REFERENCES
1.
2.
3.
Croskerry P, Sinclair D. Emergency Medicine: A
practice prone to error? Canadian J of Emerg Med;
2001: 3(4)
Heininger-Rothbucher D, Bischinger S, Ulmer H, et al.
Incidence and risk of potential adverse drug
interactions in the emergency room. Resuscitation.
2001;49:283-288
Lizer et al, Gleason et al, Lubowski et al. Medication
history reconciliation by pharmacists in an inpatient
behavioural health unit. AM J Health-Syst Pharm.
2007;64:1087 – 1091.
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