Journal of Research in Pharmacy Practice

Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

Document Type : Original Article

Authors

. Thomas Croft Buck 1
. Louise Smed Gronkjaer 1
. Marie-Louise Duckert 1
. Jens-Ulrik Rosholm 2
. Lise Aagaard 3

1 Department of Clinical Pharmacy, Odense University Hospital Pharmacy, Odense, Denmark Department of Clinical Pharmacy, Hospitals Unit for Quality Assurance of Medicines Use, Odense University Hospital, Odense, Denmark

2 Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark

3 Department of Clinical Pharmacy, Hospitals Unit for Quality Assurance of Medicines Use, Odense University Hospital, Odense, Denmark Clinical pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark

Abstract
Objective: Incomplete medication histories obtained on hospital admission are responsible 
for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy 
technicians can assist hospital physicians’ in obtaining medication histories by performing 
medication reconciliation and prescribing reviews. A secondary aim was to evaluate whether 
the interventions made by pharmacy technicians could reduce the time spent by the nurses 
on administration of medications to the patients.
Methods: This observational study was conducted over a 7 week period in the geriatric 
ward at Odense University Hospital, Denmark. Two pharmacy technicians conducted 
medication reconciliation and prescribing reviews at the time of patients’ admission to the 
ward. The reviews were conducted according to standard operating procedures developed 
by a clinical pharmacist and approved by the Head of the Geriatric Department.
Findings: In total, 629 discrepancies were detected during the conducted medication 
reconciliations, in average 3 for each patient. About 45% of the prescribing discrepancies 
were accepted and corrected by the physicians. “Medication omission” was the most 
frequently detected discrepancy (46% of total). During the prescribing reviews, a total of 860 
prescription errors were detected, approximately one per medication review. Almost all of 
the detected prescription errors were later accepted and/or corrected by the physicians. 
“Dosage and time interval errors” were the most frequently detected error (48% of total). 
The time used by nurses for administration of medicines was reduced in the study period.
Conclusion: This study suggests that pharmacy technicians can contribute to a substantial 
reduction in medication discrepancies in acutely admitted patients by performing medication 
reconciliation and focused medication reviews. Further randomized, controlled studies 
including a larger number of patients are required to elucidate whether these observations 
are of significance and of importance for securing patient safety.

Keywords

Geriatric ward
medication administration time
medication reconciliation
  medication review
pharmacy technicians
1. Lewis PJ, Dornan T, Taylor D, Tully MP, Wass V, Ashcroft DM. 
Prevalence, incidence and nature of prescribing errors 
in hospital inpatients: A systematic review. Drug Saf 
2009;32:379-89.
2. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, 
Etchells EE. Frequency, type and clinical importance 
of medication history errors at admission to hospital: 
A systematic review. CMAJ 2005;173:510-5.
3. Tully MP, Ashcroft DM, Dornan T, Lewis PJ, Taylor D, 
Wass V. The causes of and factors associated with prescribing 
errors in hospital inpatients: A systematic review. Drug Saf 
2009;32:819-36.
4. von Laue NC, Schwappach DL, Koeck CM. The epidemiology 
of preventable adverse drug events: A review of the literature. 
Wien Klin Wochenschr 2003;115:407-15.
5. Gardella JE, Cardwell TB, Nnadi M. Improving medication 
safety with accurate preadmission medication lists and 
postdischarge education. Jt Comm J Qual Patient Saf 
2012;38:452-8.
6. Musgrave CR, Pilch NA, Taber DJ, Meadows HB, 
McGillicuddy JW, Chavin KD, et al. Improving transplant 
patient safety through pharmacist discharge medication 
reconciliation. Am J Transplant 2013;13:796-801.
7. Ghatnekar O, Bondesson A, Persson U, Eriksson T. Health 
economic evaluation of the lund integrated medicines 
management model in elderly patients admitted to hospital. 
BMJ Open 2013;3:pii: e001563.
8. Lee YY, Kuo LN, Chiang YC, Hou JY, Wu TY, Hsu MH, et al. 
Pharmacist-conducted medication reconciliation at hospital 
admission using information technology in Taiwan. Int J Med 
Inform 2013;82:522-7.
9. Galvin M, Jago‑Byrne MC, Fitzsimons M, Grimes T. Clinical 
pharmacist’s contribution to medication reconciliation on 
admission to hospital in Ireland. Int J Clin Pharm 2013;35:14-21.
10. van den Bemt PM, van den Broek S, van NunenAK, Harbers JB, 
Lenderink AW. Medication reconciliation performed by 
pharmacy technicians at the time of preoperative screening. 
Ann Pharmacother 2009;43:868-74.
11. Johnston R, Saulnier L, Gould O. Best possible medication 
history in the emergency department: Comparing pharmacy 
technicians and pharmacists. Can J Hosp Pharm 2010;63:359-65.
12. Flynn EA, Barker KN, Pepper GA, Bates DW, Mikeal RL. 
Comparison of methods for detecting medication errors in 
36 hospitals and skilled-nursing facilities. Am J Health Syst 
Pharm 2002;59:436-46.
13. van den Bemt PM, van der Schrieck-de Loos EM, van der 
Linden C, Theeuwes AM, Pol AG, Dutch CBO WHO High 
5s Study Group. Effect of medication reconciliation on 
unintentional medication discrepancies in acute hospital 
admissions of elderly adults: A multicenter study. JAm Geriatr 
Soc 2013;61:1262-8.
14. Brownlie K, Schneider C, Culliford R, Fox C, Boukouvalas A, 
Willan C, et al. Medication reconciliation by a pharmacy 
technician in a mental health assessment unit. Int J Clin Pharm 
2013;Nov 15. DOI: 10.1007/s11096-013-9875-8
Journal of Research in Pharmacy Practice
Volume 2, Issue 4
Autumn 2013
Pages 145-150

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