title: Best possible medication history for hemodialysis patients obtained by a pharmacy technician.
abstract: BACKGROUND
  Outpatients undergoing hemodialysis are at high risk for adverse drug events. Limited resources make it challenging for pharmacists to routinely obtain a best possible medication history (BPMH).
  
  
  OBJECTIVE
  The primary objective was to determine whether, for patients undergoing hemodialysis, a pharmacy technician has the skills to obtain a BPMH that would allow a pharmacist to identify drug-related problems. The secondary objectives were to determine the number and types of medication discrepancies and drug-related problems identified and the time required by the technician to complete the BPMH.
  
  
  METHODS
  All patients treated in the hemodialysis unit during the study period were included, except for those who required an interpreter or were unable to participate in an in-person interview. A single technician was taught how to interview patients according to a structured format. For each patient, the technician's BMPH was verified by a pharmacist. The agreement rate between technician and pharmacists was determined, along with the number and types of discrepancies and drug-related problems identified.
  
  
  RESULTS
  The technician interviewed 99 patients. Of the 1334 medication orders reviewed, the technician and pharmacists agreed on all but 15 (agreement rate 98.9%). A total of 358 medication discrepancies were noted for 93 patients (3.8 discrepancies per patient). Of these, 210 (59%) were undocumented intentional discrepancies, and 148 (41%) were unintentional discrepancies (most commonly errors of commission). Of the 135 drug-related problems identified, the majority involved dosing problems or nonadherence. The technician required an average of 17 min for each interview.
  
  
  CONCLUSIONS
  An adequately trained technician was capable of interviewing patients to create a BPMH. A variety of medication discrepancies and drug-related problems were identified. Generation of a BPMH by a technician is a useful approach allowing pharmacists to identify drug-related problems.
authors.affiliation: , BScPharm, ACPR, PharmD, BCPS, BCPP, is a Clinical Pharmacy Specialist - Nephrology with the Pharmacy, Providence Health Care, Vancouver, British Columbia.
authors.forename: Marianna
authors.initials: M
authors.lastname: Leung
authors.forename: Joanne
authors.initials: J
authors.lastname: Jung
authors.forename: Wynnie
authors.initials: W
authors.lastname: Lau
authors.forename: Mercedeh
authors.initials: M
authors.lastname: Kiaii
authors.forename: Beverly
authors.initials: B
authors.lastname: Jung