title: A prospective cohort study of medication reconciliation using pharmacy technicians in the emergency department to reduce medication errors among admitted patients.
abstract: BACKGROUND
  The collection of a complete, verified medication history is essential to patient safety. The involvement of clinical pharmacists has been shown to improve the completeness and accuracy of medication histories; however, to our knowledge, involvement of pharmacy technicians has not been studied.
  
  
  OBJECTIVE
  Our aim was to determine whether verification of medication histories by pharmacy technicians in the emergency department (ED) would result in fewer errors in inpatient medication regimens compared to verification by the admitting physician team.
  
  
  METHODS
  We performed a prospective cohort study of adult ED patients admitted for continuing care. In the intervention group, medication reconciliation was performed by pharmacy technicians in the ED before the creation of physician admitting orders. In the control group, pharmacy technicians conducted their history taking later, after admission. Initial admitting orders were then compared to the pharmacy technicians' medication reconciliation taken before admission (intervention group) or after admission (control group). Medication discrepancies were classified and determined to be justified or unjustified. Unjustified discrepancies were rated for harm potential.
  
  
  RESULTS
  In our cohort of 113 intervention and 75 control subjects, the mean age was 55 years (standard deviation [SD] 16 years); 96 patients (51%) were male. In the intervention group, 566 changes to home medications were observed on admission; 352 (62%) were unjustified. Among controls, 406 changes to home medications were observed; 228 (56%) were unjustified. This difference was not statistically significant (p = 0.0586). The rate of unjustified medication changes per patient was likewise not significantly different (3.14 [SD 2.98] in interventions vs. 3.17 [SD 2.81] in controls; p = 0.9570). The rate of medical errors did not differ between study groups, nor did severity ratings of unjustified changes.
  
  
  CONCLUSIONS
  Medication reconciliation by pharmacy technicians in the ED did not lead to a significant reduction in unjustified medication discrepancies.
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Sarah Wallace
authors.initials: SW
authors.lastname: Cater
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Matthew
authors.initials: M
authors.lastname: Luzum
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Allison E
authors.initials: AE
authors.lastname: Serra
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Meredith H
authors.initials: MH
authors.lastname: Arasaratnam
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Debbie
authors.initials: D
authors.lastname: Travers
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ian B K
authors.initials: IB
authors.lastname: Martin
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Trent
authors.initials: T
authors.lastname: Wei
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000458:organization & administration*; D008875:Middle Aged; D010343:Patient Admission; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D011446:Prospective Studies
keywords: medical errors; medication reconciliation; patient safety; pharmacy technician; quality improvement