AHRQ Research Inspires Efforts at Banner Desert To Reduce Drug Errors in E.D. Patients

AHRQ-sponsored research on how clinical pharmacy services can reduce medication-related errors in emergency departments (E.D.) helped inspire Banner Desert Medical Center in Mesa, Arizona, to expand its current E.D. pharmacy program. Clinical pharmacists at the 549-bed hospital now depend on pharmacy technicians to work with E.D. patients to collect patients' medication histories, helping improve the safety of patients who are admitted through the E.D. The program also saves time for nurses and doctors who previously collected the information, and is making the hospital's clinical pharmacist program more effective.

Banner Desert has four full-time pharmacy technicians and one part-time technician identifying patients who are admitted to the hospital from the E.D. The technicians interview these patients to learn what drugs, vitamins, and supplements they take, as well as the dose, frequency, and pharmacy they use, in case staff needs to call and verify an unknown drug or dose. Technicians enter the information into the patient's medication history exactly as the patient states. This helps clinicians understand why the patient landed in the hospital in the first place (e.g., for failing to take medicine properly). 

"Our medication history program started in 2013 and has been successful," said Jake Regnitz, Pharm.D., Banner Desert's pharmacy operations senior manager. Three months after implementing the program, the specialized pharmacy technicians were capturing the medication histories of nearly 90 percent of patients admitted to the hospital through the E.D. According to Dr. Regnitz, Banner Desert's E.D. is the busiest in the state, with 120,000 E.D. visits and 48,500 E.D. patient admissions in 2013.

Dr. Regnitz said that the effort has been successful enough at hospitals with medication history programs that Phoenix-based Banner Health, one of the nation's largest nonprofit health care systems, wants to roll out the program to two additional hospitals—and possibly system-wide in 2015. He adds that Banner Health is looking to standardize metrics for the program. The Institute of Medicine has identified medication errors as the most common type of error in health care.

Banner's effort directly links back to research funded under AHRQ's "Partnerships in Implementing Patient Safety" grants. The effort was headed by Rollin J. Fairbanks, M.D., M.S., when he was with the University of Rochester. Among other conclusions, Dr. Fairbanks and his colleague Daniel B. Hays, Pharm.D., B.C.P.S., found that pharmacists in the E.D. often devoted an inordinate amount of time to tasks that could be done by well-qualified technicians.

"Looking back at the original AHRQ research, one of our goals was to fully optimize the role/duties of the emergency pharmacist," said Dr. Hays, who is now a clinical pharmacy specialist at Banner Desert. "I believe that the E.D.-based pharmacy technician is an extension of this. It allows the pharmacist working in the E.D. to focus on high-yield duties, such as code response and physician/patient consultation. Implementing a technician [for other tasks] allows the pharmacist to oversee their work and extend a pharmacy presence."

In overseeing the technicians' work, the E.D. pharmacist can interpret the patient's medication history to look for adverse events, one of the many reasons patients come to the E.D. With the data, the E.D. pharmacist also can work to identify medication interactions and over-utilization.

"Many times, we see patients taking multiple drugs for the same condition, which may or may not be the reason for the patient visit or admission. The pharmacist is best trained to recognize this form of error," Dr. Hays noted. "We work with the patients and the physicians to ensure that when patients leave, their therapy is truly optimal."

Before the change at Banner Desert, the medication history was completed by nurses; when issues arose, they "resulted in a significant amount of time spent on the back end by pharmacists clarifying incorrect strengths and dosages," Dr. Regnitz explained. Today, fewer clarifications are needed. When clarification is required, it's faster because the technicians have included the patient's pharmacy phone number in their chart.

"Another significant improvement: more patients' medication histories are completed by the time the physician reorders the patient's home medications," said Dr. Regnitz. "Before, it was not unheard of to have old dosages or meds no longer taken to be reordered by the physician. From a patient care standpoint, it's now safer for the patients, and it frees up more of the nurses' and physicians' time. There is also cost savings, since techs cost much less compared to physicians and nurses."

The program also helps E.D. patients who are not admitted to the hospital. By collecting medication histories of those patients, Banner Desert can provide them with medication and counseling for diabetes or psychiatric issues even if they have left their medication at home. 

"Physicians and nurses absolutely love that pharmacy is able to provide this service," Dr. Regnitz said.