Charting history: Pilot program puts pharmacy technicians in charge of interviews seeking patients’ medication histories

When it comes to getting accurate lists of the medications children have been taking when they’re admitted to the hospital, Missy McCrary and Adriana Ordaz are on the case.

Since June, the two certified pharmacy technicians with 19 and 15 years of experience respectively have been conducting medication history interviews for patients in the Emergency Department and 5 Henson-Hall and 6 Henson Towers. Their work as Medication History Technicians is part of a pilot program intended to more efficiently obtain information about what medications patients are taking at home and what they may need while in the hospital– data that’s crucial to treatment decisions.

“Medication history information is key for high quality ‘medication reconciliation,’ defined as comparing medication the patient is taking at home to inpatient medication orders,” according to Pharmacy Manager Bethany Baker, PharmD, MSHA, who led development of the pilot.

“Without appropriate medication reconciliation, patients are at risk for adverse drug reactions, inappropriate therapies, withdrawals and other issues,” increasing both cost – about $5,000 per adverse event -- and most importantly, jeopardizing patient safety.

Which makes Missy’s and Adriana’s new roles as Medication History Technicians significant.

Assigned accountability

Responsibility for conducting med history interviews has previously been shared by whomever on the care team was available -- care assistants, bedside nurses, admitting physicians, residents or pharmacists. So Bethany tapped Medication Safety Coordinator Damon Pabst, RPh; Clinical Pharmacist Brandon French, PharmD, BCPS; and Pharmacy Informatics Training Coordinator Cinthia Priest, PharmD, to review best practices and identify a path forward. Their goal: make pharmacy team members responsible for 100 percent of the medication histories conducted at Children’s Mercy for admitted inpatients.

Creating two positions dedicated to medication histories within the Pharmacy Technician team, and choosing Missy and Adriana to fill them, were the first steps on that path. Training in using the hardware and software required for data entry as well as techniques for conducting interviews, followed.

The facts of the matter

Getting an accurate medication history requires both investigative and people skills -- attention to detail, a sharp eye to spot discrepancies and an ability to make family members feel comfortable sharing information that’s important for the health care team to know.

Missy (left) and Adriana (right) were selected for the medication history pilot program because of their knowledge, experience and ability to make families feel comfortable sharing information.

Missy and Adriana review medication details documented at admission as well as previous prescription records, make follow-up calls to outside pharmacies and physicians’ offices to verify details and escalate discrepancies they discover to the pharmacists.

“Sometimes we find documentation that requires investigation, verification and validation,” Missy explained. “We’re investigators trying to solve a mystery.”

“We do a lot of research before going to the patient’s room to talk to families,” Adriana added.

It’s in those conversations where science becomes art, through thoughtful, respectful and nuanced interviewing techniques that can reveal important clues. These were skills Cinthia focused on as she developed a month-long training regimen to prepare Missy and Adriana for this key expectation of their expanded positions.

“Having worked with both of them, I know they are super-smart, have years of experience as pharmacy techs, and over time have asked questions and absorbed information about drugs and dosages beyond what’s necessary for their roles. So they came into these positions with some background,” Cinthia said.

“But I knew they would need a deeper dive,” she added. “To get the best possible med history interviews, they would need to be able to leave any personal opinions at the door, and create a safe, non-judgmental space for families to feel comfortable sharing information they might be hesitant to reveal.”

Through a series of “what-ifs” – what if a parent did this, or a patient did that – Cinthia served up scenarios Missy and Adriana might encounter. She intentionally included examples of situations that could cause tempers to flare, let them practice ways to respond, and suggested calm, respectful ways of phasing questions to elicit responses pertinent to their investigations.

“I can’t say enough about Cinthia’s training,” Missy said. “She gave us drills that put obstacles in our path requiring quick thinking – a frightened parent, a teen patient taking birth control that the parent in the room doesn’t know about, caregivers who don’t have complete information or are afraid to admit the child hasn’t been taking the medication as prescribed.”

“We learned trigger questions that might cause a parent to light up and say, ‘oooh, yes, he’s also taking this,’” said Adriana, who is bilingual and finds providing support to Spanish-speaking families especially rewarding.

“We’re there to make the patient and family feel comfortable, working together to get the information the doctors, nurses and pharmacists need. We are not there to judge,” she said.

Moving forward

Bethany is pleased with the progress of the pilot so far, so much so that services are being extended this month to 6 Hall and 4 Henson Towers. Since its inception, Adriana and Missy have completed an average of 685 histories a month, which increases the rate of medication histories obtained by a pharmacy team to 33.91 percent.

Other members of the care team have expressed appreciation for their work.

“What we’re doing frees up their time to focus on treatment, instead of histories, so they can move forward with the work at their level,” Adriana said.

“We know the names of many of the drugs and how to spell them. We’ve seen common dosages for babies vs. 16-year-olds. So if we see something that doesn’t sound right, we can escalate it to a pharmacist,” Missy said. “The bottom line is making sure the care team has the right information to ensure kiddos are getting the right dose of the right medications for their care.”

On to the next case.

Learn more about Pharmacology & Toxicology at Children's Mercy