Inaccurate medication histories present a serious safety concern for patients and healthcare organizations. Previous studies suggest that a little less than half of medication histories collected contain errors (e.g. incorrect dosage, omissions, etc.), of which, almost a fifth have potential to cause the patient harm.
However, national best practices for collecting medication histories have yet to be determined.
Vidant Health System wanted to investigate an approach to standardizing practices for collecting medication histories across their system. However, with hospitals in the system ranging from small and rural facilities, to a large academic teaching centre, a solution would not be one size fits all. Vidant Health’s Lean department were tasked with considering potential local constraints.
SIMUL8 was utilized by Process Improvement Coordinator, Amanda Peterson, to test an approach to standardizing medication histories and collect data and observations to support recommendations to senior leadership.
The process and simulation results
Using SIMUL8, Amanda developed a simulation to assess the feasibility of integrating a Pharmacy Technician into Vidant Duplin Hospital’s ED to collect patient medication history - a process currently carried out by nurses.
The process also involved the use of scripted patient interviews for collecting comprehensive medication history. The interviews covered everything from prescription medication to over the counter medication, including dietary supplements and ointments. Each interview could take anywhere between 15 to 30 minutes, depending on the patient’s medical history and how accurate the records have been up to that point.
Amanda’s simulation mapped out this entire process, utilizing existing ED data along with the required resources. The Pharmacy Technician was added to the ED simulation for seven days a week, operating an eight hour shift during the busiest hours (3.00PM and 11.00PM).
“We kept the simulation fairly simple. Even with that simplicity, it still worked and it mirrored what we are seeing now. I was very surprised at how simple the model was to build. Overall, it only took me about 60 minutes to develop the simulation.”
Patients were prioritized so that the Pharmacy Technician would see them based on the order to consult. If the patient had to be admitted, then technician would know that that patient would come first.
As this process could take up to 30 minutes, other constraints and expiry times were also modeled, so when the Pharmacy Technician was busy collecting histories, then this would default to an emergency department relief nurse.
The simulation identified that the implementation of a Pharmacy Technician would result in 14 medication histories collected per day. This was an increase over the current 10 per day, even with a lengthier, comprehensive scripted interview process for collecting medication histories from patients.