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7/21/2003

Pharmacy Technicians Improve Surgery Safety

Kate Traynor

At Fairview Southdale Hospital in Edina, Minn., pharmacy technicians use their expertise to help reduce medication errors among surgical patients.

Two or three days before a patient is admitted to Fairview Southdale for scheduled surgery, a pharmacy technician telephones the person at home and obtains a detailed medication history. A clinical pharmacist next examines the medication list for problems and potential errors.

Patty Bodeker, one of the two pharmacy technicians involved in the project from its beginning, said the clinical pharmacists have detected medication strengths that do not exist, dosages that are too high for the age of the patient, and interactions that could be problematic.

On the day of surgery, a nurse reviews the completed medication history form with the patient, consulting the pharmacy technician when needed, and the surgeon approves the completed document.

Bodeker said that telephoning patients about their medications makes the drug history more accurate than gathering the information at the hospital on the day of surgery.

When patients are contacted at home, she said, "they can actually go to their medicine cabinets and look at the bottles." Using this method, she added, the patient can provide details, such as whether the medication is an extended-release formulation—information that the patient might not mention otherwise.

"We press them for information," Bodeker said. "We know that certain drugs can have potentially dangerous effects [for] patients when they come in for surgery."

The medication history program has had dramatic results. Fairview Health Services President David R. Page, in written testimony before the Senate last month, stated that the pharmacy team "has reduced medication errors in their hospital area by 84 percent."

Petrina Ceplecha, CPhT, who has also been involved in the project since its start, said plans are afoot to expand the program throughout most of the hospital. At Fairview University Hospital, another institution in the health system, Pharmacy Director Scott Knoer, Pharm.D., said he is working on a proposal to start a similar program.

Bodeker said that acquiring medication histories at Fairview Southdale had traditionally been done by the nurses, who initially resisted having pharmacy technicians take on the task.

"They've warmed up to it since, though," Bodeker said. Now, she added, the nurses "truly do like it, because we save them a lot of work and a lot of time. And it's our area of expertise, not theirs, so they're more than willing to hand it over."

She said that most patients have been receptive to working with the pharmacy technicians. Some patients who have already provided a medication history to one of the health system's clinics ask why that information cannot be transferred to the hospital. Bodeker said that this is impractical because the clinics and hospitals are separate entities.

In any case, she added, the medication histories obtained by the pharmacy technicians are "far more accurate" than those from the clinics.

"The questions we ask," Bodeker said, "are things that a physician's office does not ask [patients] about," such as detailed information about patients' use of nonprescription and herbal products.

"We go quite a bit into herbal medications" during the technician-conducted interviews with patients, Bodeker said. "A lot of herbals, we've discovered, act as blood thinners," she said, adding that many patients and physicians are unaware of this potential for trouble during surgery.

Bodeker described the project as "a timesaver all the way around, [for] pharmacist and technician both."

Ceplecha, who works mainly on Fairview Southdale's general medicine floor, said she has been involved in the admission process for many patients since the medication-history project spread.

"I really enjoy the contact with the patients and their families," she said, adding that the medication-history project "expands the pharmacy role of the technician."

"I really do see a lot of promise" for the program, she added.

Fairview Southdale's medication-history project was one of six programs to receive the 2002 ASHP Best Practices Award in Health-System Pharmacy. The award was presented to Ryan D. Michels, Pharm.D., and Steven Meisel, Pharm.D., Dec. 9, 2002, during the ASHP Midyear Clinical Meeting in Atlanta.