Medication histories by pharmacy technicians and physicians in an emergency department

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

BACKGROUND

Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician's responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs.

METHODS

An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021.

RESULTS

In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians' work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks.

CONCLUSION

In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.

[Medication reconciliation: Interests and limits]

Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. The practice of medication reconciliation is securing for the patient because of the medication errors detected with significant clinical impact. Its implementation must comply with the recommendations of the French National Authority for Health (HAS) and its deployment is now integrated into the contract for improving the quality and efficiency of care (CAQES). However, although it allows to intercept medication errors, its impact on the length of hospitalization, the rate of readmission and/or death following discharge seems limited. Given the limited human resources to carry out this time-consuming activity, patient prioritization should be considered. Studies on the fate of patients and on the medico-economic issues are also necessary in order to make this activity sustainable.

What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: A systematic review

Pharmacy services within hospitals are changing, with more taking on medication reconciliation activities. This systematic review was conducted to determine the measured impacts of Pharmacy teams working in an acute or emergency medicine department. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered on PROSPERO, National Institute for Health and Care Research, UK registration number: CRD42020187487. The systematic review had two co-primary aims: a reduction in the number of incorrect prescriptions on admission by comparing the medication list from primary care to secondary care, and a reduction in the severity of harm caused by these incorrect prescriptions; chosen to determine the impact of pharmacy-led medication reconciliation services in the emergency and acute medicine setting. Seventeen articles were included. Fifteen were non-randomized controlled trials and two were randomized controlled trials. The number of patients combined for all studies was 7630. No studies included were based within the UK. All studies showed benefits in terms of a reduction in medicine errors and patient harm, compared to control arms. Nine articles were included in a statistical analysis comparing the pharmacy intervention arm with the non-pharmacy control arm, with a Chi2 of 101.10 and I2 value = 92%. However, studies were heterogenous with different outcome measures and many showed evidence of bias. The included studies consistently indicated that pharmacy services based within acute or emergency medicine departments in hospitals were associated with fewer medication errors. Further studies are needed to understand the health and economic impact of deploying a pharmacy service in acute medical settings including out-of-hours working.

Emergency department physicians' distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities

Background In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient's drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians' activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients' drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.

Pharmacists in advanced clinical practice roles in emergency departments (PARED)

Background Following evidence published in the Pharmacists in Emergency Departments (PIED 2016) study Health Education England funded novel advanced clinical practitioner training for pharmacists (ACP-p), to support service delivery.Objective To explore experiences and clinical activity of trainee ACP-p, and opinions and recommendations of both trainees and clinical supervisors.Setting Five Urgent/Emergency Care Departments in London UK.Method Longitudinal mixed-methods study in three phases of registered UK pharmacists appointed as trainee ACP-p. Phase 1 (May-July 2019) - early semi-structured interviews and focus group using an experiences, opinions and recommendations (EOR) framework, Phase 2 (January-December 2019) - prospective recording of trainee clinical activity, standardised using bespoke spreadsheet, Phase 3 (November-December 2019) - as Phase 1 but at conclusion of training.Main outcome measure Experiences, clinical activity, opinions and recommendations of study participants.Results Twelve (92 %) eligible trainee ACP-p and five supervisors were recruited. Identified themes were: trainee personality, educational components, length of programme, support/supervision, career transition, university and placement training alignment, recommendations. Success was dependent on effective support and supervision. Clinical supervisors should be allocated adequate supervision time. Trainees, their supervisors and emergency department staff should be given a clear brief. Study participants agreed that the programme could be successful. Trainee ACP-p reported that they could manage 82 % of 713 pre-selected clinical presentations. Additional training needs include: ECGs, X-rays and CT scans.Conclusions Pharmacists can successfully train as ACP-p in this setting over a two-year period. This career transition needs careful management and clear structures. Training ACP-p is a useful way of enhancing skills and supporting clinical services to large numbers of patients.

Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications

Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non-adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9-15] medications listed and 3 [IQR 1-5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non-adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.

Pharmacy-facilitated medication history program at a community teaching hospital: A pre-post study in an emergency department

PURPOSE

A study was conducted to compare the accuracy of medication histories compiled by pharmacy technicians with histories obtained through the usual multidisciplinary process.

METHODS

A retrospective cohort study was conducted at a community teaching hospital from January 2017 through February 2018. Inclusion criteria included patient age of at least 18 years, use of 1 or more medications at the time of admission, and hospital admission through the emergency department. Each electronically documented medication history was assessed for accuracy. The objective was to compare the accuracy of pharmacy technician-collected medication histories to those obtained through the usual multidisciplinary process.

RESULTS

Of 215 patients screened, 183 were included in the study: 91 patients whose medication histories were obtained through the usual multidisciplinary process and 92 whose medication histories were collected by pharmacy technicians. Overall, documentation for 1,773 medications listed in medication histories was reviewed. The primary outcome of medication history accuracy occurred 38% of the time with the usual multidisciplinary process and 70% of the time with pharmacy technician collection of medication histories (P < 0.001).

CONCLUSION

The study showed that the accuracy of medication histories was improved when histories were obtained by pharmacy technicians instead of via the usual multidisciplinary process.

Description of Position Ads for Pharmacy Technicians

Pharmacy technician roles are evolving alongside the changing role of a pharmacist. There is currently no uniform definition of a pharmacy technician's role in the pharmacy workforce. The objective of this study was to look at the United States-based pharmacy technician advertisement database from Pharmacy Week to find patterns and commonalities in the duties and qualifications of pharmacy technicians. A retrospective analysis was performed on fourteen days of pharmacy technician job listings from Pharmacy Week from the year 2018. Information obtained from the listings included job title, location, setting, type of job, job duties, and job requirements. Job duties and requirements were coded by themes. Fourteen days of data resulted in 21,007 individual position listings. A majority of the job listings were for full-time positions (96.4%) and most were in the retail setting (96.78%). The most common requirements were registration with State Board, high school diploma, ability to perform tasks, communication, and physical. The most common job duties were general office etiquette, performing tasks under the direct supervision of the pharmacist, and professionalism. This study provides a description of the evolving role of pharmacy technicians through the broad variety in expectations for requirements of pharmacy technician applicants and the duties they perform when hired.

Variability in training, practice, and prioritization of services among emergency medicine pharmacists

Purpose

The purpose of this survey-based research project is to identify factors, including prior training, institution demographics, and pharmacist prioritization of services that may impact variability in practice among emergency medicine (EM) pharmacists.

Methods

An electronic survey was available for 6 weeks. Participants were contacted through professional membership directories. Survey questions addressed EM pharmacist training and institution demographics. Pharmacists were asked to define the frequency with which they performed ASHP-identified best practice services.

Results

Responses were received by 208 pharmacists (response rate = 9.4%) who were primarily from academic (48.1%) or community (47.6%) emergency departments (EDs). Pharmacists working in an academic ED were more likely to have EM postgraduate year 2 training (27.8%) compared to a community ED (11.2%) (p = 0.0182). Pharmacists practicing in an academic emergency department (ED) reported participating in traumas, care for boarded patients, and performing scholarly activities more frequently (p < 0.01) and medication reconciliations less frequently (p < 0.01) than those in a community ED. Most EM pharmacists reported postgraduate year 1 training (45.7%) as compared to postgraduate year 2 EM (18.3%) or critical care (13.7%) pharmacy residency training.

Conclusion

Institution and ED demographics as well as pharmacist level of training can affect the frequency of services provided in the ED setting.

Prevalence, clinical relevance and predictive factors of medication discrepancies revealed by medication reconciliation at hospital admission: prospective study in a Swiss internal medicine ward

OBJECTIVE

Medication reconciliation (MedRec) is a relevant safety procedure in medication management at transitions of care. The aim of this study was to evaluate the impact of MedRec, including a best possible medication history (BPMH) compared with a standard medication history in patients admitted to an internal medicine ward.

DESIGN

Prospective interventional study. Data were analysed using descriptive statistics followed by univariate and multivariate Poisson regression models and a zero-inflated Poisson regression model.

SETTING

Internal medicine ward in a secondary care hospital in Southern Switzerland.

PARTICIPANTS

The first 100 consecutive patients admitted in an internal medicine ward.

PRIMARY AND SECONDARY OUTCOME MEASURES

Medication discrepancies between the medication list obtained by the physician and that obtained by a pharmacist according to a systematic approach (BPMH) were collected, quantified and assessed by an expert panel that assigned a severity score. The same procedure was applied to discrepancies regarding allergies. Predicting factors for medication discrepancies were identified.

RESULTS

The median of medications per patient was 8 after standard medication history and 11 after BPMH. Total admission discrepancies were 524 (5.24 discrepancies per patient) with at least 1 discrepancy per patient. For 47 patients, at least one discrepancy was classified as clinically relevant. Discrepancies were classified as significant and serious in 19% and 2% of cases, respectively. Furthermore, 67% of the discrepancies were detected during the interview conducted by the pharmacist with the patients and/or their caregivers. The number of drugs used and the autonomous management of home therapy were associated with an increased number of clinically relevant discrepancies in a multivariable Poisson regression model.

CONCLUSION

Even in an advanced healthcare system, a standardised MedRec process including a BPMH represents an important strategy that may contribute to avoid a notable number of clinically relevant discrepancies and potential adverse drug events.

Using pharmacy technicians and telepharmacy to obtain medication histories in the emergency department

OBJECTIVES

To determine if telepharmacy can be used to collect medication histories on patients admitted in the emergency department (ED) in a large health system.

PRACTICE DESCRIPTION

As part of an effort to address safety concerns, resource limitations, and a decline in medication history completions, a program was developed to use telepharmacy to conduct medication histories on patients admitted in the ED.

SETTING

The medication history program covers 5 large facilities. It is staffed by 6 full-time pharmacy technicians 7 days a week and is overseen by a pharmacist.

INNOVATION

Medication histories are conducted with the use of mobile carts enhanced with videoconferencing equipment allowing technicians to operate from a remote central location. The program allows the technicians to observe multiple EDs at one time, interview patients through videoconferencing, and document completed medication histories in the electronic medical record (EMR). The technicians also transcribe preoperation (pre-op) medication lists for patients being admitted for surgeries.

EVALUATION

Medication history completion rates and barriers were assessed. In addition, potential medication errors, medication history accuracy rates for nursing and pharmacy technicians, and a cost analysis of preventable ADEs were explored.

RESULTS

The program, on average, conducts medication histories on 56% to 79% of patients admitted through the ED during hours of operation. In fiscal year 2018, the technicians entered 24,980 medication histories and pre-op lists. A cross-sectional analysis of data collected from December 2016 to March 2017, including 124 patients, revealed 320 potential medication errors among a total of 382 high-risk medications.

CONCLUSION

Based on the current performance and continued expansion of this novel strategy, use of telepharmacy to obtain medication histories in the ED has led to resource optimization for the remote delivery of a pharmacy service.

[Involvement of hospital pharmacy technician for expanding medication reconciliation process in France: Actors' willingness and opinions]

OBJECTIVES

Medication reconciliation is widely promoted by international health authorities. Its expansion requires human resources, which are limited and unequally distributed among health care facilities. Recent international studies support the involvement of pharmacy technician in the medication reconciliation process but his role remains unstructured in France. We aimed to assess pharmacy technicians' opinions and willingness to be involved in the medication reconciliation process expansion and to identify the levers and barriers of the project.

METHODS

A field study was conducted among health facilities of our territory hospital group. Semi-structured interviews were carried out with different pharmacy technicians. Data were analyzed using a qualitative thematic analysis approach.

RESULTS

Overall, 12 pharmacy technicians from 5 hospitals were interviewed and almost all assumed their rightful place in the medication reconciliation process (n=11), with a view to revaluating tasks. For all pharmacy technicians, the main barriers to participate in medication reconciliation were the lack of time and training. The spread of a "patient culture", the supervision by pharmacists, the desire to be part of the care team in the ward and additional training requests were major levers of change.

CONCLUSIONS

Pharmacy technicians' role in expanding medication reconciliation process is legitimate and must be standardized in France. The deployment of the project requires to be formalized within a territory and should consider and develop local organisations.

An environmental scan of medication history technician programs within the Veterans Health Administration

PURPOSE

Results of a study to identify medication history technician (MHT) programs within the Veterans Health Administration (VHA) and to evaluate the personnel, structure, and scope of such programs are reported.

METHODS

Specially trained pharmacy technicians can take accurate patient medication histories and contribute to the medication reconciliation process. An environmental scan of MHT programs within VHA was conducted via an email query of pharmacy personnel. Semistructured interviews of personnel at each responding site (an MHT, a pharmacist, or both) were conducted.

RESULTS

Ten VHA sites had existing MHT programs; the earliest was initiated in 2010. Sites employed from 1 to 4 MHTs, who most commonly worked in the inpatient setting (7 sites). At most sites (9), MHTs obtained a "best possible medication history" through systematic collection of medication information using 2 reliable sources, such as patients, caregivers, and medical records. Survey respondents at all sites reported benefits of MHT programs, including dedicated time to obtain medication histories, allowing for more effective use of pharmacists' time. Six sites were eager to increase the reach of their programs. MHT training, oversight, and quality assurance varied across the sites. The survey results indicated that there are opportunities nationally-within and outside VHA-to develop standardized training, competency assessments, and quality assurance measures for MHT programs.

CONCLUSION

Ten VHA sites with MHT programs were identified. MHTs most commonly worked in inpatient settings as part of admission medication reconciliation processes.

Hospital pharmacy technicians practice and perceptions in France and Quebec, Canada

OBJECTIVES

To describe practice and perceptions of hospital pharmacy technicians (HPTs) in France and in Quebec, Canada. The secondary objective was to compare both work settings to identify differences.

METHODS

Cross-sectional online survey in December 2016 and February 2017. The survey was comprised of four sections: demographic, factors contributing to career choice and satisfaction, perceptions regarding training, skills and recognition and interest in new opportunities. The proportion of responses from respondents in France and Quebec was compared with a chi-squared test.

KEY FINDINGS

There were 101 respondents from France and 224 from Quebec. In comparison with Quebec respondents, French respondents came from large hospitals (France: 87%, 84/97 versus Quebec: 50%, 112/223, P < 0.001). Few HPTs supported pharmacists' clinical activities (France: 4%, 4/97 versus Quebec: 29%, 65/222, P < 0.001). A majority of HPTs indicated that working in the healthcare field contributed to their job satisfaction (France: 94%, 87/93 versus Quebec: 90%, 188/209). Respondents found their training sufficient (France: 54%, 49/90 versus Quebec: 78%, 159/205, P < 0.001). However, few identified having access to sufficient continuing education (France: 40%, 36/90 versus Quebec: 29%, 59/205). Not many thought that their job was well recognized in their centre (France: 13%, 12/90 versus Quebec: 13%, 26/203). However, they felt it had a direct impact on the quality of care, especially in Quebec (France: 86%, 77/90 versus Quebec: 98%, 199/203, P < 0.001). The majority was interested in supporting the pharmacists' clinical activities (France: 91%, 78/86 versus Quebec: 82%, 163/199).

CONCLUSIONS

Overall, HTP from France and Quebec shared a satisfaction about their profession. They showed an interest in increased recognition and responsibilities (e.g. training, pharmacist support).

Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study

OBJECTIVES

In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians.

DESIGN

Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach.

SETTING

Internal medicine units in two mid-sized Swiss hospitals.

PARTICIPANTS

21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians).

RESULTS

Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries.

CONCLUSION

The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety.

Pharmacy Students and Pharmacy Technicians in Medication Reconciliation: A Review of the Current Literature

Objective:

A literature review was conducted to examine how pharmacy students and technicians have been utilized in medication reconciliation processes in an effort to evaluate expanded roles for pharmacy students and technicians. Data were summarized on accuracy of obtaining medication histories, time requirements, discrepancy identification, and cost savings. Limitations and areas for future research also were identified.

Data Sources:

A search of PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO and a manual searching of bibliographies were performed.

Study Selection:

Articles were included in this literature review if they focused on medication reconciliation with pharmacy student or technician outcomes independent of pharmacist involvement, they are available in English from any country, and the outcomes were empirical.

Data Synthesis:

Of 2112 identified studies, 32 met the inclusion criteria. The literature review revealed pharmacy technicians or students were involved in several medication reconciliation activities. Trained pharmacy students and technicians were able to obtain thorough medication histories as well as identify medication history discrepancies and take appropriate action to correct these discrepancies. Through the use of pharmacy students and technicians in the medication reconciliation process, hospitals experienced cost savings and other health-care professionals had more time for other patient care activities as well as an increased trust in the accuracy of medication histories.

Conclusion:

These findings suggest that pharmacy students and technicians are accurate, time efficient, decrease costs, and provide support to other health-care professionals when they are included in the medication reconciliation process.

Pain monitoring and medication assessment in elderly nursing home residents with dementia

Objective:

To monitor pain intensity, pain symptoms, and medication use in elderly with dementia.

Methods:

Nursing home residents above 65 years of age, diagnosed with dementia, and showing pain symptoms were included in the study. The patients’ mental status was monitored through a mini-mental state examination score and observations of pain symptoms using Part 1 of the Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MOBID-2) pain scale. Community pharmacists reviewed the patients’ medication use, and the prescriptions were compared with guidelines for treatment of geriatric patients. Alterations to the patients’ medicine use were forwarded to the general practitioners.

Findings:

Sixty-one nursing home residents diagnosed with dementia were identified, 15 of these fulfilled the inclusion criteria, and 12 agreed to participate in the study. The mean age was 87 years of age (range: 77-96), and 42% of the residents were males. The patients’ overall pain intensity was 83% for observations on the numeric pain rating scale (NRS) >0 and 67% for NRS ≥3. Most painful were the situations in which the residents were to mobilize their legs, turn around to both sides of the bed, and when sitting on the bed. The medication reviews identified a total of 95 individual prescriptions, and 33% of these were for nervous system medications, followed by medicines for the treatment of alimentary tract and metabolism disorders (31% of total). Eleven prescriptions for pain medicine were identified; the majority of these were for paracetamol and opioids. Seventeen proposals to patients’ medication use were suggested, but the general practitioners accepted only 6% of these.

Conclusion:

This study indicates that the MOBID-2 pain scale in combination with medication reviews can be used as a tool for optimization of patients’ medication use. However, we recommend the conduction of a larger-scale study in multiple settings, to validate our results and the generalizability of the findings.

Impact of clinical pharmacist intervention on length of stay in an acute admission unit: a cluster randomised study

Objectives

Physicians in acute admission units (AAUs) are obliged to obtain medication history and perform medication reconciliation, which is time consuming and often incomplete. Studies show that clinical pharmacists (CPs) can obtain accurate medication histories, but so far no studies have investigated the effect of this on time measures. Therefore, the objective of the present study was to investigate the effect of a CP intervention on length of stay (LOS) in an AAU.

Methods

The study was designed as a prospective, cluster randomised study. Weekdays were randomised to control or intervention. CP intervention consisted of obtaining medication history and performing medication reconciliation and review. The primary outcome was LOS in the AAU. Secondary outcomes were other time-related measures-for example, physicians' self-reported time spent on medication topics. Finally, the number of documented medications per patient was established.

Results

232 and 216 patients, respectively, were included on control (n=63) and intervention (n=63) days. The mean LOS was 342 (95% CI 323 to 362) min in the intervention group and 339 (95% CI 322 to 357) min in the control group, which was not statistically significantly different. Physicians spent on average 4.3 (95% CI 3.7 to 5.0) min in the intervention group and 7.5 (95% CI 6.6 to 8.5) min in the control group, corresponding to an overall reduction of 43.0% (95% CI 30.9% to 53.0%, p<0.001). The number of documented medications per patient was 10.0 (intervention group) and 8.8 (control group).

Conclusions

This study indicates that LOS in the AAU was not affected by CP intervention; however, physicians reported a significant reduction in time spent on medication topics.

Trial registration number

Clinical Trial Gov: 1-16-02-379-13.