1122: HIGHLIGHTING THE ROLE OF MEDICATION HISTORY TECHNICIANS IN CRITICAL CARE UNITS

Introduction: Discrepancies in medication histories can lead to adverse drug events in hospitalized patients. The 2022 National Patient Safety Goals for the Hospital Program include reconciling medications to identify and resolve discrepancies that can affect patient outcomes. Previous literature has demonstrated how pharmacists can impact medication histories and reconciliations, including decreased discrepancies and improved medication safety and patient outcomes. The objective of this study was to quantify and categorize discrepancies found by medication history technicians (MHTs) when reviewing medication histories initially completed by non-pharmacy team members for critically ill patients. Methods: This descriptive, single-center study focused on patients admitted to intensive care units between November 16, 2020 and February 13, 2021. Critical care pharmacists requested review of medication histories by MHTs when it appeared discrepancies may be present in their clinical judgment. MHTs used a standardized note to record the type of discrepancy found, cause of discrepancy, medication involved, source of information, and time to completion. Patients were excluded if the pharmacy team completed the medication history before non-pharmacy team members, the pharmacist determined revision was not needed, the standardized note was not used, and if they left the unit, expired, or were made comfort care within 48 hours of admission. Descriptive statistics are used to report data. Results: Of 231 charts reviewed, 94 had medication histories initially performed by non-pharmacy personnel. Pharmacists determined 39 (41%) of these histories required revision by MHTs, and 26 used the standardized note. 229 discrepancies were identified, (average 8.8 +/- 5.8 per patient, median 9.5.) The most common types of discrepancies were omission (33.2%) and addition (23.5%). Respiratory (15.7%), cardiovascular (12.7%), gastrointestinal (12.7%), nutritional (12.7 %), and endocrine agents (10.9%) were the most common therapeutic classes involved in discrepancies. Conclusions: This study demonstrates MHTs identify and resolve many medication reconciliation discrepancies in critically ill patients, improving home medication list accuracy. Future studies are needed to fully quantify the clinical benefits this service provides.