Study finds pharmacy technicians take more accurate drug histories than nurses in elective surgical patients

Background

Every patient requiring surgery- or anaesthesia-led sedation should have a formal pre-operative assessment (POA). As well as identifying risk factors and co-morbidities for patients, it allows a complete drug history to be taken and medication advice given for the pre-operative period. Prescribing pharmacists have been working in POA after research into pre-operative medicines reconciliation; however, there is little research on the introduction of pharmacy technicians to the service. Pharmacy technicians have the underpinning competency and knowledge to work in this clinical environment: taking a drug history and giving medication advice, and referring to a pharmacist in complex cases. The current pharmacy service does not include gynaecology, so this was identified as an area of expansion for the service.

Objective

• To compare the accuracy of a nurse drug history to a pharmacy technician drug history

Target: 100% of drug histories are accurate

• To evaluate the accuracy of a doctor written inpatient chart using a nurse drug history

Target: 100% of inpatient drug charts are accurate

Method

Retrospective data was collected from nurse drug histories over ten working days for gynaecology patients in POA (13/05/2024 to 24/05/2024). This data was compared with the patient’s summary care record (SCR) by the pharmacy technician. Retrospective data was collected from elective gynaecology inpatient drug charts over the same ten days, and this was compared with the nurse drug history and SCR by the pharmacy technician.

Results

• 52 gynaecology patients had a nurse drug history with 39 taking regular medication
• 41% of drug histories were accurate to the summary care record
• The average number of errors was 2, ranging from 0 to 11
• The most common error was the omission of medication
• Two patients had errors in critical medication such as anti-epileptics and medication for diabetes
• Drug histories completed by the pharmacy technician over the same ten-day period had no errors
• 40 elective gynaecology inpatients were admitted, with 28 patients taking regular medication
• 50% had errors on their drug chart and 25% had no regular medication prescribed at all, including medication for diabetes.

Conclusions

The results show that drug histories taken by pharmacy technicians were more accurate than those taken by nurses for elective surgical patients. This impacts the accuracy of inpatient drug charts, potentially leading to increased risk of harm. Limitations include intentional drug history discrepancies not identified from comparing to the SCR alone. A future pilot in which the pharmacy technician completes drug histories for gynaecology inpatients will allow for more accurate comparison. Capturing additional data around the impact of a prescribing pharmacist in gynaecology will help to build a case for a pharmacist to support the pharmacy technician with complex patients and drug chart transcription.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.