J Am Pharm Assoc (2003). 2021 Jul-Aug;61(4):e301-e315. doi: 10.1016/j.japh.2021.01.018. Epub 2021 Feb 12.
Medication discrepancies at transitions of care may compromise patient safety. Trained pharmacy technicians can reduce harmful medication discrepancies at transitions of care by collecting medication histories.
We describe how to create a program integrating medication history technicians (MHTs) into the hospital discharge process using implementation science.
We created our MHT program at a Veterans Affairs (VA) hospital.
We used an evidence-based framework and implementation science to tailor our MHT program to meet local stakeholder needs.
We completed a literature review and review of current discharge practices. Then, we completed a workflow pilot, a needs assessment, and semistructured interviews with pharmacy technicians and pharmacists. We integrated these findings to identify barriers of MHT program implementation. Finally, we mapped these barriers to implementation strategies to create an MHT program implementation blueprint.
The literature review and review of current discharge practices revealed opportunities for our program to reduce medication discrepancies. We applied these findings to our proof-of-concept workflow pilot, which reduced medication discrepancy rates at discharge. When we explored barriers in the needs assessment, we learned that 4 of 6 pharmacy technicians had some training conducting medication histories, but 5 of 6 requested additional training for the new MHT role. We explored these and additional barriers in semistructured interviews. Four themes emerged: elements of pharmacy technician training, challenges to implementation, program logistics and workflow, and pharmacy technician self-efficacy. We mapped barriers to implementation strategies to create an MHT program implementation blueprint, including developing pharmacy technician training materials, modifying our workflow, creating program evaluation materials, and strategizing how to overcome anticipated and current implementation barriers.
We used implementation science to create a tailored MHT program. Others may adapt our implementation blueprint to fit local stakeholder needs.
在医疗保健过渡期间的药物差异可能会危及患者安全。经过培训的药剂师技术人员可以通过收集药物史来减少医疗保健过渡期间的有害药物差异。
我们将描述如何使用实施科学在医院出院过程中创建一个整合药物史技术员（MHT）的计划。
我们在退伍军人事务部（VA）医院创建了我们的 MHT 计划。
我们使用循证框架和实施科学来调整我们的 MHT 计划，以满足当地利益相关者的需求。
我们完成了文献综述和当前出院实践的审查。然后，我们完成了工作流程试点、需求评估以及与药剂师技术人员和药剂师的半结构化访谈。我们整合了这些发现，以确定 MHT 计划实施的障碍。最后，我们将这些障碍映射到实施策略上，以创建 MHT 计划实施蓝图。
文献综述和当前出院实践的审查揭示了我们的计划有机会减少药物差异。我们将这些发现应用于我们的概念验证工作流程试点，该试点降低了出院时的药物差异率。当我们在需求评估中探讨障碍时，我们了解到 6 名药剂师中有 4 名对进行药物史有一定的培训，但 6 名中有 5 名要求为新的 MHT 角色提供额外的培训。我们在半结构化访谈中探讨了这些和其他障碍。出现了四个主题：药剂师技术人员培训的要素、实施挑战、计划后勤和工作流程以及药剂师技术人员的自我效能。我们将障碍映射到实施策略上，以创建 MHT 计划实施蓝图，包括开发药剂师技术人员培训材料、修改我们的工作流程、创建计划评估材料以及策划如何克服预期和当前的实施障碍。
我们使用实施科学创建了一个定制的 MHT 计划。其他人可以根据当地利益相关者的需求调整我们的实施蓝图。
