A time and motion study of pharmacists and pharmacy technicians obtaining admission medication histories

Of the 37 observed AMHs, 30 had complete data. Seven AMHs were excluded because not all task times were recorded, due to the schedule restraints of the research nurse. Pharmacists and PSPTs obtained 12 and 18 AMHs, respectively. Mean patient ages were 83.3 (95% confidence interval [CI], 77.3-89.2) and 79.8 (95% CI, 71.5-88.0), for pharmacists and PSPTs, respectively (P = 0.55). Patient’s EHRs contained a mean of 14.3 (95% CI, 11.2-17.5) and 16.3 (95% CI, 13.2-19.5) medications, prior to pharmacists and PSPTs obtaining an AMH, respectively (P = 0.41).

The mean time pharmacists and PSPTs needed to obtain an AMH was 58.5 (95% CI, 46.9-70.1) and 79.4 (95% CI, 59.1-99.8) minutes, respectively (P = 0.14). Summary time data per provider is reported in the Figure. The mean time for pharmacist supervision of technicians was 26 (95% CI, 14.9-37.1) minutes. Mean times of tasks and comparisons of these means times between providers are reported in the Table. The percent mean time for each task per patient for providers combined is also reported in the Table, in which utilizing the EHR was associated with the greatest percentage of time spent at 42.8% (95% CI, 37.4-48.2).

In the 18 cases for which a caregiver (or SNF medication list) was available, providers needed only 58.1 (95% CI, 44.1-72.1) minutes to obtain an AMH, as compared with 90.5 (95% CI, 67.9-113.1) minutes for the 12 cases lacking these resources (P = 0.02). We also found that among PSPTs, years of AMH experience were positively correlated with AMH time (coefficient of correlation 0.49, P = 0.04). No other studied variables were correlated with or associated with differential AMH times.

We estimated mean labor costs for pharmacists and PSPTs to obtain AMHs as $55.91 (95% CI, 44.9-67.0) and $45.00 (95% CI, 29.7-60.4) per patient, respectively (P = 0.32). In the latter case, $24.85 (95% CI, 14.3-35.4) of the $45.00 would be needed for pharmacist supervisory time. The labor cost for a PSPT-obtained AMH ($45.00) was the sum of the PSPT’s mean time (79.4 minutes) multiplied by technician wage data ($15.23/hour) and supervising pharmacist’s mean time (26.0 minutes) multiplied by pharmacist wage data ($57.34/hour).

Although limited by sample size, we observed no difference in time or costs of obtaining AMHs between pharmacists and PSPTs. Several prior studies reported that pharmacists and technicians needed less time to obtain AMHs (20-40 minutes), as compared with our findings.^12-14 However, most prior studies used younger, healthier patients. Additionally, they used clinician self-reporting instead of third-person observer time and motion methodology. Indeed, the pharmacist times we observed in this study were consistent with prior findings⁶ that used accepted third-person observer time and motion methodology.¹⁰

We observed more variation in time to obtain AMHs among PSPTs than among pharmacists. While variation may be at least in part to the greater number of technicians studied, variation also points to the need for training and oversight of PSPTs. Selection of PSPTs with prior experience interacting with patients and functioning with higher levels of autonomy, standardized training of PSPTs, and consistent dedication of trained PSPTs to AMH functions to maintain their skills, may help to minimize such variation.

Limitations include the use of a single center and a small sample size. As such, the study may be underpowered to demonstrate statistically significant differences between providers. Furthermore, 7 AMHs (19%) had to be excluded because complete task times were missing. This was exclusively because the workday of the research nurse ended before the AMH had been completed. Another limitation was that the tasks observed could have been dissected further to identify even more specific factors that could be targeted to decrease AMH times. We recommend that future studies be larger, investigate in more depth various factors associated with time needed to obtain AMHs, consider which patients would most likely benefit from PSPTs, and use a measure of value (eg, number of history errors prevented/dollar spent).

In summary, we found that PSPTs can obtain AMHs for similar cost to pharmacists. It will be especially important to know whether PSPTs maintain the accuracy documented in prior studies.^8-9 If that continues to be the case, we expect our findings to allow many hospitals to implement programs using PSPTs to obtain accurate AMHs.

Acknowledgment

The authors thank Katherine M. Abdel-Razek for her role in data collection.

Disclosure

This research was supported by NIH/National Center for Advancing Translational Science UCLA CTSI Grant Number KL2TR000122 and National Institute on Aging Grant Number K23 AG049181-01 (Pevnick). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The investigators retained full independence in the conduct of this research.