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Employing pharmacists and pharm techs to tackle med rec and education

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At El Camino Hospital, pharmacists and pharmacy technicians play a key role in medication reconciliation and education.

The Issue

Our HCAHPS scores around medication were relatively low. We heard from patients that they weren’t sure how to take their medication, what the side effects were, and what red flags they should look out for. We had a case of a patient getting his medication confused. When he happened to show the medication to one of our team members during a home visit, it was the wrong pill at the wrong dose and could have stopped the patient’s heart.


El Camino is a non-profit hospital in Mountain View, CA. It has 399 beds and serves a primarily affluent and educated population, many of who are non-English speaking or have English as a second language. Their transitions program began in 2012 and is influenced by the Care Transitions Program.

What We Tried

We work with unit pharmacists and have a transitions pharmacist on our team. Our pharmacist works very closely with the physicians to review the patient’s medications from and to home, and confirm that the prescription and dosing are correct. The unit pharmacists provide education to any patient who starts a high-risk medication like warfarin or insulin in the hospital. It was important that they understood why they were taking the medication, how to take it, what the side effects were, and what the follow-up should be.


Involving pharmacists in the transitions process has improved our HCAHPS scores around medication and also reduced our readmissions due to medication problems.


Originally our transitions pharmacist was doing the education on the floor, but we later realized that the unit pharmacists could do this, freeing up our pharmacist to work closely with the physicians and oversee pharmacy technicians in the medication reconciliation process.

Ruth Zaltsmann


Organization Background

Organization Name: El Camino Hospital

Location: El Camino Hospital, Mountain View, CA, United States

Organization Type: Non-profit

Organization Model: ctp

  1. Shery Tiemeyer 4 years ago

    Did you consider off site pharmacy med rec for patients admitted through the ED? I've heard that offered as a solution.

    • Author
      Ruth Zaltsmann 4 years ago


      For patients seen and discharged from the ED, generally they were told to follow up with their PCP. For patients who don't have a PCP, they were provided a list of local PCP and received follow up phone calls to confirm they have scheduled an appointment.

      Transitions program mostly focused on unplanned admissions through the ER. Scheduled admissions (usually surgical patients) generally are healthier and have a complete medication reconciliation at the pre-admission appointment. In addition to medication reconciliation in the hospital by the pharmacist, high risk patients had an in-home visit by an outpatient RN case manager and a med rec was done. If the CM had questions, she would call the pharmacist from the home and get clarification. If a change was recommended, immediate follow up calls to the providers were made.

  2. Toni Winter 4 years ago

    A problem I have noticed in our community clinic system is that the patient may see multiple specialists, who are not necessarily communicating with each other, and the primary care team. Then when the patient is admitted/discharged and meds are changed, there is often some confusion. How do you facilitate communication between the hospital pharmacist(s) and the primary care team, to evaluate and reconcile the home meds, medications prescribed during the inpatient stay, and post-discharge? Phone calls? Integrated EMR? Just curious about the mechanisms for the reconciliation process…

    • Author
      Ruth Zaltsmann 4 years ago


      There definitely is a gap in communication between providers and duplication of medications. Suddenly patient finds themselves taking 13 meds, 3 are for the same thing – as an example. Generally during hospital admission is when duplication of meds and unnecessary prescriptions are often being weaned out. However, it needs to happen more often in the outpatient setting. The best way to look at multiple providers is while it is important that patients have access to all the specialists they need, it does not downplay the role of a primary care provider (PCP). I see the PCP as a quarterback for all the providers. Meaning that if a specialist prescribes a ne w med/changes a med, it is important for the PCP to be notified. While in an ideal world this would be the responsibility of providers to communicate, until we get this communication being a standard practice, it's important to enable patients over their own care. Patients should communicate with their PCP on a regular basis. Not to ask permission to take a medication but for awareness. If the PCP sees a problem with the meds, they will then communicate with the various providers. This can only be done through education/coaching of patients. Also educate patients about carrying a complete medication list any time they see a provider. A patient (or a family) member who has just a little bit more info about their health conditions and meds they take will prevent many problems around meds.

      If a patient does get hospitalized, it should be standard practice to send the H&P, discharge summary, discharge instructions to all the patient providers. That way the next time the patient sees a provider, they have access to the most important documentation.

      Communication, communication, communication!

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