Whytal K, Isaman C, Meeks L
… +2 more, Phidd D, Rattansuwan T
Am J Health Syst Pharm
· 2026 Jun · PMID 42320514
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PURPOSE: This study aimed to evaluate the completeness and readability of patient education materials available through 3 widely used drug information databases and assess their potential impact on patient comprehension....PURPOSE: This study aimed to evaluate the completeness and readability of patient education materials available through 3 widely used drug information databases and assess their potential impact on patient comprehension. METHODS: A cross-sectional comparative analysis of patient education materials for 50 commonly prescribed medications was conducted across 3 different drug information databases. Medications were selected from diverse therapeutic classes, such as cardiovascular, endocrine, mental health, and others. Completeness was evaluated using the American Society of Health-System Pharmacists guidelines, including indications, dosing, administration, adverse effects, drug interactions, and precautions. Readability was analyzed using validated tools, such as the Simplified Measure of Gobbledygook (SMOG) and Flesch-Kincaid scale. Subgroup analysis examined variation by therapeutic class. RESULTS: All 3 databases were assigned high completeness scores, with drug interactions, lifestyle, and diet being the most common missing components. Readability scores varied significantly across databases. Database 1 produced materials closest to the National Institutes of Health/American Medical Association-recommended 6th-grade reading level, whereas databases 2 and 3 had higher literacy demands, producing materials from the 7th-grade to college level. It was also observed that education materials include numerous specific drug names. For instance, database 2 and database 3 often provided comprehensive medication lists for potential drug interactions, which increased readability scores and grade levels. When these lists were removed, the readability scores and grade levels decreased. CONCLUSION: While most essential information was included in the patient education materials, readability remained a barrier to patient comprehension. Balancing clarity with completeness is essential for supporting adherence and safety.
Am J Health Syst Pharm
· 2026 Jun · PMID 42319115
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PURPOSE: This report describes the implementation, workflow structure, and outcomes of a centralized, investigational drug service (IDS)-led process for concomitant medication reviews in oncology clinical trials. This in...PURPOSE: This report describes the implementation, workflow structure, and outcomes of a centralized, investigational drug service (IDS)-led process for concomitant medication reviews in oncology clinical trials. This initiative aimed to improve standardization and enhance protocol compliance by transitioning initial concomitant medication review responsibilities to IDS pharmacists. SUMMARY: A dedicated IDS pharmacist role was established to support centralized concomitant medication reviews, ensuring a standardized and efficient process. This initiative included developing a structured request system, electronic documentation, and protocol-specific concomitant medication review guides to enhance consistency. Over a 24-month evaluation period, IDS pharmacists completed 1,052 concomitant medication reviews, averaging 43.8 reviews per month. Drug-drug interactions were identified in 34.3% of cases, with the highest prevalence observed in phase 1 trials. IDS review times remained consistent, with a mean system-tracked time of 1.31 hours per review. However, delays in medication reconciliation emerged as the primary bottleneck, often prolonging review completion. A financial analysis confirmed the program's sustainability, demonstrating that the billable fee-for-service model effectively supported its implementation. Despite these successes, challenges remained, including variability in protocol interpretation and limited guidance on herbal and supplement use. CONCLUSION: The IDS-led concomitant medication review model improved workflow standardization while supporting operational efficiency and financial sustainability. This approach provides a scalable framework that can be adapted to other clinical trial programs and expanded to include ongoing medication monitoring.
Yashima H, Araki T, Kaneta A
… +8 more, Takei H, Kobayashi N, Miyazawa Y, Ogawa Y, Tsukamoto J, Nakamura H, Handa H, Yamamoto K
Am J Health Syst Pharm
· 2026 Jun · PMID 42317146
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PURPOSE: Tirabrutinib, an oral Bruton's tyrosine kinase inhibitor, is used in the treatment of relapsed or refractory primary central nervous system lymphoma (PCNSL) and other B cell malignancies. Although this medicatio...PURPOSE: Tirabrutinib, an oral Bruton's tyrosine kinase inhibitor, is used in the treatment of relapsed or refractory primary central nervous system lymphoma (PCNSL) and other B cell malignancies. Although this medication is also administered to older patients, those experiencing dysphagia may require nasogastric administration via a tube. The impact of different administration routes on pharmacokinetics remains a pertinent clinical concern. SUMMARY: An 82-year-old male patient with relapsed PCNSL initiated tirabrutinib at 320 mg/day under fasting conditions. While the patient was initially able to swallow tablets, progression of dysphagia necessitated a switch to nasogastric administration using the simple suspension method. Serum tirabrutinib concentrations were determined 11 hours after administration by each route using liquid chromatography followed by tandem mass spectrometry and compared. The serum concentration increased from 83.2 ng/mL with oral administration to 191 ng/mL with nasogastric administration, representing an increase of more than 2-fold. The dose, concomitant medications, and sampling conditions were consistent. On day 19, a rash developed that was suspected to be drug induced, prompting discontinuation of tirabrutinib; however, the serum concentration with nasogastric administration was not markedly higher than the previously reported mean 12-hour concentration of around 120 ng/mL. The observed increase in tirabrutinib concentration may primarily reflect enhanced dispersion with the simple suspension method, leading to improved absorption. Potential auxiliary factors, such as changes in absorption rate or inter-individual variability, cannot be excluded. Although a rash occurred, it is unlikely to represent an adverse event due to excessive exposure. CONCLUSION: Tirabrutinib concentrations may increase with nasogastric administration using the simple suspension method. In patients unable to ingest tablets orally, careful clinical monitoring is warranted, and therapeutic drug monitoring may be considered in select cases. The accumulation of further cases and pharmacokinetic investigations are warranted.
Hughes E, Przespolewski E, Baron J
… +5 more, Matthews Conti C, Defayette A, Mullin S, Catalfamo K, Riebandt G
Am J Health Syst Pharm
· 2026 Jun · PMID 42287144
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PURPOSE: The objective of this study is to identify program factors contributing to oncology postgraduate year 2 (OPGY2) preceptor demands and the impact they have on well-being. METHODS: A 22-question survey was sent to...PURPOSE: The objective of this study is to identify program factors contributing to oncology postgraduate year 2 (OPGY2) preceptor demands and the impact they have on well-being. METHODS: A 22-question survey was sent to 127 oncology residency program directors (ORPDs) listed in the American Society of Health-System Pharmacists (ASHP) residency directory. The ORPDs were asked to complete and share the survey with preceptors supporting their program. The survey included questions about their program, workload perceptions, and time requirements. A one-time Professional Fulfillment Index (PFI) assessment was performed to assess burnout. Descriptive statistics were used to analyze responses. Nonparametric measurements were used to assess correlations between program characteristics and potential impact on well-being endpoints. RESULTS: At least one representative from 44 (33%) of the invited OPGY2 programs completed the survey. The average number of preceptors per program was 18.2, with an average of 9 learners precepted per respondent. Most of the programs (73.3%) had residency program coordinators. The majority of respondents (80%) received no incentives for being a preceptor. Some programs reported budgeted travel stipends (8.4%), financial incentives (6.2%), and reduced clinical responsibilities (4.5%). No preceptor reported budgeted protected time for precepting responsibilities. More than half (56.6%) of preceptors had considered resigning over the past year; the top 3 contributing factors were work-related burnout (43.8%), no compensation (30.9%), and ineffective leadership (29.2%). The mean PFI score was 2.41, and the mean burnout score was 1.42. Spearman's rank correlation coefficient was -0.5216 (P < 0.001), suggesting a moderately strong negative correlation between burnout and PFI. CONCLUSION: Site-specific and organizational support are needed to provide reform to balance preceptorship with other responsibilities.
Am J Health Syst Pharm
· 2026 Jun · PMID 42269100
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PURPOSE: The goals of this project were to determine (1) what proportion of compounded sterile product investigational products (CSP IPs) stocked by our institution's investigational drug service have barcodes, and (2) w...PURPOSE: The goals of this project were to determine (1) what proportion of compounded sterile product investigational products (CSP IPs) stocked by our institution's investigational drug service have barcodes, and (2) whether CSP IPs that do have barcodes contain a number that is usable by our institution's IV workflow management system. A secondary goal was to determine sponsor willingness to embed a drug identifier in the barcodes. SUMMARY: A survey of the site's inventory was conducted to identify CSP IPs. The vials were examined to determine if they contained a barcode, and if so, scanning was performed to determine what number was embedded in each barcode. In addition, sponsors of vials with barcodes were queried about whether they would be willing to embed a drug identifier, while sponsors with no barcodes were queried about their willingness to add barcodes. CONCLUSION: The study found that 66.9% of the CSP IP vials contained barcodes. However, the numbers embedded in the barcodes on most of these IPs varied from vial to vial. The structure of the numbers embedded in each barcode did not match the GS1-128 structure seen on FDA-approved products, and there was no usable drug identifier in any barcode in the opinion of the team's informatics pharmacist.
Phillips B, Romaniszyn R, Metri J
… +5 more, Buckley K, Nelson SD, Luchen GG, Low K, Selby A
Am J Health Syst Pharm
· 2026 Jun · PMID 42267658
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PURPOSE: To develop a structured, pharmacy-specific framework that defines the essential digital health and telehealth knowledge and skills required for student pharmacists and practicing pharmacists across educational a...PURPOSE: To develop a structured, pharmacy-specific framework that defines the essential digital health and telehealth knowledge and skills required for student pharmacists and practicing pharmacists across educational and practice settings. SUMMARY: An expert panel convened by the American Society of Health-System Pharmacists conducted a targeted literature review and environmental scan, followed by an iterative, consensus-driven development process over 18 months. The resulting framework organizes competencies into 7 domains: Technology and Digital Literacy; Patient Communication, Education, and Engagement; Documentation and Information Management; Clinical Assessment and Decision-Making; Operational Management and Workflow Integration; Regulatory Compliance and Ethical Practice; and Quality Improvement and Evaluation. Each domain includes actionable skills aligned with real-world telehealth workflows and mapped to entrustable professional activities to support competency-based education. The framework also incorporates practical curricular applications, including learning objectives, assessment strategies, and experiential activities, to facilitate integration into didactic curricula, experiential training, and continuing professional development. This approach addresses gaps in current pharmacy education, where digital health training is often fragmented, inconsistent, or insufficiently tailored to the pharmacist's role in interdisciplinary care. CONCLUSION: This framework provides a comprehensive and adaptable foundation for integrating digital health and telehealth competencies into pharmacy education and practice. By standardizing expectations and aligning training with evolving healthcare technologies, it supports the preparation of pharmacists to deliver safe, effective, and patient-centered care in digitally enabled environments while promoting ongoing professional development and workforce readiness.
Strong S, Huang J, Nelkin H
… +3 more, Ramudhin A, Goldblatt CM, Greszler CA
Am J Health Syst Pharm
· 2026 Jun · PMID 42266101
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PURPOSE: To evaluate the implementation of a technology-assisted workflow (TAWF) system across 3 hospitals within an integrated delivery network. The overall goal was to assess the system's impact on compounding complian...PURPOSE: To evaluate the implementation of a technology-assisted workflow (TAWF) system across 3 hospitals within an integrated delivery network. The overall goal was to assess the system's impact on compounding compliance, workflow efficiency, and operational standardization. SUMMARY: The study was conducted at 3 community teaching hospitals in the northeast United States. Prior to TAWF implementation, regulatory documentation practices were largely manual and varied between sites. The TAWF system was selected for its flexibility, minimal hardware requirements, and adaptability to existing workflows. Implementation included standardized training, staggered go-live dates, and continued adjustments based on site feedback. Outcomes were evaluated using a mixed-methods approach, including ethnographic observation, workflow mapping, and data analytics. After implementation, 2 of 3 sites showed significant improvements in compounding record (CR) compliance. Adjusted workflow mapping revealed TAWF did not increase overall compounding time. Unexpected benefits included barcode scanning and photo documentation, enhanced traceability and safety, and accumulation of centralized data enabling better recall management and financial auditing. CONCLUSION: TAWF implementation improved documentation compliance, maintained workflow efficiency, and enabled enterprise-wide standardization. The system also delivered unanticipated benefits in medication safety monitoring and enterprise operational oversight. These findings support broader TAWF adoption across the health system and highlight the value of technology in meeting changing regulatory standards while enhancing pharmacy practice.
Am J Health Syst Pharm
· 2026 Jun · PMID 42263195
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OBJECTIVE: Bispecific T-cell engager (BiTE) therapies activate cytotoxic T cells and promote cytokine release, potentially increasing the risk of atrial fibrillation (AF). The atrial arrhythmic risk associated with BiTE...OBJECTIVE: Bispecific T-cell engager (BiTE) therapies activate cytotoxic T cells and promote cytokine release, potentially increasing the risk of atrial fibrillation (AF). The atrial arrhythmic risk associated with BiTE therapy remains unclear. METHODS: We analyzed individual case safety reports (ICSRs) from the US Food and Drug Administration Adverse Event Reporting System (FAERS) from the second quarter of 2014 to December 31, 2024. Reporting odds ratios (RORs) with 95% CIs and information components (ICs) with 95% credible intervals (CrIs) were used to assess whether AF was disproportionally reported with BiTE therapy as compared to all other drugs in the FAERS. We also evaluated positive (chimeric antigen receptor T-cell [CAR-T] therapy) and negative (paracetamol) control therapies. RESULTS: Analysis of 11,129,381 deduplicated ICSRs identified 14,337 cases involving BiTE therapy as a suspect drug, with 97 (0.68%) reporting AF. A signal for disproportional reporting (SDR) of AF with BiTE therapies was observed (ROR, 1.28 [95% CI, 1.04-1.57]; IC, 0.35 [95% CrI, 0.02-0.60]). Individually, epcoritamab (ROR, 2.95 [95% CI, 2.01-4.18]; IC, 1.50 [95% CrI, 0.91-1.92]) and mosunetuzumab (ROR, 3.88 [95% CI, 1.92-7.01]; IC, 1.76 [95% CrI, 0.74-2.46]) were associated with SDRs. No other BiTE therapy showed an SDR. CAR-T therapy, the positive control, showed an SDR for AF (ROR, 2.40 [95% CI, 2.05-2.79]; IC, 1.24 [95% CrI, 0.99-1.42]). In contrast, the negative control, paracetamol, did not. CONCLUSION: AF appears to be disproportionally reported with BiTE therapy in the FAERS. This association warrants further investigation.
Fielding M, Khosla A, Ammar M
… +5 more, Chung R, Aliling A, Warzecha T, Johnson J, Zichichi A
Am J Health Syst Pharm
· 2026 Jun · PMID 42262839
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PURPOSE: Rapid sequence intubation (RSI) with neuromuscular blocking agents (NMBAs) can result in awareness with paralysis (AWP) if sedation is inadequate. This is of particular concern with rocuronium due to its prolong...PURPOSE: Rapid sequence intubation (RSI) with neuromuscular blocking agents (NMBAs) can result in awareness with paralysis (AWP) if sedation is inadequate. This is of particular concern with rocuronium due to its prolonged half-life. This study evaluated sedation practices before and after the implementation of an RSI clinical decision support (CDS) update with sedation guidance linked to rocuronium orders. METHODS: This retrospective, multicenter, observational, before-after study included adult patients who received rocuronium for RSI. The preimplementation cohort spanned the period July 1, 2022, to January 1, 2023; the postimplementation cohort spanned the period January 1 to July 1, 2024. Coprimary outcomes were sedative selection and initial sedative dose within 1 hour after rocuronium administration. Secondary outcomes included time to sedative initiation, time to adequate sedation, and incidence of hypotension requiring vasopressors. Groups were compared using a t test or Mann-Whitney U test for continuous variables and χ2 or Fisher's exact test for categorical variables. RESULTS: A total of 713 patients were included (308 in the preimplementation and 405 in the postimplementation cohort). After CDS implementation, propofol use increased (56.8% vs 73.1%, P < 0.0001), and initial dosing increased (median, 5 µg/kg/min vs 20 µg/kg/min; P < 0.0001). Midazolam use decreased (from 32.1% to 19.3%, P < 0.0001). The median (interquartile range [IQR]) time to sedation initiation decreased (from 14 [10-22] minutes to 12 [12-15] minutes; P = 0.001), as did median time to adequate sedation (from 32 [15.3-51.4] minutes to 14 [12-25] minutes; P < 0.0001). The incidence of new-onset hypotension was similar between groups (25.0% vs 25.2%, P = 0.95). CONCLUSION: A CDS update linking sedation guidance to rocuronium orders resulted in faster initiation of higher doses of sedation after paralysis without increasing hemodynamic instability, supporting the use of CDS strategies in the peri-intubation period.
Datt M, Taylor AN, Forehand C
… +3 more, Pearman E, Lopez A, Smith BA
Am J Health Syst Pharm
· 2026 Jun · PMID 42262836
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PURPOSE: Analgosedation is the standard of care for managing mechanically ventilated critically ill patients. Most sedative medications are lipophilic, with increased volume of distribution in patients with obesity; howe...PURPOSE: Analgosedation is the standard of care for managing mechanically ventilated critically ill patients. Most sedative medications are lipophilic, with increased volume of distribution in patients with obesity; however, data about dosing these drugs in critically ill patients with obesity are limited. In 2022, our institution changed to an ideal body weight (IBW) dosing strategy for all weight-based continuous infusions of analgesia and sedation agents, including fentanyl, ketamine, propofol, and dexmedetomidine. This study evaluated whether utilizing IBW dosing for critically ill patients with obesity results in decreased analgesic requirements. METHODS: This was a single-center, retrospective, observational cohort study that included critically ill adult patients with a body mass index (BMI) of greater than 30 kg/m2 receiving analgosedation with continuous fentanyl from January 1 to March 31, 2020 (actual body weight [ABW] group) and from January 1 to March 31, 2024 (IBW group). Patients were excluded if they required deep sedation or mechanical circulatory support, had a history of chronic opioid use or opioid use disorder, or had a positive COVID-19 result. The primary outcome was cumulative morphine milligram equivalent (MME) requirements during the fentanyl continuous infusion. Secondary outcomes included the cumulative doses of sedation and duration of mechanical ventilation, as well as intensive care unit (ICU) and hospital length of stay (LOS). Efficacy was evaluated via RASS and CPOT score and by as-needed opioid and benzodiazepine requirements in MME and midazolam equivalents. RESULTS: Forty-six patients in the ABW group and 31 patients in the IBW group were included. The median BMI was similar (ABW group, 35.3 kg/m2; IBW group, 34.9 kg/m2; P = 0.83). The IBW group had significantly lower median cumulative intravenous MME requirements (ABW group, 931.2 mg; IBW group, 537.9 mg; P = 0.04). For the secondary outcomes, the cumulative MME requirements for fentanyl differed between the dosing strategies (ABW group, 914.1; IBW group, 485.8; P = 0.03), but no differences were found for other sedatives, as-needed opioids or benzodiazepines, duration of mechanical ventilation, ICU LOS, or hospital LOS. CONCLUSION: Utilizing IBW dosing decreased cumulative opioid requirements in critically ill patients with obesity without resulting in increased doses of other sedatives or as-needed medications.
Anyanwu N, Serao D, Jen P
… +2 more, Cohen M, Torppey K
Am J Health Syst Pharm
· 2026 Jun · PMID 42261817
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PURPOSE: The purpose of this study was to evaluate the impact of pharmacist-led interventions on sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescribing in hospitalized patients with heart failure with reduced ejec...PURPOSE: The purpose of this study was to evaluate the impact of pharmacist-led interventions on sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescribing in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). METHODS: A quality improvement study was conducted at an academic medical center with 2 phases: a retrospective medication-use evaluation (phase I) and a prospective intervention period (phase II). Phase I assessed eligibility for SGLT2i initiation in hospitalized patients with HFrEF without active study intervention. In phase II, interdisciplinary education on the benefits and place in therapy of SGLT2i was provided. A pharmacist routinely reviewed electronic health records to identify patients eligible for SGLT2i and recommended therapy initiation. The primary endpoint of the study was the percentage of eligible patients on an SGLT2i before and after implementation of pharmacist intervention. Secondary endpoints included 30-day all-cause and heart failure readmission rates, the quantity and acceptance rate of pharmacist interventions, and the incidence of adverse outcomes. RESULTS: Among 150 patients in phase I and 133 patients in phase II, 123 and 94 were eligible for SGLT2i therapy, respectively. The overall frequency of inpatient SGLT2i prescribing significantly increased from phase I to phase II (38.2% vs 68.1%, respectively; P < 0.001). Continuation of outpatient SGLT2i therapy during hospitalization also improved after implementation of pharmacist intervention (from 16.3% to 36.2%; P = 0.001). There were no differences in readmission rates or the incidence of adverse events. The acceptance rate for pharmacist interventions was 50%. CONCLUSION: Increased prescribing of SGLT2i therapy in hospitalized patients with heart failure was observed following pharmacist-led education and prospective reviews with feedback.
Tong K, Thomas KC, Zuckerman A
… +12 more, Choi L, Gargurevich N, Godley E, Gosser R, Kehasse A, Lewis K, Loucks J, McCarthy K, Pilat S, Plaia G, Rizkalla N, VanSice M
Am J Health Syst Pharm
· 2026 Jun · PMID 42261681
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PURPOSE: Patients being initiated on treatment with select immunomodulators should be screened for tuberculosis (TB) and hepatitis B virus (HBV). Previous studies found disparities in TB/HBV screening before therapy init...PURPOSE: Patients being initiated on treatment with select immunomodulators should be screened for tuberculosis (TB) and hepatitis B virus (HBV). Previous studies found disparities in TB/HBV screening before therapy initiation. Health-system specialty pharmacies (HSSPs) have access to electronic health records and can evaluate infection screening completion. SUMMARY: A multisite, prospective, observational cohort study was conducted at 12 HSSPs. Patients 18 years of age or older prescribed an immunomodulator between March 1 and May 31, 2023, were included. Patients prescribed medications associated with a risk of TB or HBV reactivation within the previous year or referred from a non-health-system provider were excluded. Patients were followed for 6 months. Screening completion was summarized as percentages. Univariate logistic regression models were used to evaluate the association between the number of HSSP services provided and completion of safety screening, and safety screening-related pharmacist interventions. Of 1,597 pharmacy referrals, 737 patients were included. Patients had rheumatological (55.5%; n = 409), dermatological (29%; n = 214), or gastroenterological conditions (15.5%; n = 114). In total, 95.1% of patients (n = 701) had any screening for TB and HBV, and 81.5% (n = 601) completed screenings within 2 years before or 60 days after referral. Screening was completed within 1 year before or 60 days after referral for 75.3% of patients (n = 555). More HSSP services were associated with increased likelihood of completed safety screening (odds ratio [OR], 1.23; P = 0.012) and pharmacist interventions (OR, 2.68; P = 0.04). CONCLUSION: High rates of screening for TB and HBV before immunomodulator therapy initiation were observed in patients referred to HSSPs.
Qureshi N, Pevnick JM, Torbati SS
… +5 more, Leang D, Mai E, Malkhasian Y, Ho J, Berdahl CT
Am J Health Syst Pharm
· 2026 Jun · PMID 42261625
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PURPOSE: Obtaining accurate medication histories for older adults in the emergency department (ED) is essential but challenging due to operational barriers and incomplete electronic health records (EHRs). We implemented...PURPOSE: Obtaining accurate medication histories for older adults in the emergency department (ED) is essential but challenging due to operational barriers and incomplete electronic health records (EHRs). We implemented a stakeholder-engaged intervention integrating pharmacy technicians (pharm techs) to obtain triage medication histories (T-MHs) for ED patients aged 65 years or older. METHODS: Starting in June 2023, pharm techs collected T-MHs from patients awaiting clinician evaluation. The intervention was developed using literature review, EHR data analysis, and focus groups with ED clinicians, pharm techs, and pharmacists. We identified key chief complaint-medication interactions and designed ED workflows for T-MH implementation. RESULTS: Three high-impact chief complaint-medication interactions were identified: (1) trauma with anticoagulant use; (2) any complaint with recent medication changes or adherence concerns; and (3) any complaint while on antibiotics. We educated pharm techs about these chief complaint-medication interactions and asked them to notify ED clinicians about cases identified. T-MHs were obtained in 3,197 ED encounters (41.2%) before any medication order or disposition decision. Focus groups revealed that patients and their care partners generally agreed to participate in medication histories, but, contrary to expectations, efforts to date have had minimal impact on clinician awareness of prior-to-admission medications, prescribing decisions, and disposition decisions. CONCLUSION: Integrating pharm techs to obtain medication histories in the ED is feasible and acceptable, but further efforts are needed to optimize workflow integration and handoff processes to improve clinical impact and patient safety.