Background Drug related problems (DRP) are relatively common in hospitalised patients and can result in patient morbidity and mortality. It has been shown that pharmacists, as members of an inpatient care team, can reduce the number of these problems.

Purpose To analyse DRP detected by the clinical pharmacist in the emergency department observation unit (EDOU).

Material and methods The study was conducted in September 2016. The activity of a clinical pharmacist in the EDOU was assessed. The pharmacist undertook clinical activity from Monday to Friday in the morning, selecting patients at increased risk of having a DRP: those patients >65 years of age, polypharmacy, pluripathological and home treatment with high risk medications. The pharmacist interviewed the patient/caregiver and reviewed the electronic medical records to develop the home medication list, and checked the prescribed treatment. With that information, the pharmacist revised: medication reconciliation, dose regimens, adaptation to the guidelines, adjustment of the drug dose in the setting of renal failure, allergies, interactions and other DRP, and provided information to the responsible physician to optimise the treatment prescribed in the EDOU. Our own classification was used for interventions.

Results Of the 140 patients in the EDOU, 42 inpatients were included (30%). 54.8% were men and mean age was 75.4±11.6 years. The average home medication per patient was 7.6±5. The main diagnoses in the EDOU were: 14.3% urinary infection, 11.9% congestive heart failure, 9.5% chest pain, 7.1% atrial fibrillation and 7.1% angina. 88.1% of patients were admitted later.

74 DRP were found (1.8±1.5 per patient): 40.5% treatment omission, 24.3% adaptation to medication available in the hospital, 9.5% different dose or regimen prescribed, 6.8% chronic treatment optimisation, 5.4% acute pathology treatment optimisation, 4.1% adjustment for renal failure, 2.7% prescribed drug that the patient no longer takes, 2.7% drugs of low therapeutic utility, 1.4% therapeutic duplication, 1.4% incomplete prescription and 1.4% allergies or intolerances. 90.5% of the interventions made by the pharmacist were accepted.

Conclusion We found that physically locating the pharmacist in the EDOU improve the quality of care, obtaining a high percentage of acceptance by physicians.

No conflict of interest