The role of clinical pharmacists in the optimisation of medication prescription and reconciliation on admission in an emergency department

Objectives: To describe a clinical pharmacist's (CP) activity in an emergency department (ED) regarding medication reconciliation and optimisation of pharmacotherapy of patients at hospital admission.

Methods: A 1-year prospective observational study was conducted to analyse the activity of a CP in the ED of a 350-bed hospital in Spain. The CP reviewed home medications and medical prescriptions of patients to perform medication reconciliation if required and intervene if medication errors were detected.

Results: The CP reviewed medications and medical orders of 1048 patients. 816 patients had home medication: 440 patients (53.9%) were correctly reconciled by the physician; 136 (16.7%) were reconciled by the physician with unintentional discrepancies; and 240 (29.4%) by the CP, with a higher percentage in patients admitted to surgical departments (χ²:38.698; P<0.001). Following pharmaceutical validation, 434 pharmaceutical interventions were performed.

Conclusions: The presence of a CP in an ED could increase the detection of reconciliation errors and help resolve medication errors.