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Clinical pharmacy and clinical trials (including case series)
Pharmacist-detected inappropriate medicines and recommendations made regarding a change of medicines in the emergency ward
  1. E. Celikkayalar,
  2. E. Suvikas-Peltonen,
  3. J. Lohikoski,
  4. E. Vaula,
  5. J. Palmgren
  1. 1Satakunta Central Hospital Hospital Pharmacy, Pori, Finland
  2. 2Satakunta Central Hospital, Emergency Department, Pori, Finland


Background Emergency departments have serious concerns about drug safety. Inappropriate medicines are common. Medicines charts may often remain incomplete. Physicians and nurses may not have enough time to review medicines charts regularly.

Purpose To evaluate the inappropriate medicines in the emergency ward based on the pharmacist's medicines chart review. To review the physicians' acceptance rate of pharmacist recommendations regarding a change in the medicines regimen on the emergency ward.

Materials and methods Medicines charts of all emergency ward patients were reviewed by a pharmacist prospectively for five months from April to August 2011. The pharmacist made oral or written recommendations to physicians regarding a change in medicines regimen. Recommendations were made on drug interactions, inappropriate drug dosages, inappropriate duration of drug treatments, wrong medicines, missing medicines and duplications.

Results 855 admissions were reviewed. 94 recommendations regarding 67 admissions were made for 38 drug interactions (40.4%), 26 inappropriate drug dosages (27.7%), 10 inappropriate duration of drug treatments (10,6%), 8 wrong medicines (8.5%), 6 missing medicines (6.4%) and 6 duplications (6.4%). The overall physicians' acceptance rate for all pharmacist recommendations was 62% (n:58). Of the accepted recommendations 20 of 38 (52.6%) drug interactions, 14 of 26 (54%) inappropriate drug dosages, 8 of 10 (80%) inappropriate duration of drug treatments, 6 of 8 (75%) wrong medicines, 4 of 6 (66.7%) missing medicines and all duplications were accepted by physicians. The most common inappropriate medicines detected by the pharmacist were NSAIDs, SSRIs, benzodiazepines and warfarin.

Conclusions A pharmacist was able to detect important inappropriate medicines by reviewing medicines charts of emergency ward patients. Many pharmacist recommendations leading to a change in medicines regimen were accepted by the physicians.

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