Background The presence of a full-time pharmacist in the ER is well established and acknowledged in many institutions to be of great value.
Purpose To analyse and assess the clinical impact of the pharmacist’s interventions in the ER of a tertiary-level teaching institution.
Materials and Methods Patients >65 years-old on >4 medications were included. Drug-related problems (DRP) were classified according to: (a) therapeutic group; (b) intensity: mild, moderate, severe, and very severe; and (c) type (from Martí et al, 2005): indication, safety, adherence, and effect. Patients were monitored for up to 72 h upon subsequent admission to a ward.
Results 111 patients were included, 70.2% male, median age 78.9 years [65–94]. 34 pharmaceutical recommendations were made (one for every 3.2 patients included), of which 85.2% were subsequently accepted. The largest number of interventions concerned antithrombotics, followed by antihypertensives (29.4 and 5.4% of the interventions, respectively). 18.01% met an indication (81.1% of them were off-label conditions), 5.4% were to do with safety (mostly overdose), 1.8% concerned compliance and 0.9% involved under-dosing. Overall, 75.86% of the interventions had a mild-to-moderate impact, whilst 17.25% were moderate-to-severe (involving mainly anticoagulants), and 6.89% (immunosuppressants) were serious or very serious.
Conclusions Real time support to physicians and nurses in the ER allowed the early detection of potential DRPs in one third of the patients. Cardiovascular disease required almost two thirds of interventions, with antithrombotic drugs as the drugs mainly involved (1/10 patients in need of thromboprophylaxis lacked it). However, the clinical impact was minimised by the short time spent in the unit (slightly under one day), and by the further revision of their medicines upon admission to a ward. In addition, the narrower the therapeutic range of the drugs involved (such as immunosuppressants), the more important is the timely contribution of the pharmacist. In conclusion, the presence of a full-time pharmacist in the ER would reduce DRPs by an exhaustive assessment of pharmacotherapeutic needs, which is particularly important for older or polymedicated patients.
No conflict of interest.
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