Background The emergency departments have operating characteristics that make them especially prone to the occurrence of medication errors (ME). Moreover, usual medication management in this area is more complicated. Hence, any intervention to minimise ME is justified, including medication reconciliation in a multidisciplinary way.
Purpose To analyse the intervention of a pharmacist in an emergency observation unit, and to focus on reducing ME, including pharmaceutical validation of free text medication orders and medication reconciliation.
Material and methods A prospective cross sectional study was carried out from January to March 2016. We analysed patients who were admitted to the emergency observation unit in a tertiary referral hospital daily at the start of the working day. We validated the medication orders as free text for all patients aged >65 years, and we carried out a process of reconciliation of medication in patients aged >65 years who were awaiting admission to a hospital bed. We communicated verbally with the doctors any medication related problems that we detected. These recommendations and their acceptance were recorded and classified in Excel format.
Results 289 patients were validated of whom 105 (36.3%) had reconciliation of medication. We conducted 153 interventions: medication related problems concerning allergies 2.6% (4), change in dose or dose regimen 11.8% (18), change in route of administration or pharmaceutical form 3.9% (6), complete the medication dose or dose regimen 9.8% (15), complete the route of administration 3.9% (6), information about treatment at home 1.3% (2), start medication not prescribed 9.2% (14), drug interaction 4.6% (7), adaptation to the hospital´s pharmacotherapy guide 34% (52), inadequate drug suspension 4.6% (7), unnecessary drug suspension 3.3% (5), suspension of drugs with a controversial therapeutic use 1.3% (2), suspension of the medication that the patient was not taking at home 5.2% (8) and therapeutic duplicity 4.6% (7). The doctors accepted 134 of the 153 recommendations (87.6%).
Conclusion The intervention of the pharmacist in the emergency departments may reduce ME of medical orders as a free text. As our results show, the degree of acceptance was high. This initiative could be the beginning of other activities related to the safe use of medicines in which the pharmacist is involved.
No conflict of interest
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