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The role of clinical pharmacists in the optimisation of medication prescription and reconciliation on admission in an emergency department
  1. José Javier Arenas-Villafranca1,
  2. Juan Manuel Rodríguez-Camacho2,
  3. María Antonia Pérez-Moreno3,
  4. Manuela Moreno-Santamaría1,
  5. Francisco de Asís Martos-Pérez1,
  6. Begoña Tortajada-Goitia1
  1. 1 Department of Pharmacy and Nutrition, Costa Del Sol Hospital, Marbella, Malaga, Spain
  2. 2 Department of Pharmacy, Son Llàtzer Hospital, Palma de Mallorca, Balearic Island, Spain
  3. 3 Department of Pharmacy, Virgen del Rocío Hospital, Seville, Seville, Spain
  1. Correspondence to Dr María Antonia Pérez-Moreno, Department of Pharmacy, Virgen del Rocío Hospital, Seville 41013, Spain;{at}


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.

  • clinical pharmacy
  • medication reconciliation
  • pharmacist intervention
  • admission

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