Background and importance Prescription in the emergency department (ED) is compromised by multiple causes which could lead to a higher risk of medication errors.
Aim and objectives To compare and analyse pharmaceutical interventions (PIs) performed in frail patients (FP) with those performed in the rest of the patients (ROP).
Material and methods A prospective interventional study (January 2019–June 2019) was conducted in a tertiary hospital. A medical reconciliation was made daily using electronic prescriptions (EP) of patients own drugs and ED treatment of all patients admitted. FP (defined by their primary care physician) were also personally interviewed.
Electronic medical history was consulted to evaluate current treatment and to collect demographic data. PIs were performed electronically in ROP and discussed personally with the clinician in charge of FP. PIs were categorised. The rate of medical acceptance was evaluated. Drugs were classified as high risk drugs (HRD), potentially inappropriate drugs in the elderly (PID) and other.
Results We included 418 patients: 61 in the FP group (mean age 78.8 years (SD=10.4), 55.7% men) and 357 in the ROP group (mean age 76.4 years (SD=13.5), 50.0% men).
In the FP group, 188 PIs were registered (mean interventions/patient 3.1 (DE 2.3)): 43.6% were medical reconciliation errors, 16.5% were to discontinue a prescription (DP), 11.2% were omission of a drug in the acute treatment (ODAT) and 12.7% were other reasons. A total of 22.3% of the interventions were made in HRD (85.7% accepted) and 12.2% in PID (73.9% accepted).
In the ROP group, 370 PIs were registered (mean interventions/patient 1.25 (DE 0.6)): 29.5% were incorrect dose, 18.1% were medical reconciliation errors, 14.7% were exchange of a drug was proposed, 7.8% were adjustment to renal function, 5.4% were DP, 5.1% were ODAT and 19.4% were other. A total of 19.5% of interventions were done in HRD (75.0% accepted) and 11.4% in PID (40.5% accepted).
The approval rates for FP and ROP were 80.9% and 69%, respectively. Results were presented to the hospital’s security commission. Six security measurements were accepted and implemented, two related to HRD (insulin and anticoagulants).
Conclusion and relevance The high rates of acceptance of the PIs showed that the integration of the pharmacist in the multidisciplinary ED team improved the safety of the prescriptions, especially when the pharmacist was physically present.
References and/or acknowledgements No conflict of interest.
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