Background and Importance High-risk medication and the associated errors represent a potential source of adverse effects and readmissions for patients.

Aim and Objectives To analyse the utility of early pharmaceutical validation of direct oral anticoagulants (DOACs) and long-acting insulins (LAIs) in a Hospital Emergency Department (ED).

Material and Methods This retrospective study was conducted between May 15, 2023, and September 28, 2023. Two groups of high-risk medications (HRMs) were selected: DOACs (apixaban/dabigatran/edoxaban/rivaroxaban) and LAIs (degludec/detemir/toujeo (glargine)) due to their high-risk nature, requiring validation by a pharmacist for the early in the morning dispensation. On weekdays, these medications were identified in the ED through the electronic prescription program and subjected to pharmaceutical validation. All locations, appropriateness, and, in cases of inappropriateness, both the underlying reasons and their acceptance were recorded. Recommendations were communicated through the patient‘s electronic medical record or by telephone to the attending physician. Locations reviewed on previous days were excluded to prevent duplication. The primary variable was the degree of total non-appropriateness, both overall and by therapeutic group. Secondary variables included the reasons for non-appropriateness, the degree of acceptance of pharmaceutical recommendations, and, in cases of non-acceptance, the occurrence of adverse drug events (ADEs) for each therapeutic group. The analysis was performed using Microsoft Excel® for Microsoft 365 MSO (2308 version).

Results During the study period, a total of 338 locations were recorded: 193 DOACs and 145 LAIs. The overall degree of non-appropriateness was 16.6% (56/338), with 13.0% (25/193) for DOACs and 21.4% (31/145) for LAIs. The main reasons for non-appropriateness for DOACs were 52.0% temporary contraindication (13/25), 36.0% inappropriate dosage (9/25), and 12.0% reconciliation (3/25); for LAIs: 58.1% inappropriate dosage (18/31), 32.3% contraindication (10/31), and 9.7% inappropriate presentation (3/31). The overall acceptance rate of recommendations made was 86.0% (49/57), with rates of 100% (13/13) and 88.0% (22/25) for DOACs and LAIs, respectively. No ADEs occurred.

Conclusion and Relevance Early and proactive validation by the pharmacist in the Emergency Department of selected high-risk drugs appears to optimise pharmacotherapy and reduce the occurrence of adverse events associated with these medications.

Conflict of Interest No conflict of interest.