Scientific Online Resource System

Annual for Hospital Pharmacy

Promoting clinical pharmacy services through advanced medication review in the emergency department

Ana de Lorenzo-Pinto, Raquel García-Sánchez, Ana Herranz, Iria Miguens, María Sanjurjo-Sáez

Abstract

Objectives: To determine if an advanced medication review carried out in the emergency departmen t (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors.

Methods: We designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay.

Results: The study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached.

Conclusions: An advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors.


Full Text


References

Arroyo Conde C, Aquerreta I, Ortega Eslava A, et al. [Clinical and economic impact of the pharmacy resident incorporation into the healthcare team]. Farm Hosp 2006;30:284–90.

Wietholter J, Sitterson S, Allison S. Effects of computerized prescriber order entry on pharmacy order-processing time. Am J Health Syst Pharm 2009;66:1394–8.

Hatfield MD, Cox R, Mhatre SK, et al. Impact of computerized provider order entry on pharmacist productivity. Hosp Pharm 2014;49:458–65.

Arrabal-Durán P, Durán-García ME, Ribed-Sánchez A, et al. Pharmaceutical interventions in prescriptions for patients admitted with chronic renal failure. Nefrologia 2014;34:710–5.

Pérez-Moreno MA, Rodríguez-Camacho JM, Calderón-Hernanz B, et al. Clinical relevance of pharmacist intervention in an emergency department. Emerg Med J 2017;34:495–501.

García-Molina Sáez C, Urbieta Sanz E, Madrigal de Torres M, et al. Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study. J Clin Pharm Ther 2016;41:203–8.

The nature of prescribing in the emergency department. Hospital Pharmacy Europe. http://www.hospitalpharmacyeurope.com/featured-articles/nature-prescribing- emergency-department (cited 14 Oct 2017).

RedFastER: Farmacia Asistencial en Urgencias. http://gruposdetrabajo.sefh.es/ redfaster/ (cited 14 Jan 2018).

Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract 2017;6:37–46.

PCNE statement on medication review 2013. https://www.pcne.org/upload/files/150_ 20160504_PCNE_MedRevtypes.pdf (cited 12 Aug 2018).

Otero López MJ, Castaño Rodríguez B, Pérez Encinas M, et al. [Updated classification for medication errors by the Ruiz-Jarabo 2000 Group]. Farm Hosp 2008;32:38–52.

National Coordinating Council for Medication Error Reporting and Prevention. About medication errors. http://www.nccmerp.org/ (cited 14 Oct 2017).

Gómez-De Rueda F, Tena-Sempere ME, Del Moral-Alcázar MC, et al. Analysis and evaluation of results following the implementation of a programme of e-prescribing in a tertiary hospital. Ars Pharm 2016;57:49–54.

Hellström LM, Höglund P, Bondesson A, et al. Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model–impact on all-cause emergency department revisits. J Clin Pharm Ther 2012;37:686–92.

Standard Operating Protocol. The High 5s Project. http://www.who.int/patientsafety/implementation/solutions/high5s/h5ssop.pdf (accessed 12 Aug 2018).

Pérez León M, Alonso Ramos H, González Munguía S, et al. [Evaluation of the quality of scientific evidence of pharmaceutical interventions in an emergency department]. Farm Hosp 2014;38:123–9.

Juanes A, Garin N, Mangues MA, et al. Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial. Eur J Hosp Pharm, 2018;25:274–80.

Hohl CM, Partovi N, Ghement I, et al. Impact of early inhospital medication review by clinical pharmacists on health services utilization. PLoS One 2017;12:e0170495.




DOI: http://dx.doi.org/10.14748/ahp.v7i1.8075

Refbacks

Article Tools
Email this article (Login required)
|