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Rahman RN, Polinder S, Nikolik B, Hoek AE, Janssen MJA, Schuit SCE, van den Bemt PMLA, Karapinar-Çarkit F. Medication reviews by emergency department pharmacists in patients hospitalised for an adverse drug event: a cost study. BMC Health Serv Res 2024; 24:975. [PMID: 39180043 PMCID: PMC11344293 DOI: 10.1186/s12913-024-11346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 07/23/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE To perform a cost study of pharmacist-led medication reviews in patients with an acute hospitalization for adverse drug events. METHOD Emergency department pharmacists performed medication reviews in patients hospitalized after visiting the emergency department for an adverse drug event (ADE). Control patients were hospitalized after an emergency department visit not related to an ADE and received usual care. The costs of the intervention were labour costs of the junior emergency department pharmacist and the cost savings consisted of costs of medication that was stopped or reduced during six months after the intervention. Sensitivity analyses were performed to evaluate different scenarios. RESULTS In the intervention group (n = 104) 113 medication changes led to stopping or reducing medication, accounting for averted costs of €22,850. In the control group (n = 112) 39 medication changes led to stopping or reducing medication, accounting for averted costs of €299. The mean labour costs of the intervention were €138 per patient, resulting in saved costs of €61 per patient per six months. Sensitivity analyses showed that if the intervention would be performed by a senior clinical pharmacist, there are no cost savings (€-21), if parts of the intervention would be executed by pharmacy technicians (e.g. administrative tasks), cost savings would be augmented to €87, if outliers in costs associated with medication reduction would be excluded, there are no cost savings (€-35) and if the costs of reduced medication were extrapolated to one year, cost savings would be €260. CONCLUSION In this study, medication reviews by junior emergency department pharmacists in patients hospitalized after an emergency department visit for an ADE lead to a cost reduction over a six month period. TRIAL REGISTRATION The main study is registered on the ISRCTN registry with trial ID ISRCTN12506329 on 06-03-2022.
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Affiliation(s)
- Rehana N Rahman
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bojan Nikolik
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Amber E Hoek
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjo J A Janssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Stephanie C E Schuit
- Board of Directors, University Medical Center Groningen, Groningen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Pharmacy, CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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Involvement of Pharmacists in the Emergency Department to Correct Errors in the Medication History and the Impact on Adverse Drug Event Detection. J Clin Med 2023; 12:jcm12010376. [PMID: 36615176 PMCID: PMC9821377 DOI: 10.3390/jcm12010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists' interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians' medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians' medication histories.
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Durand A, Gillibert A, Membre S, Mondet L, Lenglet A, Mary A. Acceptance Factors for In-Hospital Pharmacist Interventions in Daily Practice: A Retrospective Study. Front Pharmacol 2022; 13:811289. [PMID: 35401242 PMCID: PMC8984177 DOI: 10.3389/fphar.2022.811289] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction: Performing pharmacist interventions (PIs) during the medication review helps to improve the quality of care. The acceptance by the physician of these PIs is a good indicator of the quality of this clinical pharmacy activity. The objective of this study was to determine, in the Amiens-Picardie teaching hospital (France), factors of acceptance in a variable environment of activity (central pharmacy, in the care units, computer assisted). Methods: All PIs transcribed by pharmacists on the Act-IP© site between November 2018 and April 2019 were analyzed using a complementary search in patient records. The environment, type, and clinical impact on patient health of each PI was collected. Linear mixed-effects models with a random pharmacist intercept were used to investigate the relationship between PI modalities and their chance of being accepted. Results: A total of 3,100 PIs were traced, of which 2,930 had been followed over time. Of these, 2,930 PIs, 1,504 (51.3%) were performed by a postgraduate pharmacist and 1,426 (48.7%) by a pharmacy resident, 1,623 (55.4%) were performed by verbal exchange, 455 (15.5%) by telephone, 846 (28.9%) by computer software, and 6 (0.2%) by paper. The clinical impact on patient health was major for 976 PIs (33.3%) and vital for 26 PIs (0.9%). According to the Anatomical Therapeutic Chemical Classification (ATC), they were mainly related to anti-infectives (30.3%), the nervous system (18.7%), and blood and blood-forming organs (17.3%). In total, 2,415 PIs (82.4%) were accepted. According to the multivariate model, a PI was more often accepted when it was transmitted orally rather than by software (+27.7%, 95% CI: +23.2 to +32.1%) and when it was transmitted to a medical resident rather than a postgraduate physician (+4.4%, 95% CI: 1.2-7.6%). In these cases, there was a major rather than a moderate clinical impact on patient health (+4.3%, 95% CI: +1.1-+7.6%). Conclusion: This study highlights the importance of the quality of the exchange with the prescriber and the prioritization of high-risk interventions as key points of medication review to improve rate of pharmacist interventions accepted by physician.
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Affiliation(s)
- Amaury Durand
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France.,Department of Pharmacy, Intercommunal Hospital of the Baie de Somme, Saint Valery sur Somme, France
| | - André Gillibert
- Department of Biostatistics, Rouen Teaching Hospital, Rouen, France
| | - Sophie Membre
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
| | - Lisa Mondet
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
| | - Aurélie Lenglet
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
| | - Aurélien Mary
- Department of Pharmacy, Amiens-Picardie Teaching Hospital, Amiens, France
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Laureau M, Vuillot O, Gourhant V, Perier D, Pinzani V, Lohan L, Faucanie M, Macioce V, Marin G, Giraud I, Jalabert A, Villiet M, Castet-Nicolas A, Sebbane M, Breuker C. Adverse Drug Events Detected by Clinical Pharmacists in an Emergency Department: A Prospective Monocentric Observational Study. J Patient Saf 2021; 17:e1040-e1049. [PMID: 32175969 DOI: 10.1097/pts.0000000000000679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adverse drug events (ADEs) are a major public health issue in hospitals. They are difficult to detect because of incomplete or unavailable medication history. In this study, we aimed to assess the rate and characteristics of ADEs identified by pharmacists in an emergency department (ED) to identify factors associated with ADEs. METHODS In this prospective observational study, we included consecutive adult patients presenting to the ED of a French 2600-bed tertiary care university hospital from November 2011 to April 2015. Clinical pharmacists conducted structured interviews and collected the medication history to detect ADEs (i.e., injuries resulting directly or indirectly from adverse drug reactions and noncompliance to medication prescriptions). Unsure ADE cases were reviewed by an expert committee. Relations between patient characteristics, type of ED visit, and ADE risk were analyzed using logistic regression. RESULTS Among the 8275 included patients, 1299 (15.7%) presented to the ED with an ADE. The major ADE symptoms were bleeding, endocrine problems, and neurologic disorders. Moreover, ADEs led to the ED visit, hospitalization, and death in 87%, 49.3%, and 2.2% of cases, respectively. Adverse drug event risk was independently associated with male sex, ED visit for neurological symptoms, visit to the ED critical care unit, or ED short stay hospitalization unit, use of blood, anti-infective, antineoplastic, and immunomodulating drugs. CONCLUSIONS This study improves the knowledge about ADE characteristics and on the patients at risk of ADE. This could help ED teams to better identify and manage ADEs and to improve treatment quality and safety.
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Miarons M, Marín S, Amenós I, Campins L, Rovira M, Daza M. Pharmaceutical interventions in the emergency department: cost-effectiveness and cost-benefit analysis. Eur J Hosp Pharm 2021; 28:133-138. [DOI: 10.1136/ejhpharm-2019-002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/13/2020] [Accepted: 02/04/2020] [Indexed: 11/03/2022] Open
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The efficacy of a medication review programme conducted in an emergency department. Int J Clin Pharm 2019; 41:757-766. [DOI: 10.1007/s11096-019-00836-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/30/2018] [Indexed: 10/26/2022]
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Morgan SR, Acquisto NM, Coralic Z, Basalyga V, Campbell M, Kelly JJ, Langkiet K, Pearson C, Sokn E, Phelan M. Clinical pharmacy services in the emergency department. Am J Emerg Med 2018; 36:1727-1732. [PMID: 29475633 DOI: 10.1016/j.ajem.2018.01.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/16/2022] Open
Abstract
The emergency department (ED) is a fast-paced, high-risk, and often overburdened work environment. Formal policy statements from several notable organizations, including the American College of Emergency Physicians (ACEP) and the American Society of Health-System Pharmacists (ASHP), have recognized the importance of clinical pharmacists in the emergency medicine (EM) setting. EM clinical pharmacists work alongside emergency physicians and nurses at the bedside to optimize pharmacotherapy, improve patient safety, increase efficiency and cost-effectiveness of care, facilitate antibiotic stewardship, educate patients and clinicians, and contribute to scholarly efforts. This paper examines the history of EM clinical pharmacists and associated training programs, the diverse responsibilities and roles of EM clinical pharmacists, their impact on clinical and financial outcomes, and proposes a conceptual model for EM clinical pharmacist integration into ED patient care. Finally, barriers to implementing EM clinical pharmacy programs and limitations are considered.
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Affiliation(s)
- Sofie Rahman Morgan
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA; Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Zlatan Coralic
- Department of Pharmacy, University of California, San Francisco, CA, USA; Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Vicki Basalyga
- American System of Health-System Pharmacists (ASHP), Bethesda, MD, USA
| | | | - John J Kelly
- Department of Emergency Medicine, Einstein Healthcare Network, Jefferson Medical College, Philadelphia, PA, USA
| | - Kevin Langkiet
- Department of Emergency Medicine, Benefis Health System, Great Falls, MT, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Erick Sokn
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Phelan
- Emergency Services Institute, Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Enterprise Quality, Cleveland, OH, USA
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Coralic Z, Hayes BD. Emergency medicine pharmacists on an international scale. Arch Emerg Med 2017; 34:492-493. [DOI: 10.1136/emermed-2016-206470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 02/15/2017] [Indexed: 11/04/2022]
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Hughes E, Terry D, Huynh C, Petridis K, Aiello M, Mazard L, Ubhi H, Terry A, Wilson K, Sinclair A. Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation. Int J Clin Pharm 2017; 39:960-968. [PMID: 28653261 PMCID: PMC5541106 DOI: 10.1007/s11096-017-0497-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 06/07/2017] [Indexed: 11/24/2022]
Abstract
Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.
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Affiliation(s)
- Elizabeth Hughes
- Health Education England - St Chads Court, 213 Hagley Road, Edgbaston, West Midlands, Birmingham, B16 9RG, UK
| | - David Terry
- Academic Practice Unit, Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
- Pharmacy Department, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
| | - Chi Huynh
- Academic Practice Unit, Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
- Pharmacy Department, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Konstantinos Petridis
- Academic Practice Unit, Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
- Aston Business School, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Matthew Aiello
- Health Education England - St Chads Court, 213 Hagley Road, Edgbaston, West Midlands, Birmingham, B16 9RG, UK
| | - Louis Mazard
- Academic Practice Unit, Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Hirminder Ubhi
- Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Alex Terry
- Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Keith Wilson
- Pharmacy Department, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Anthony Sinclair
- Pharmacy Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
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