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Currey EM, Falconer N, Isoardi KZ, Barras M. Impact of pharmacists during in-hospital resuscitation or medical emergency response events: A systematic review. Am J Emerg Med 2024; 75:98-110. [PMID: 37939522 DOI: 10.1016/j.ajem.2023.10.020] [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: 05/28/2023] [Revised: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND We sought to determine the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill patients requiring resuscitation or medical emergency response team care in a hospital setting. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of databases from January 1995 to April 2023 was conducted to identify studies of contemporary pharmacist practice. Results were extracted and analysed for included studies, those evaluating the impact of the presence of a pharmacist on medication and patient related outcomes during the emergency management of critically ill hospitalised patients requiring resuscitation or medical emergency response team care. To determine risk of bias, the Newcastle-Ottowa Quality Assessment scale was used for non-randomised studies and the Revised Cochrane risk-of-bias tool for randomised trials. RESULTS Of 1345 studies identified, 54 were selected for full text review, and 30 were included in the final analysis. There were 29 cohort studies and one randomised controlled trial. The studies reported the impact of a pharmacist for a variety of patient presentations. The study team assigned each study to one of eight patient cohorts: acute stroke, cardiac arrest, rapid response calls, S-T segment elevation myocardial infarction, acute haemorrhage, major trauma resuscitation, sepsis and status epilepticus. The most frequently reported outcome, associated with a statistically significant benefit in 23 studies, was time to medication administration. Few studies reported a significant difference in patient outcome measures such as mortality. Only 8 of the 30 studies were assessed to have a low risk of bias. CONCLUSIONS The results of this systematic review provide support for a beneficial impact of a pharmacist presence and intervention during resuscitation or medical emergency response team care, with significant improvements in outcomes such as time to initiation of time-critical medications, medication appropriateness and guideline compliance. However, studies were predominantly small and retrospective and were not powered to detect differences in patient related measures such as length of stay and mortality. Future research should investigate the clinical impacts of the pharmacist in ED resuscitation settings in controlled, prospective studies with robust sampling methods.
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Affiliation(s)
- Elizabeth M Currey
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
| | - Nazanin Falconer
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
| | - Katherine Z Isoardi
- Emergency Department and Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia; School of Medicine, University of Newcastle, Newcastle, NSW, Australia.
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Zahl-Holmstad B, Garcia BH, Svendsen K, Johnsgård T, Holis RV, Ofstad EH, Risør T, Lehnbom EC, Wisløff T, Chan M, Elenjord R. Completeness of medication information in admission notes from emergency departments. BMC Health Serv Res 2023; 23:1425. [PMID: 38104071 PMCID: PMC10724918 DOI: 10.1186/s12913-023-10371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness. METHODS Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness. RESULTS Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness. CONCLUSIONS Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway.
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renata V Holis
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Parkveien 95, Bodø, 8005, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar, 392 31, Sweden
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, Lørenskog, 1478, Norway
| | - Macty Chan
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
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3
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Park J, You SB, Ryu GW, Kim Y. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 2023; 12:230. [PMID: 38093372 PMCID: PMC10717502 DOI: 10.1186/s13643-023-02386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature. METHODS This scoping review was conducted using the framework proposed by Arksey and O'Malley and PRISMA-ScR. Overall, four databases-PubMed, Web of Science, EMBASE, and CINAHL-were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar. RESULTS A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs. CONCLUSIONS Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.
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Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Sang Bin You
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Gi Wook Ryu
- Department of Nursing, Hansei University, 30, Hanse-Ro, Gunpo-Si, 15852, Gyeonggi-Do, Korea.
| | - Youngkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
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Atey TM, Peterson GM, Salahudeen MS, Simpson T, Boland CM, Anderson E, Wimmer BC. Clinical and economic impact of partnered pharmacist medication charting in the emergency department. Front Pharmacol 2023; 14:1273657. [PMID: 38143495 PMCID: PMC10748591 DOI: 10.3389/fphar.2023.1273657] [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: 08/07/2023] [Accepted: 10/19/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction: Partnered pharmacist medication charting (PPMC), a process redesign hypothesised to improve medication safety and interdisciplinary collaboration, was trialed in a tertiary hospital's emergency department (ED). Objective: To evaluate the health-related impact and economic benefit of PPMC. Methods: A pragmatic, controlled study compared PPMC to usual care in the ED. PPMC included a pharmacist-documented best-possible medication history (BPMH), followed by a clinical conversation between a pharmacist and a medical officer to jointly develop a treatment plan and chart medications. Usual care included medical officer-led traditional medication charting in the ED, without a pharmacist-obtained BPMH or clinical conversation. Outcome measures, assessed after propensity score matching, were length of hospital or ED stay, relative stay index (RSI), in-hospital mortality, 30-day hospital readmissions or ED revisits, and cost. Results: A total of 309 matched pairs were analysed. The median RSI was reduced by 15.4% with PPMC (p = 0.029). There were no significant differences between the groups in the median length of ED stay (8 vs. 10 h, p = 0.52), in-hospital mortality (1.3% vs. 1.3%, p > 0.99), 30-day readmission rates (21% vs. 17%; p = 0.35) and 30-day ED revisit rates (21% vs. 19%; p = 0.68). The hospital spent approximately $138.4 for the cost of PPMC care per patient to avert at least one medication error bearing high/extreme risk. PPMC saved approximately $1269 on the average cost of each admission. Conclusion: Implementing the ED-based PPMC model was associated with a significantly reduced RSI and admission costs, but did not affect clinical outcomes, noting that there was an additional focus on medication reconciliation in the usual care group relative to current practice at our study site.
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Affiliation(s)
- Tesfay Mehari Atey
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Mohammed S. Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Tom Simpson
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart, TAS, Australia
| | - Camille M. Boland
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart, TAS, Australia
| | - Ed Anderson
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart, TAS, Australia
| | - Barbara C. Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Atey TM, Peterson GM, Salahudeen MS, Wimmer BC. The impact of partnered pharmacist medication charting in the emergency department on the use of potentially inappropriate medications in older people. Front Pharmacol 2023; 14:1273655. [PMID: 38026998 PMCID: PMC10664652 DOI: 10.3389/fphar.2023.1273655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: A process redesign, partnered pharmacist medication charting (PPMC), was recently piloted in the emergency department (ED) of a tertiary hospital. The PPMC model was intended to improve medication safety and interdisciplinary collaboration by having pharmacists work closely with medical officers to review and chart medications for patients. This study, therefore, aimed to evaluate the impact of PPMC on potentially inappropriate medication (PIM) use. Methods: A pragmatic concurrent controlled study compared a PPMC group to both early best-possible medication history (BPMH) and usual care groups. In the PPMC group, pharmacists initially documented the BPMH and collaborated with medical officers to co-develop treatment plans and chart medications in ED. The early BPMH group included early BPMH documentation by pharmacists, followed by traditional medication charting by medical officers in ED. The usual care group followed the traditional charting approach by medical officers, without a pharmacist-collected BPMH or collaborative discussion in ED. Included were older people (≥65 years) presenting to the ED with at least one regular medication with subsequent admission to an acute medical unit. PIM outcomes (use of at least one PIM, PIMs per patient and PIMs per medication prescribed) were assessed at ED presentation, ED departure and hospital discharge using Beers criteria. Results: Use of at least one PIM on ED departure was significantly lower for the PPMC group than for the comparison groups (χ2, p = 0.040). However, PIM outcomes at hospital discharge were not statistically different between groups. PIM outcomes on ED departure or hospital discharge did not differ from baseline within the comparison groups. Discussion: In conclusion, PIM use on leaving ED, but not at hospital discharge, was reduced with PPMC. Close interprofessional collaboration, as in ED, needs to continue on the wards.
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Affiliation(s)
| | | | - Mohammed S. Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Australia
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Zahl-Holmstad B, Garcia BH, Johnsgård T, Ofstad EH, Lehnbom EC, Svendsen K, Risør T, Holis RV, Elenjord R. Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study. BMJ Open Qual 2023; 12:bmjoq-2022-002239. [PMID: 37217242 DOI: 10.1136/bmjoq-2022-002239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients' perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present. METHODS We conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis. RESULTS From our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed. CONCLUSION Despite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients' individual needs.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eirik Hugaas Ofstad
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elin Christina Lehnbom
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torsten Risør
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health, University of Copenhagen, København, Denmark
| | | | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
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van Nuland M, Butterhoff M, Verwijmeren K, Berger F, Hogervorst VM, de Jonghe A, van der Linden PD. Assessment of drug-related problems at the emergency department in older patients living with frailty: pharmacist-led medication reviews within a geriatric care team. BMC Geriatr 2023; 23:215. [PMID: 37016324 PMCID: PMC10074685 DOI: 10.1186/s12877-023-03942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Older patients are vulnerable to experiencing drug related problems (DRPs), which may result in emergency department (ED) visits. However, it is not standard practice to conduct medications reviews during ED visit. The aim of this study was to assess the number of DRPs in older patients living with frailty at the ED, identified through pharmacist-led medication reviews within a geriatric care team, and to determine the acceptance rate of pharmacists' recommendations among hospital physicians and general practitioners or elderly care specialists. METHODS A retrospective observational study was performed in patients ≥ 70 years living with frailty at the ED at Tergooi Medical Center. Pharmacist-led medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. The acceptance rate of given recommendations was determined during follow-up. RESULTS A total of 356 ED visits were included. The mean (standard deviation, SD) age of patients was 83 (6.8) years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP (SD 1.3) per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients. CONCLUSIONS Pharmacist-led medication reviews as part of a geriatric care team identified DRPs in 76% of older patients living with frailty at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients.
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Affiliation(s)
- Merel van Nuland
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands.
| | - Madelon Butterhoff
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Karin Verwijmeren
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Florine Berger
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | | | | | - Paul D van der Linden
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
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8
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Atey TM, Peterson GM, Salahudeen MS, Bereznicki LR, Simpson T, Boland CM, Anderson E, Burgess JR, Huckerby EJ, Tran V, Wimmer BC. Impact of Partnered Pharmacist Medication Charting (PPMC) on Medication Discrepancies and Errors: A Pragmatic Evaluation of an Emergency Department-Based Process Redesign. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1452. [PMID: 36674208 PMCID: PMC9859430 DOI: 10.3390/ijerph20021452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies' clinical significance, with 'unintentional' discrepancies deemed 'errors'. Fewer patients in the PPMC group had at least one error (3.5%; 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4%; 95% CI: 42.5% to 56.3%) and usual care group (61.4%; 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.
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Affiliation(s)
- Tesfay Mehari Atey
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Mohammed S. Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Luke R. Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Tom Simpson
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - Camille M. Boland
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - Ed Anderson
- Pharmacy Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - John R. Burgess
- Department of Endocrinology, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia
| | - Emma J. Huckerby
- Emergency Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
| | - Viet Tran
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia
- Emergency Department, Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia
| | - Barbara C. Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
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