The Feasibility and Impact of Prospective Medication Review in the Emergency Department

Medication reviews by emergency department pharmacists in patients hospitalised for an adverse drug event: a cost study

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.

Implementation and safety evaluation of autoverification for select low-risk, high-volume medications in the emergency department

PURPOSE

Use of autoverification has decreased in many emergency departments (EDs) with the expansion of emergency medicine (EM) pharmacists. Few studies have evaluated ways to prioritize verification of medications. Here we describe a process to design, implement, and measure the safety of autoverification of low-risk, high-volume medications.

SUMMARY

A 3-month retrospective review of medications ordered and administered in the ED generated a list of medications to be considered for autoverification. Concurrently, a novel risk stratification tool was created to identify low-risk medications. Taking these together, medications that were high volume and low risk were considered potentially autoverified medications (PAMs). To evaluate the safety of PAMs, a retrospective review of the ED medication orders placed before implementation of autoverification was performed. A total of 7,433 medication orders were reviewed. Of these, 3,057 orders (41%) were identified as PAMs. EM pharmacists verified 2,982 (97.5%) of the orders without changes. Of the remaining 93 orders that were modified or discontinued and met autoverification criteria, only 2 (0.07%) were identified as potentially inappropriate for autoverification.

CONCLUSION

Low-risk, high-volume medications can be safely autoverified in the ED by using a systematic approach to order selection. Using these methods can provide large decreases in verification volume, close to 41%, without compromising patient safety.

Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review

PURPOSE

Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists' interventions in acute care settings.

METHODS

An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice.

RESULTS

The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm.

CONCLUSION

Cost-avoidance studies of pharmacists' interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.