Omitted medications were the most common error reported in an article by ASHP in 2012.

LITERATURE:

46% Omitted meds

23% Omitted/changed freq

12% Omitted/changed dose

7% Discontinued therapy

10% Extraneous medication

2% Patient education

GOAL

DATA COMPARISON

INTERVENTIONS ALLERGY INTERVENTIONS

Pharm Assist in Emergency DepartmentTAMMY DOMANICO, PHARMD, KELLI FARNELL PHARMD, THUY NGUYEN PHARMD

BROWARD HEALTH IMPERIAL POINT

OBJECTIVES

methods

RESULTS

REFERENCES

FUTURE GOALS

Assist the ED staff in obtaining the most accurate, current medication history list prior to admission

Contributions of an ED based pharmacist in obtaining medication histories

IDENTIFY patients to be admitted in FirstNet.

REVIEW patients current medication list, medication history, problem and diagnoses, allergies to medications, supplements and foods as well as the clinical notes from the ER providers.

INTERVIEW the patient and/or family member or caregiver.

RESOLVE medication issue (s) identified in the home medication list and update in Powerchart.

NOTE medication compliance and mentioned barriers to compliance in Powerchart.

1. Joint Commission. Hospital National patient safety goals effective January 1, 2015; 1-15

2. Monte AA, et al. J Emerg Med. 2015 Mar 19. Accuracy of electronic medical record medication reconciliation in emergency department patients.

3. Carter MK, Allin DM, Scott LA, Grauer D. Pharmacist-acquired medication histories in a university hospital emergency department. Am J Health Syst Pharm. 2006 Dec 15;63(24):2500-3

4. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of Hospital admission. Arch Intern Med. 2005;165:424-9

5. Jennifer R. Pippins, MD et al. Classifying and predicting errors of inpatient medication reconciliation J Gen Intern Med. 2008 Sept; 23(9): 1414-1422

6. Etchells E et al. Healthcare Quarterly, 2009 Aug:102-109. Implementation of admission medication reconciliation at two academic health sciences centers challenges and success factors.

7. Becerra-Camargo J, et al. A multicenter, double-blind, randomized, controlled, parallel-group study of a pharmacist-aquired medication history in an emergency department. BMC Health Services Research 2014, 13:337.

8. Quelennec B et al. Potential clinical impact of medication discrepancies at hospital admission. Eur J Intern Med. 2013 Sep;24(6):530-5.

9. Reeder TA, Mutnick A. Pharmacist-versus physician obtained medication histories. Am J Health Syst Pharm. 2008;65(9):857-860

10. B Sin et al. Hosp Pharm. 2015 Feb;50(2): 134-8 Implementation of a 24 hour pharmacy service with prospective medication review in the emergency department.

11. Institute for Safe Medication Practices Canada. Assuring Medication Accuracy at Transitions in Care: Medication Reconciliation. High 5’s Action on Patient Safety Getting Started Kit. 2009

12. Pharmacists key to improving medication reconciliation. Pharmacy Times 2014, Feb.

13. Simple Solutions: Medication Reconciliation. American Academy of Emergency Medicine. 2008;15(6):15

14. Buckley, B. Med Rec Efforts Can be Difference in Patient Safety. Pharmacy Practice News, January 2014.

• To Improve patient safety and outcomes by communicating with patients and the medical staff.

• Improve compliance to NPSG #3 to maintain and communicate accurate patient medication information.

• Contribute to providing patients with a smooth transition of care from the ED to inpatient unit.

• Improve the efficiency of the central pharmacist medication review and verification process.

• Maintain visibility and availability for assisting nursing with medication administration issues: Y-site compatibilities, verifying dose calculations, etc.

• Available to assist medical staff with drug information, dosing, drug identification, protocols, CPOE issues

• Quickly identify non-formulary medications in the patient medication list for which there is no substitute.

• Provide pharmacist coverage 5 days/week.

• Utilize Pharm.D. students/residents to increase the amount of patients interviewed.

• Categorize medication issues into their potential to cause harm.

• Determine costs avoided by pharmacy interventions in the ED.

• Review and verification of ED medications orders at or closer to the administration time.

• Improve compliance with JC by reviewing medications for appropriateness prior to administration.

• Provide the ability for the ED pharmacist to document in power-chart a progress note stating any pertinent recent changes in therapy and any recommendations for further therapy change.

• Offer outpatient retail pharmacy Rx services to discharge patients.

• Provide medication education to the ED staff during their shift meetings.

• Continue to develop a collaborative relationship with the ED healthcare team.

• There is a growing trend for positioning pharmacists in the ED. BHMC, BHN, BHCS have pharmacist coverage in the ED. Studies have shown that pharmacists are able to obtain the best possible medication histories.

First Day: April 28th, 2015

Data as of: October 13, 2015

Number of Days (4 hr shifts) of Pharmacist in ER: 57

Number of Pts Interviewed by Pharmacist: 327

Patient Demographics Pt Age Range: 19 – 98

Patients Over 55 Years Old: 68%, 222 pts

MALE 49%

FEMALE 51%

• 327 patients with a total of 2888 medications were included.

• Resulting in a total of 1375 interventions.

• 88% of patients interviewed had at least 1 intervention.

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1500

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Total # of Meds Reviewed

Total # of Interventions

2888

1375

47.6%

Allergy Clarification82.5%

Add Allergy15% Remove Allergy

2.5%

Altered Allergy Information 37%

Unaltered Allergy Information 63%

32%

13% 13%

22%

4% 11% 3%

1% 0% 1%

Omitted med: 443

Omitted/changed dose: 177

Omitted/changed frequency: 180

Discontinued drug/completed therapy: 299

Duplicate drug/therapy: 58

Allergies added/removed/clarified:148

Change administration time: 40

NICHE Designated Hospital

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