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Study objective To determine the rate and details of interventions associated with emergency medicine (EM) pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, to evaluate care providers’ satisfaction with such services provided by EM pharmacists. Methods This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of EM pharmacist interventions on discharge prescriptions were compiled using a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the impact and satisfaction of this new EM pharmacist provided service. Results The 674 discharge prescriptions reviewed by EM pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. EM pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% [95% confidence interval (CI), 8.0% to 12.7%]. The intervention rate was 8.5% (95% CI, 6.4% to 11.1%) for adult prescriptions, and was 23.6% for pediatric prescriptions (95% CI, 14.7% to 35.3%) (difference 15.1%, 95% CI 5.1–25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%) respectively. Over 95% of survey respondents felt the new pharmacist services improved patient safety, optimized medication regiments, and improved patient satisfaction. Conclusions EM pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions, and is highly valued by ED care providers.

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A secondary analysis of data from a previously published study at four medical centers indicated that ED pharmacists often recommend interventions that improve the quality of medication use and adherence to EBM and national quality standards.

Purpose: To design and evaluate the accuracy and efficiency of a medication reconciliation workflow incorporating pharmacist home medication ordering. Methods: Designed and implemented an admission medication reconciliation workflow that expanded the pharmacists’ role to include an initial ordering of home medications. Performed a prospective, pre–post cohort analysis comparing preimplementation accuracy and efficiency data from inpatient medicine and cardiology patients to postimplementation accuracy and efficiency data from our emergency department observation unit. Accuracy for the preimplementation group was defined by the number of unintentional discrepancies identified by pharmacists between the prescriber admission orders and the reconciled home medication lists. Accuracy for the postimplementation group was defined by the prescriber acceptance of pharmacist-ordered home medications. Efficiency was measured by pharmacist time to complete the admission medication reconciliation process. Results: Prescribers accepted 98% of home medication orders placed by pharmacists, which correlated with a significant decrease in the occurrence of home medication orders containing a medication-related problem or discrepancy (46.4% vs 1.3%, P < .0001). The mean pharmacist time spent completing medication reconciliation per admission decreased from 64 to 23 minutes ( P < .0001). Conclusion: Implementation of an admission process that incorporates pharmacist ordering of home medications increased prescribing accuracy and efficiency.