Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis

Abstract

BackgroundPharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised.ObjectiveThis systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED.MethodsA systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses.ResultsThirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI −0.42 to −0.23, I2=51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I2=85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I2=95%) and quicker initiation of time-critical medications.ConclusionThe evidence indicates improved quality use of medicines when pharmacists are included in ED care teams.PROSPERO registration numberCRD42020165234.

Assessment of drug-related problems at the emergency department in older patients living with frailty: pharmacist-led medication reviews within a geriatric care team

“…These results show that by practical implementation of a medication review program at the ED, comparable DRP rates are found as in literature. In a recently published meta-analysis, the impact of pharmacist interventions in the ED were studied [ 12 ]. Overall, by pharmacist interventions the percentage of patients with at least one medication error was reduced by 73% and the mean number of medication errors per patient was reduced by 0.33.…”

“…Although its impact on mortality was limited [ 5 , 8 , 9 ], other studies have indicated shorter hospital stays, reduced ED visits, heightened patient satisfaction, and decreased healthcare costs [ 5 , 10 – 11 ]. Additionally, pharmacist interventions in the ED was linked to more accurate and thorough medication histories, and higher prescription appropriateness [ 12 ]. While the effects of in-hospital medication reviews have been well-researched, the impact of medication reviews for older patients living with frailty in the ED has yet to be fully studied.…”

Pharmacist-led medication reviews: A scoping review of systematic reviews

“…Two reviews included patient populations with cardiovascular disease and/ or other chronic conditions [15,16]. Four reviews included restricted settings: two included studies based only in hospital [18,31], one in care homes [13], and another ambulatory care [30].…”

“…Evidence for MRs having a positive effect on medication-related problems is inconclusive due to mixed results. Reviews reported that pharmacists were able to identify medicines-related problems [8, 9,11,13,14,19,20,22,31]; this was quanti ed in ve of these reviews [8,11,13,20,26] with the remaining reviews reporting this in results or discussion. However, the resolution of medicines-related problems was not reported or yielded mixed results.…”

“…Twelve systematic reviews included only randomised controlled trials (RCTs) [8][9][10][11][12][13][14][15][16][17][18][19], one included only non-randomised studies [20] and all other reviews included both randomised and non-randomised trials [21][22][23][24][25][26][27][28][29][30][31].…”