Implementation and Impact of Pharmacist-Initiated Home Medication Ordering in an Emergency Department Observation Unit

Abstract

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.

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

“…These studies included 13 242 participants in total, with sample sizes varying considerably between 34 and 3594 participants 17 18. Ten studies were controlled pre–post interventional studies,19–28 nine were cohort studies,29–37 three were RCTs,38–40 three were controlled concurrent studies,18 41 42 three were pre–post interventional studies without controls,17 43 44 two were controlled sequential studies45 46 and one was a multicentre cross-sectional study 47. Seven of the studies exclusively limited the participants to older adults, aged 65 years and above 18 23 28 40 41 45 46…”

“…Types of interventions were clustered around eight activities (table 2 and online supplemental table 4). Pharmacists were predominantly involved in comprehensive medication reviews and order verification,19 20 22 23 28–33 37–42 44 45 identification of drug-related problems,19 32 40 41 43 46 47 structured patient and/or caregiver interviews,19 20 28 33 37–41 43–47 or medication prescribing/co-prescribing 18 20 21 23 29 35 36 46…”

“…Sixteen studies reported that the interventions were provided to patients in ED either before being seen by doctors,38 39 45–47 before the creation of medication orders,18 33 35 40 44 or during the initiation of medication orders 21 27 30 31 34 37…”

“…Eighteen studies reported the interventions’ impact on medication errors17–20 22 25 28 29 33 35 38 40 41 43–47 and one study on adverse drug events (online supplemental table 4). 39 The errors in the intervention groups17 19 20 22 25 28 29 33 35 38 40 41 43–47 and control groups17 20 25 28 35 38 40 41 43–47 were prospectively identified in the majority of the studies. The errors were retrospectively identified from the medical records in one study for the intervention group18 and in five studies for the control groups 2 18 19 22 29 33.…”

“…The errors were retrospectively identified from the medical records in one study for the intervention group18 and in five studies for the control groups 2 18 19 22 29 33. Nine studies reported that the errors were communicated to the treating physicians,17 19 29 32 35 40 44–46 and the errors had been rectified in three of them 19 29 45…”