Implementation of pharmacist targeted discharge prescription review in an emergency department

Lineberry, Emily; Rozycki, Elizabeth; Jordan, T.; Mellett, John; North, Andrew M.

doi:10.1016/j.ajem.2021.04.054

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…DDI screening and alerting systems should be implemented in electronic medical records ( Celebi et al, 2019 ; Horn and Ueng, 2019 ; Anrys et al, 2021 ). Pharmacist-driven prescription review system in real time has been allowed to optimize therapy ( Lineberry et al, 2021 ). In certain instances, a multidisciplinary team with a physician, a pharmacist and a nurse was required especially in complex drug regimens ( Silva et al, 2015 ; Aghili and Kasturirangan, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Zhao

Liu²,

Feng³

et al. 2022

Front. Pharmacol.

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Introduction: Polypharmacy are commonly observed among older adults with cardiovascular disease. However, multiple medications lead to increased risk of drug-drug interactions (DDIs). Therefore, identification and prevention actions related to harmful DDIs are expected in older adults. The study aimed to describe the prevalence of potential DDIs (pDDIs) in discharge prescriptions among older adults with chronic coronary syndrome (CCS).Methods: A single-center cross-sectional study was performed in a tertiary public hospital in Beijing, China. CCS patients aged 65 years and above who were admitted to cardiology wards over a 3-month period and alive at discharge were included. Electronic medical records and discharge prescriptions were reviewed. pDDIs were evaluated through the Lexi-Interact online.Results: pDDIs were identified in 72.9% of the 402 individuals (n = 293). A total of 864 pDDIs were obtained. 72.1% of patients were found with C DDIs (n = 290) and 20.3% were categorized in D and X DDIs (n = 82). The only X DDI was between cyclosporine and atorvastatin. Under category D, glycemia alterations within antidiabetics and increased chances of bleeding with antithrombotic were the most common. Concomitant use of clopidogrel and calcium channel blockers was a frequent situation within category C, followed by synergic blood pressure lowering agents and increased rosuvastatin concentration induced by clopidogrel.Conclusion: DDIs exposure was common in older CCS. DDIs screening tools should be introduced to alert potential adverse effects. Prescribers need to rigorously review or modulate therapies to prevent DDI-related adverse outcomes. Clinical pharmacists should be more involved in complex drug regimen management.

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Section: Discussionmentioning

confidence: 99%

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Zhao

Liu²,

Feng³

et al. 2022

Front. Pharmacol.

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“… 10 Several studies evaluated the use of real‐time, computerized decision support or ED pharmacist review in the ED to identify high‐risk medications. 51 , 52 The use of an EMR tool is increasing in hospital settings, 53 and it is likely a valuable option for ED providers in determining dispositions and prescribing medications for older adults. It also provides an opportunity to identify the culprit high‐risk medications that are contributing to the admitting diagnosis of fall or delirium.…”

Section: Discussionmentioning

confidence: 99%

“…Harrison et al reported that the use of medications listed in the Beers criteria is very common and questioned the applicability of using the criteria in the ED 10 . Several studies evaluated the use of real‐time, computerized decision support or ED pharmacist review in the ED to identify high‐risk medications 51,52 . The use of an EMR tool is increasing in hospital settings, 53 and it is likely a valuable option for ED providers in determining dispositions and prescribing medications for older adults.…”

Section: Discussionmentioning

confidence: 99%

Challenges and opportunities in creating a deprescribing program in the emergency department: A qualitative study

Lee

Fillman

Carnahan

et al. 2022

J American Geriatrics Society

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Background: As the population of older adults increases, appropriate deprescribing becomes increasingly important for emergency geriatric care. Older adults represent the sickest patients with chronic medical conditions, and they are often exposed to high-risk medications. We need to provide an evidencebased, standardized deprescribing program in the acute care setting, yet the evidence base is lacking and standardized medication programs are needed. Methods:We conducted a qualitative study with the goal to understand the perspective of healthcare workers, patients, and caregivers on deprescribing high-risk medications in the context of emergency care practices, provider preferences, and practice variability, along with the facilitators and barriers to an effective deprescribing program in the emergency department (ED). To ensure rich, contextual data, the study utilized two qualitative methods: (1) a focus group with physicians, advanced practice providers, nurses, pharmacists, and geriatricians involved in care of older adults and their prescriptions in the acute care setting; (2) semi-structured interviews with patients and caregivers involved in treatment and emergency care. Transcriptions were coded using thematic content analysis, and the principal investigator (S.L.) and trained research staff categorized each code into themes.Results: Data collection from a focus group with healthcare workers (n = 8) and semi-structured interviews with patients and caregivers (n = 20) provided evidence of a potentially promising ED medication program, aligned with the vision of comprehensive care of older adults, that can be used to evaluate practices and develop interventions. We identified four themes: (1) Challenges in medication history taking, (2) missed opportunities in identifying high-risk medications, (3) facilitators and barriers to deprescribing recommendations, and (4) how to coordinate deprescribing recommendations.This project was supported by a Carver College of Medicine innovation award. The authors are responsible for the content of this article.

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“…1 Lineberry et al identified that 50% of their anticoagulant discharge prescriptions from their ED required pharmacist intervention or clarification. 2 Discharge education by ED pharmacists leads to improved patient understanding and appropriate use of anticoagulants. 3 In 2018, a patient was diagnosed with a pulmonary embolism and discharged from our hospital ED outside of regular pharmacy hours with a prescription for warfarin and bridging enoxaparin.…”

Section: Introductionmentioning

confidence: 99%

“…Lineberry et al . identified that 50% of their anticoagulant discharge prescriptions from their ED required pharmacist intervention or clarification 2 . Discharge education by ED pharmacists leads to improved patient understanding and appropriate use of anticoagulants 3 …”

Section: Introductionmentioning

confidence: 99%

Improving the safety of anticoagulation initiation in patients discharged from the emergency department

Harding

Mitri

Yeoh

2022

Emerg Medicine Australasia

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Objective To improve the safety of anticoagulation initiation by increasing the proportion of patients reviewed by a pharmacist. Methods An electronic intervention was developed to ensure all patients prescribed anticoagulation on discharge were reviewed by an ED pharmacist. Safe anticoagulation initiation was compared for patients seen and not seen. Results The intervention increased the number of patients seen by an ED pharmacist. Pre‐intervention (n = 238) 84.5% of patients were reviewed by a pharmacist. Post‐intervention (n = 253) 99.6% of patients were reviewed by a pharmacist. Of the 38 patients not reviewed by a pharmacist, 20 (52.6%) had safe anticoagulation initiation and in a sample of 40 patients reviewed by a pharmacist, all 40 (100%) had safe anticoagulation initiation (52.6% vs 100%, P < 0.001). Conclusion The real‐time electronic intervention improved the number of patients reviewed by a pharmacist. ED pharmacist reviewed patients were more likely to have safe anticoagulation initiation.

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Implementation of pharmacist targeted discharge prescription review in an emergency department

Cited by 5 publications

References 12 publications

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Potential drug-drug interactions in drug therapy for older adults with chronic coronary syndrome at hospital discharge: A real-world study

Challenges and opportunities in creating a deprescribing program in the emergency department: A qualitative study

Improving the safety of anticoagulation initiation in patients discharged from the emergency department

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