Pharmacist elicited medication histories in the Emergency Department: Identifying patient groups at risk of medication misadventure

Ajdukovic, Maja; Crook, Meredith; Angley, Christopher; Stupans, Ieva; Soulsby, Natalie; Doecke, Christopher J; Anderson, Barbara A.; Angley, Manya

doi:10.4321/s1886-36552007000400004

Cited by 18 publications

(23 citation statements)

References 27 publications

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“…This is in line with the findings from a study by Ajdukovic et al, who found that pharmacist elicited medication histories for 'at risk' groups in the Emergency department can reduce medication misadventure and errors [27]. …”

Section: Discussionsupporting

confidence: 90%

Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

2011

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BackgroundWhile the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs) by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service.MethodsThe study was undertaken (February March 2009-June 2010) in three phases. Development (Phase 1) involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3) of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs.ResultsThe pharmacist screened most patients (88.4%, 373/422) referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52), and a variety of DRPs (113) were detected at this point, the most common being "patient requests drug information" (25%, 28/113) and "condition not adequately treated" (22%, 25/113). The pharmacist made 120 recommendations in relation to her interventions.Fifty percent of online survey respondents (10/20) had interacted 10 or more times with the pharmacist for advice. All felt that the pharmacist's role was helpful, improving their knowledge of the different medications used in palliative care. The six team members who participated in the focus group indicated that there were several benefits of the pharmacist's contributions towards medication screening and review.ConclusionsThe inclusion of a pharmacist in a community palliative care team lead to an increase in the medication-related knowledge and skills of its members, improved patients' medication management, and minimised related errors. The model of care created can potentially be duplicated by other palliative care services, although its cost-effectiveness was unable to be accurately tested within the study.

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Section: Discussionsupporting

confidence: 90%

Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

2011

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“…Professional characteristics of the reviewer must also be considered when exploring reliability in DRV detection. It has been previously demonstrated that physicians overlook DRPs as a cause for emergency department visits [52],[53].…”

Section: Discussionmentioning

confidence: 99%

Drug-Related Hospital Visits and Admissions Associated with Laboratory or Physiologic Abnormalities—A Systematic-Review

2013

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Countless studies have demonstrated that many emergency-room visits and hospital admissions are drug-related and that a significant proportion of these drug-related visits (DRVs) are preventable. It has not been previously studied which DRVs could be prevented through enhanced monitoring of therapy. The objective of the study was to determine the incidence of DRVs attributed to laboratory or physiologic abnormalities. Three authors independently performed comprehensive searches in relevant health care databases using pre-determined search terms. Articles discussing DRV associated with poisoning, substance abuse, or studied among existing in-patient populations were excluded. Study country, year, sample, design, duration, DRV identification method, proportion of DRVs associated with laboratory or physiologic abnormalities and associated medications were extracted. The three authors independently assessed selected relevant articles according to the Strengthening the reporting of observational studies in epidemiology (STROBE) as applicable according to the studies' methodology. The initial literature search yielded a total of 1,524 articles of which 30 articles meeting inclusion criteria and reporting sufficient laboratory or physiologic data were included in the overall analysis. Half employed prospective methodologies, which included both chart review and patient interview; however, the overwhelming majority of identified studies assessed only adverse drug reactions (ADRs) as a drug-related cause for DRV. The mean (range) prevalence of DRVs found in all studies was 15.4% (0.44%–66.7%) of which an association with laboratory or physiologic abnormalities could be attributed to a mean (range) of 29.4% (4.3%–78.1%) of cases. Most laboratory-associated DRVs could be linked to immunosuppressant, antineoplastic, anticoagulant and diabetes therapy, while physiologic-associated DRVs were attributed to cardiovascular therapies and NSAIDs. Significant proportions of laboratory and physiologic abnormalities contribute to DRVs and are consistently linked to specific drugs. These therapies are potential targets for enhanced medication monitoring initiatives to proactively avert potential DRVs.

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“…However, combining the two approaches to older patients (>70 years) presenting to an ED might assist with accurately documenting pre‐admission medications early, alert hospital doctors to potential concerns and allow for the provision of an ED clinical pharmacist medication review (EDMR) for patients who might not require hospitalisation. There have been limited numbers of related studies in Australia, some prospective but none randomised . Specifically, there was no information regarding the attitude of general practitioners (GPs) to having advice provided by hospital pharmacists.…”

Section: Introductionmentioning

confidence: 99%

Clinical pharmacist review: A randomised controlled trial

Briggs

Pearce

Dilworth

et al. 2015

Emerg Medicine Australasia

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Pharmacist elicited medication histories in the Emergency Department: Identifying patient groups at risk of medication misadventure

Cited by 18 publications

References 27 publications

Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

Drug-Related Hospital Visits and Admissions Associated with Laboratory or Physiologic Abnormalities—A Systematic-Review

Clinical pharmacist review: A randomised controlled trial

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