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Analysis of medication-related problems detected after bringing a pharmacist onto the emergency department staff

Ucha Samartín M, Pichel Loureiro Á, Våzquez López C, Benito García I, Martínez López De Castro N, Amador Barniela L

Servicio de Farmacia, Hospital Meixoeiro (CHUVI), Vigo, Spain.

Objective: To analyze the incidence of medication problems in an emergency
department after incorporation of a pharmacist into the multidisciplinary team.
Methods: Prospective observational study lasting 1 year. All patients in observation and
preadmission beds were included. The pharmacist verified the patients' medication use
and when problems came to light the team discussed them and came to an agreement
on the recommended course of action. The reasons for problems and their seriousness
were analyzed, along with patient characteristics (demographic and clinical) and the
medical specialty involved.
Results: A total of 1725 medication interventions in 950 patients (59.5% under the care
of emergency physicians, 29.3% under another specialist physician's care, and 11.2%
under a surgeon's care); 668 were therapeutic replacements and 1057 were medication
errors. Problems affected the safety we seen in patients under an emergency physician’s
care (68%) (P<.05), while prescription problems were mainly in patients under a
surgeon's care (48%) (P<.05). Agents affecting the cardiovascular system (27.3%) or the
digestive tract (22.3%) were most often involved in problems. Most required a change
in therapy or increased monitoring (71.1%). Seventy-eight percent of the problems were
solved, and 11% could not be assessed (half in patients under an emergency physician’s
care) (P<.05). The incorporation of an emergency department pharmacist led to an
estimated savings of 20% in medication costs.
Conclusions: The emergency department has a high incidence of problems related to
medication. Incorporating a staff pharmacist and training multidisciplinary teams are
measures that help correct medication problems early and improve the cost-effectiveness
of drug therapy.

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