TY - JOUR
T1 - Comprehensive identification of medication-related problems occurring prior to, during and after emergency department presentation
T2 - An Australian multicentre, prospective, observational study
AU - Taylor, Simone E.
AU - Mitri, Elise A.
AU - Harding, Andrew M.
AU - Taylor, David Mc D.
AU - Weeks, Adrian
AU - Abbott, Leonie
AU - Lambros, Pani
AU - Lawrence, Dona
AU - Strumpman, Dana
AU - Senturk-Raif, Reyhan
AU - Louey, Stephen
AU - Crisp, Hamish
AU - Tomlinson, Emily
AU - Manias, Elizabeth
N1 - Funding Information:
The authors wish to thank the EDs and pharmacy departments at each participating site for their in-kind support to undertake patient recruitment and data collection. We also thank the Centre for Quality and Patient Safety Research at Deakin University for their seeding grant to support data analysis for this project. SET was responsible for the conception and design, data acquisition, analysis and interpretation, drafting/revising critically, final approval and agreement to be accountable. EAM, AMH, AW, LA, PL, DL, DS, RS-R, SL, HC were responsible for the data acquisition, analysis and interpretation, drafting/revising critically, final approval and agreement to be accountable. DMT, EM were responsible for the conception and design, analysis and interpretation, drafting/revising critically, final approval and agreement to be accountable. ET was responsible for analysis and interpretation, drafting/revising critically, final approval and agreement to be accountable. None declared.
Publisher Copyright:
© 2020 Australasian College for Emergency Medicine
PY - 2020/6
Y1 - 2020/6
N2 - Objective: Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. Methods: We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. Results: A total of 904 patients were recruited: 14.8% aged ≥80 years, 18.9% taking more than eight regular medications; 581 MRPs were identified; 287 (49.4%, 95% confidence interval [CI] 45.3–53.5%) of moderate-high significance. Most highly significant MRPs involved high-risk medications, particularly strong opioids, insulin and anti-coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9–45.5%) had at least one MRP; 31.4% (95% CI 28.4–34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4–14.8%) had MRPs that could be identified or managed by screening at ED discharge. Conclusions: Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.
AB - Objective: Patients present to EDs with various medication-related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. Methods: We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre-specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. Results: A total of 904 patients were recruited: 14.8% aged ≥80 years, 18.9% taking more than eight regular medications; 581 MRPs were identified; 287 (49.4%, 95% confidence interval [CI] 45.3–53.5%) of moderate-high significance. Most highly significant MRPs involved high-risk medications, particularly strong opioids, insulin and anti-coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9–45.5%) had at least one MRP; 31.4% (95% CI 28.4–34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4–14.8%) had MRPs that could be identified or managed by screening at ED discharge. Conclusions: Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs.
KW - adverse drug event
KW - continuum of care
KW - emergency department
KW - medication-related problem
UR - http://www.scopus.com/inward/record.url?scp=85078758520&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.13439
DO - 10.1111/1742-6723.13439
M3 - Article
C2 - 31970884
AN - SCOPUS:85078758520
SN - 1742-6731
VL - 32
SP - 457
EP - 465
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
IS - 3
ER -