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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Impact of an emergency department pharmacy on medication omission and delay
Greg P Marconi1, Ilene Claudius
1Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA. gmarconi@chla.usc.edu
Insights
Adding a clinical pharmacist to a pediatric emergency department (ED) significantly reduced medication omissions and delays, especially for patients with prolonged stays. This improvement in medication safety was sustained over time.
Area of Science:
- Pharmacology
- Emergency Medicine
- Patient Safety
Background:
- Medication omissions and delays are frequent in emergency departments (EDs).
- Patients with prolonged ED stays (≥8 hours) face heightened risks of medication errors.
- The role of clinical pharmacists in optimizing medication management within ED settings requires further investigation.
Purpose of the Study:
- To assess the impact of integrating a clinical pharmacist into a pediatric ED.
- To evaluate changes in medication omissions and delays for patients with extended ED stays (≥8 hours).
- To determine the effect on medication errors in this specific patient population.
Main Methods:
- Retrospective review of medication omissions and delays.
- Data collected from a tertiary-care children's hospital ED.
- Analysis conducted during three periods: pre-pharmacist, immediately post-pharmacist, and 6 months post-pharmacist addition.
Main Results:
- Significant reductions in both urgent and nonurgent medication omissions/delays were observed immediately after pharmacist integration (P < 0.0001).
- These improvements were sustained at 6 months, with nonurgent medications showing statistical significance (P < 0.0001).
- For patients with prolonged ED stays (≥8 hours), medication omission/delay rates dropped from 52.8% to 28.6% immediately after pharmacist addition.
Conclusions:
- Emergency departments experience high rates of medication omissions and delays.
- Prolonged ED boarding increases the risk of medication administration errors.
- Integrating clinical pharmacists into EDs can effectively decrease medication omissions and delays, enhancing patient safety.
Objectives:
The objective of the study was to evaluate the impact of adding a clinical pharmacist within a pediatric emergency department (ED) on medication omissions and delays, as well as medication errors on patients with prolonged ED stays of 8 hours or greater.
Methods:
This is a retrospective review of medication omissions and delays on all patients admitted to a large, tertiary-care children's hospital through the ED during a month before the addition of a clinical pharmacist (April 2007), during a month immediately after the addition of a clinical pharmacist (April 2009), and 6 months after the addition of a clinical pharmacist (October 2009). The medication omissions and delays were separated for urgent and nonurgent medications. A subgroup was further analyzed to evaluate the rate of medication omissions and delays for admitted patients boarded within the ED for 8 hours or greater.
Results:
Medication omissions and delays decreased immediately after the addition of a clinical pharmacist for urgent medications (P = 0.007) and nonurgent medications (P < 0.0001). This decrease persisted 6 months after the addition of a clinical pharmacist approaching significance for urgent medications (P = 0.06) and statistically significant for nonurgent medications (P < 0.0001). For the patients who were boarded within the ED for 8 hours or greater, 52.8% experienced a medication omission or delay before the addition of a clinical pharmacist, compared with 28.6% and 36.2% experiencing an omission or delay in medications administration immediately after or 6 months after the addition of a clinical pharmacist, respectively.
Conclusions:
Medication omissions and delays are common within the ED. Admitted patients boarded within the ED for 8 hours or greater are at an increased risk for medications omissions and delays. The addition of a clinical pharmacist within an ED may reduce the number of medication omissions and delays occurring.
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