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Development of Screening Tools to Predict Medication-Related Problems Across the Continuum of Emergency Department
Simone E Taylor1,2,3, Elise A Mitri1,2, Andrew M Harding1,2
1Pharmacy Department, Austin Health, Heidelberg, VIC, Australia.
Frontiers in Pharmacology
|July 25, 2022
Summary
This study identified key predictors of medication-related problems (MRPs) in emergency department (ED) patients. These findings can inform the development of screening tools to help ED pharmacists identify high-risk individuals for targeted interventions.
Area of Science:
- Pharmacoeconomics and Health Economics
- Clinical Pharmacy and Practice
- Patient Safety and Quality Improvement
Background:
- Medication-related problems (MRPs) are a significant issue across the emergency department (ED) care continuum, from presentation to post-discharge.
- Identifying patients at high risk for MRPs is crucial for effective intervention and improved patient outcomes.
- This study aimed to identify predictors of MRPs and develop screening tools for ED pharmacists.
Purpose of the Study:
- To determine predictors of medication-related problems (MRPs) across the emergency department (ED) care continuum.
- To develop and validate screening tools for identifying patients at high risk of MRPs upon ED presentation and discharge.
- To enable targeted interventions by ED pharmacists for at-risk patient populations.
Main Methods:
- A prospective, observational, multicenter study involving 904 adult patients across nine EDs.
- Data collection included patient interviews and medical record reviews within one week of ED discharge.
- Logistic regression analysis was used to identify predictor variables for MRPs, informing the development of two screening tools.
Main Results:
- Key predictors for MRPs at ED presentation included medication self-administration, carer assistance, medication-related ED visits, advanced age, adherence issues, recent specialist visits, concession card status, prior hospitalization, male gender, and difficulty reading labels.
- Predictors for MRPs at ED discharge included potential medication adherence issues, prolonged ED stay (>8 hours), difficulty reading labels, and medication regimen changes during the ED visit.
- The developed screening models demonstrated good predictive accuracy (C-statistic 0.84 for ED presentation, 0.78 for ED discharge).
Conclusions:
- Predictors for medication-related problems (MRPs) are readily identifiable at the bedside in the emergency department (ED).
- Screening tools developed from these predictors can effectively identify high-risk patients upon ED presentation and discharge.
- Further validation and implementation studies are needed to assess the impact of these screening tools on patient care outcomes.
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