Managing emergency department patients with potential medication-related harm: a qualitative study

Medication-related harm (is a challenge globally and contributes to emergency department (ED) presentations. Accurate medication histories are essential to identify whether medication-related harm contributed to an ED presentation.

The aim of this study was to explore the perspectives of ED clinicians on prioritising ED patients admitted due to potential medication-related harm.

We conducted semi-structured qualitative interviews with purposively selected ED doctors, pharmacists, and nurses from a hospital and health service in Southeast Queensland, which includes both a tertiary and secondary ED. Participants were interviewed face-to-face May-July 2023. Interviews were guided by a piloted interview guide with seven open-ended questions focusing on clinicians' views of medication management and prioritisation in suspected medication-related harm cases.

Fifteen clinicians with varying ED experience levels were interviewed: five doctors, five pharmacists, five nurses. Average interview time was 19 min (9-44 min). Thematic analysis of the interview data identified two key themes and six subthemes related to the prioritisation of patients with suspected medication-related harm and the role of ED clinicians in medication management. ED clinicians used varied and inconsistent processes to identify and flag patients who were either admitted with or suffered potential medication-related harm during admission and identified a need for a strategic structured process. The value of ED pharmacists was highlighted by all non-pharmacist participants.

Findings indicate that, in the absence of standardised prioritisation processes, ED clinicians rely heavily on individual clinical judgement. This underscores the need for the development of a tool specifically designed for the ED context to guide patient prioritisation.