Reducing Errors in Overcrowded EDs

Pharmacists can help reduce medication errors, but high patient volumes in emergency departments is negatively impacting patient care.

Emergency departments (EDs) have become increasingly overcrowded. Patients using them, sometimes as their usual source of primary care for problems better handled elsewhere, can expect long waits. They may also be subject to more medication errors and adverse drug events than ever before. Some patients may be “boarded” in the ED if available beds are full. Associated problems include missed doses of necessary medication, longer hospital stays once they reach an acceptable ward, and increased morbidity.

Children’s Hospital of Los Angeles began staffing their ED with a full time clinical pharmacist in April 2009. Greg Marconi, MD, and Ilene Claudius, MD, conducted a retrospective chart review for the total number of medications dispensed, as well as medication type, indication, and time of administration. They report 2 important findings in the January 2012 issue of Pediatric Emergency Care:

· Adding a satellite clinical pharmacist within their ED reduced medication omissions and delays

· Medication errors within EDs, even with a clinical pharmacist, are still a major problem

The clinical pharmacist’s greatest contribution was a decreased number of overlooked, missed and delayed nonurgent medications—medications for chronic problems unrelated to the patient’s current ED visit, including necessities like anticonvulsants or immunosuppressants. Using medication reconciliation, the ED pharmacist was able to ensure some continuity of chronic care while more pressing issues were addressed.

Despite the addition of a clinical ED pharmacist and a dramatic decrease in medication errors, Drs. Marconi and Claudius note that EDs still have serious problems with medication errors. When ED stays exceeded 8 hours, more than half of patients missed doses or received their medications late at the study’s start. After employing a full time pharmacist, medication delays or omissions decreased to 28.6%, which is still significant and unacceptable. They stress that one of the most important ways to decrease errors further is improved teamwork and heightened awareness that medication errors continue to be a common but unnecessary concern.

There are only a handful of hospitals that currently employ emergency room pharmacists in the United States, including Community Regional Medical Center in Fresno, California. Community’s 2 emergency department pharmacists explain about their role and the importance of emergency department pharmacy:

The Pharmacy Times Health-System Edition is here! Check www.PharmacyTimes.com in January 2012 for practical information for the health-system pharmacist, including Formulary Drug Reviews, Chronic Care Focus, Pharmacist Rounds, News & Trends, and more!