Implementation of pharmacist targeted discharge prescription review in an emergency department
| Autor: | Elizabeth Rozycki, Emily Lineberry, Trisha A. Jordan, Andrew M. North, John Mellett |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pharmacist Psychological intervention Notification system Pharmacists Workflow 03 medical and health sciences Patient safety 0302 clinical medicine Anti-Infective Agents Physicians Medicine Electronic Health Records Humans Medication Errors Nurse Practitioners Medical prescription Implementation Science Retrospective Studies Antiinfective agent business.industry Anticoagulants 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged medicine.disease Patient Discharge Physician Assistants Emergency Medicine Female Medical emergency business Emergency Service Hospital Pharmacy Service Hospital Patient education |
| Zdroj: | The American journal of emergency medicine. 48 |
| ISSN: | 1532-8171 |
| Popis: | Background/Purpose Little data has been published regarding emergency medicine pharmacist (EMP) review of discharge prescriptions. An internal retrospective review of a limited sample size of emergency department (ED) discharge prescriptions demonstrated a 13.6% potential intervention rate by EMPs. With this information, it was postulated that EMPs could provide a valuable service via a process of targeted review of ED discharge prescriptions that would yield intervention rates higher than the internal audit. The aim of this project was therefore to develop a real-time notification system within the electronic health record (EHR) for targeted discharge prescription review, to establish an associated EMP workflow, and to evaluate the intervention rate achieved through targeted discharge prescription review. Methods This was a single-center, retrospective review of the implementation of a new pharmacist-driven clinical service over a 12 week period from February 19th, 2018 to May 14th, 2018. Criteria for prescription review were determined after an internal audit by the EMPs and included an assessment of established high-alert medications. Discharge prescriptions that met the inclusion criteria were filtered into a real-time work queue in the EHR for EMP review. When necessary, EMPs discussed recommendations with prescribers, or adjusted prescriptions according to institutional pharmacist privileges. Interventions were reviewed and categorized to assess rate of intervention and the types of medication-related problems (MRPs) identified. Results EMPs reviewed 378 discharge prescriptions and a total of 158 prescriptions were identified as having at least one MRP. Of these, 70 prescriptions were intervened upon thereby resulting in an 18.5% intervention rate. The most common interventions included a change in the dose/frequency, duration/refills of the medication, and patient education. The highest number of interventions were made for anticoagulant and antiinfective agents. Conclusion Utilization of a real-time notification system for prospective ED discharge prescription review is feasible. Using targeted criteria for review, pharmacists intervened on 18.5% of prescriptions reviewed. Prospective discharge prescription review by EMPs using a real-time notification system within the electronic health record identified opportunities for the pharmacist to ensure safe and optimal prescribing. |
| Databáze: | OpenAIRE |
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