Role of Pharmacists in the Emergency Department : Medication Reconciliation on Admission

Background: Inadequate medication reconciliations are often cited as the cause of medication discrepancies seen in the Emergency Department (ED). Poorly conducted ED medication reconciliations increase the risk for adverse events and serious patient harm during the patients’ hospitalizations due to inaccurate or incomplete admission orders. As medication experts, pharmacists have been trained in conducting patient interviews specific to drug therapy

Purpose: To identify the number and types of medication discrepancies missed in the ED which were identified through a pharmacist-conducted medication reconciliation process.

Methods: Study was conducted over a 2 week period at Clara Maass Medical Center (CMMC).  Patients who presented to the ED and were admitted to CMMC were reviewed and interviewed by a pharmacist from Monday to Friday, 8:00 to 15:00.Patients were excluded if unable to communicate (written or verbal) due to language barriers or physical disability. A caregiver present to speak for the patient was acceptable. ED triage sheets, nursing home records, and patient’s self reported medication lists were reviewed before the interview.Pharmacist-conducted medication reconciliation interviews were conducted and documented on a standardized form. The forms were then compared with the ED medication reconciliation form and admission orders to identify discrepancies.

Results: 46 patients were interviewed by a pharmacist. Seventy percent had at least one discrepancy identified after the pharmacy medication reconciliation interview. The average discrepancies per patient was 1.17. Omission was the most common discrepancy identified, which accounted for 74%. Omissions included home medications (which included legend drugs, over-the-counter (OTC) medications, herbals and vitamin supplements)

Conclusion: Pharmacist present in the ED identified multiple medication discrepancies which could have impacted patient’s hospital stay. Continued pharmacist presence in the ED could help reduce medication discrepancies, prevent adverse events, and improve patient care.