Pharmacists Play a Crucial Role in Mitigating Medication Errors in Emergency Department

Due to their role as medication experts, pharmacists can easily determine whether a combination of prescription drugs may cause adverse events. Despite training and education, other health care professionals may not be as efficient in preventing medication errors compared with pharmacists, according to a study published by BMJ Quality & Safety.

The study authors found that having pharmacists and pharmacy technicians take medication histories of patients in the emergency department (ED) can reduce mistakes in drug orders by more than 80%.

The authors have now implemented these findings in a real-world setting. Now, Cedars-Sinai assigns pharmacists to take medication histories for high-risk ED patients.

Hundreds of thousands of patients each year experience an injury related to medication errors, making it the most common type of inpatient injury sustained at US hospitals, according to the authors.

Errors in medication history are a significant driver of injuries since it can cause physicians to prescribe the wrong drug, dose, or frequency, according to the study.

While electronic health records (EHRs) can help prevent some cases of medication errors, they are not always successful, the authors said.

"Across health care settings, errors that are introduced into the record by individuals with varying levels of knowledge can become 'hardwired' and used for prescribing medications that can cause harm," said co-investigator Rita Shane, PharmD.

Establishing correct medication histories can be challenging, especially in the ED; however, pharmacists can be a valuable asset in ensuring the information is correct, according to the authors.

"The standard practice in the US is for doctors and nurses to take these histories, along with simultaneously delivering and coordinating care for the patients," said researcher Joshua Pevnick, MD. "That's why it's so helpful to assign this task to pharmacy experts, whose sole role is to take these histories."

Included in the study were 306 medically complex patients treated at Cedars-Sinai who were taking at least 10 prescription drugs. All patients had a history of heart failure and other conditions.

The authors discovered that when pharmacists or pharmacy technicians took patients’ medication histories in the ED, errors in the histories and medication orders plummeted more than 80%, according to the study.

As a result of more accurate histories, the authors hypothesize that there were significantly fewer incorrect drug orders made.

This approach may be especially useful for high-risk patients, including those who are elderly and taking multiple drugs.

Pharmacists and pharmacy technicians may need to supplement EHRs with prescription databases, verbal information, or written lists from the patient, their pharmacy, or their physician, according to the study.

Due to the challenges of gathering this information from patients in the ED, the authors concluded that pharmacists may be better suited for this task than physicians or nurses who may not be able to devote significant time to investigating medication history.