Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United
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RESEARCH ARTICLE
Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States Jesse Castillo1 · Matthew J. Campbell2 · Erick Sokn2 · Michael Spinner2 · Simon W. Lam2 · Stephen Meldon3 · Seth Podolsky4 Received: 10 November 2019 / Accepted: 21 October 2020 © Springer Nature Switzerland AG 2020
Abstract Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED. Methods: This was a retrospective observational study of patients discharged with prescriptions from the ED over two months. EM pharmacists reviewed discharge prescriptions and provided drug therapy recommendations. Two independent reviewers rated the clinical significance of interventions. High risk criteria were proposed a priori and included in a multivariable logistic regression analysis to identify variables independently associated with pharmacist intervention. Main Outcome Measure The primary outcome measure was the rate, type, and clinical significance of interventions associated with EM pharmacist review of discharge prescriptions. Results A total of 3107 prescriptions for 1648 patients were reviewed. Interventions occurred for 7.3% of patients with 29% of interventions rated as significant. The intervention rate was higher in patients with at least 1 high risk criteria versus those without (9.6% vs. 3.7%, p 10x normal) of drug with narrow therapeu c index
Ambiguous or nonstandard abbrevia on
Errant dual drug therapy for single condi on
Dosage resulted in serum drug concentra on in poten ally toxic range
Inappropriate drug frequency or dura on, low poten al for harm
Inappropriate dosage interval
Drug could exacerbate the pa ent’s condi on
Inappropriate drug therapy, low poten al for harm
Omission of medica on order
Documented allergy to drug
Inappropriate drug frequency or dura on, moderate poten al for harm
Inappropriate drug frequency or dura on, high poten al for harm
Inappropriate drug therapy , moderate poten al for harm
Inappropriate drug therapy , high poten al for harm
Fig. 3 Clinical significance scale used to rate EM pharmacist interventions
and one EM physician (S.P.) from the study team independently rated the clinical significance of EM pharmacist interventions. Secondary outcome measures included an evaluation of the correlation between high risk criteria and EM pharmacist intervention rate and a comparison of health-system ED and/or hospital readmission rates within 30 days from the index ED visit between patients with and without EM pharmacist review. High risk criteria were defined a priori and included both patient and prescription factors that have been a
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