Background:To reduce medication discrepancies (unintended differences between a patient's outpatient and inpatient medication regimens), Canadian institutions have implemented medication reconciliation forms that are prepopulated with outpatient medication dispensing data. These may prompt prescribers to reorder discontinued medications or continue newly contraindicated medications. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after the implementation of such forms.Methods: This retrospective chart review included patients previously enrolled in an observational study in which a research pharmacist prospectively collected best-possible medication histories in the emergency department. Research assistants uninvolved with the parent study compared medication orders written in the first 48 hours after admission with the research pharmacist's best-possible medication history to identify medication discrepancies and errors of commission, defined as inappropriate medication continuations and reordering of previously stopped medications. An independent panel adjudicated the clinical significance of the errors. Results:Of 151 patients, 71 (47.0% [95% confidence interval (CI) 39.2-54.9]) were exposed to 112 medication errors on admission. Of the 112 errors, 24 (21.4% [95% CI 14.9-29.9]) were clinically significant. Errors of commission accounted for 24.1% ]) of all errors; 10 (37.0% .2]) of the errors of commission were clinically significant.Interpretation: Medication errors were common after the implementation of electronically prepopulated medication reconciliation forms. Prospective research is required to examine the impact of prepopulated medication reconciliation forms and ensure they do not facilitate errors of commission. AbstractResearch Research CMAJ OPEN E346CMAJ OPEN, 5(2) tronic medication dispensing records have developed medication reconciliation forms that are prepopulated with outpatient medication dispensing data. Yet, such databases do not capture medications dispensed outside of community pharmacies (e.g., in long-term care facilities) and may list inaccurate dosages of medications titrated by patients or care providers (e.g., warfarin). 19,20 Prepopulated medication reconciliation forms may facilitate errors of commission by prompting health care providers to restart a discontinued medication that remains in the electronic medication dispensing history or to continue a medication in the setting of a new contraindication. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after implementation of an electronically prepopulated medication reconciliation form. A secondary objective was to evaluate factors associated with both types of error. Methods DesignWe conducted a structured 2-staged chart review at Vancouver General Hospital, a 955-bed academic tertiary care centre. This was an a priori planned substudy of a large prospective observational cohort study that aimed to validate previously derived cl...

Inter-rater review of 4.5% of abstracted health records revealed a kappa score of 0.8. Conclusion: This study highlights that a remarkably low proportion of HFUs received allied health consultations at the study sites, likely corresponding to a lack of available consultants outside of daytime work hours. Our findings suggest the need to address significant gaps in order to balance the clinical needs of patients who frequent the ED with currently available resources. Keywords: frequent users, administration, emergency department crowding LO50 Headache presentations to emergency departments in Alberta: understanding investigative approaches C. Alexiu, BSc, L. Krebs, MPP, MSc, C. Villa-Roel, MD, PhD, S.W. Kirkland, MSc, B.R. Holroyd, MD, MBA, M. Ospina, PhD, C. Pryce, BScN, MN, J. Bakal, PhD, S.E. Jelinski, PhD, DVM, E. Lang, MD, G. Innes, MD, B.H. Rowe, MD, MSc, University of Alberta, Edmonton, AB Introduction: Headaches are a common emergency department (ED) presentation. The objective of this study was to characterize headache presentations in Alberta over a five-year period and explore the proportion of patients with potentially severe pathology. Methods: Administrative health data for Alberta (years 2011-2015) were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) headache presentations (ICD-10-CA: G43, G44, R51). Patients with a primary or secondary diagnosis code of headache were eligible for inclusion in the study. Exclusions were made using the following criteria: 1) sites without computed tomography (CT) scanners; 2) presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1; 3) patients with trauma or external mechanism of injury (e.g., ICD-10-CA codes S,T, V,W,X,Y); and 4) presentations receiving an enhanced/contrast CT (head). NACRS data were linked with a provincial diagnostic imaging data. Data are reported as means and standard deviation (SD), medians and interquartile range (IQR) or proportions, as appropriate. Results: From 2011-2015, 98,333 presentations were made by 66,970 patients (~0.3 presentations per patient per year; equivalent to one presentation every 3.4 years). Headache presentations increased from 15,643 in 2011 to 21,636 in 2015. The median age was 38 years (IQR: 29, 51 years); more patients were female (69.3%), had a CTAS score of 3 (55%) and arrived at the ED without ambulance (90.3%). The majority of patients had a primary ED diagnosis of headache (88%) and the most common co-diagnosis was benign hypertension (2.8%). Additional diagnoses indicating severe or pathological headaches, included: stroke (0.63%), subarachnoid hemorrhage (0.43%), infection (i.e., meningitis) (0.11%), and other brain hemorrhages (0.08%). Overall, the ED management of approximately 25% of presentations involved a head CT. Most patients were discharged from the ED (89.4%) after a median length of stay of 3.5 hours (IQR: 2.1, 5.2 hours). Conclusion: Headache-related ED presentations are increasing in Alberta, yet few severe/pathological diagnoses are ...