An intervention to encourage ambulance paramedics to bring patients' own medications to the ED: Impact on medications brought in and prescribing errors

Abstract

The multifaceted intervention encouraging paramedics to bring POM to ED was effective. POM were brought into ED more frequently and prescribing errors reduced.

A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients

“… Mason et al [ 43 ] UK, England Mixed methods None Evaluated the appropriateness, satisfaction and cost-effectiveness of an emergency care practitioner role in a primary care practitioner led out of hrs service or nurse-led walk in centre. Care delivered by emergency care practitioners appeared to reduce emergency hospital admissions Campbell et al [ 45 ] Canada Retrospective observational study None Advanced care practitioner role - based in hospital setting (and not focused on stroke, myocardial infarction or trauma) Procedural sedation and analgesia conducted in the emergency department by trained paramedics is not associated with significant number of adverse events (only one was recorded) Ranchord et al [ 42 ] New Zealand Retrospective observational study Myocardial infarction Evaluated the impact of pre-hospital electrocardiogram for myocardial infarction patients, and following a decision made by a physician, a paramedic administered thrombolysis Prehospital paramedic-administered thrombolysis was deemed to be safe and reduced time to treatment and heart failure Chan et al [ 21 ] Australia Uncontrolled before and after study None Focused on medication reconciliation (and not focused on stroke, myocardial infarction or trauma); i.e., paramedics were asked to bring patients’ own medication to the emergency department Patients’ own medication was brought into emergency department more frequently and prescribing errors reduced Waßmer et al [ 22 ] Germany Uncontrolled before and after study None Evaluated a simple training intervention to improve communication in a rescue teams and handover to emergency department physicians using simulated emergency operations The simple training intervention resulted in better structured communication between teams and handover of paramedics (frequency of negative communication events decreased from 3.9 per scenario before training to 1.8 after training) Mason et al [ 44 ] UK, England Quasi-experimental study None Evaluated the impact of the emergency care practitioner role (generic practitioner with a nursing or paramedic background) on patient pathways based in different emergency care settings (i.e., paramedics did not transport patients and were based in settings such as an urgent care centre) Impact of emergency care practitioners is greatest when the operate in mobile settings when care is taken to the patient ...…”

“…One study focused specifically on the role of paramedics in relation to patient medication during handover [ 21 ], which reported a statistically significant increase in the percentage of patients’ who were reconciled with their own medication in the ED (67% at pre-intervention versus 87% post-intervention) and a reduced percentage of errors in regular medications prescribed (18.9% pre-intervention versus 8.8% post-intervention).…”

The quality and quantity of patients’ own drugs brought to hospital during admission

“…Pre-intervention, paramedics brought in some or all PODs in 67% of cases compared with 87% of cases post intervention 10. This indicates that there is a potential for more patients to bring PODs to the study hospitals if guidelines or local policies are established.…”

Prescribing errors in emergency department medication history taking: will electronic medication management systems help?

“…Despite attempts at educational interventions to promote accurate MH taking, errors still occur. Causes of these errors in hospital have been documented previously, including issues with general practitioner (GP) letters, 2 patients not bringing their own medications with them, 3 interruptions, multitasking and sleep deprivation. 4 ED MH commonly have errors and are often incomplete, and pharmacists have been shown to be especially suited to obtaining accurate MH in this setting.…”