Drug-related emergency department visits in older patients: an applicability and reliability study of an existing assessment tool

Kempen, Thomas; Hedman, Anton; Gillespie, Ulrika

doi:10.1007/s11096-022-01456-x

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…Medication-related problems are important causes of ED visits [ 6 – 8 ] and medication errors occur frequently in ED patients [ 9 , 10 ]. Adding the consequences related to readmissions, morbidity and mortality [ 6 , 34 , 35 ], it is surprising that physicians in our study spent less than 10% of their time on medication-related tasks. A previous Norwegian study from 2022 found that physicians in EDs spent 17.8% of their time conducting medication-related tasks [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

Johnsgård,

Elenjord,

Holis

et al. 2024

BMC Emerg Med

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Background Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician’s responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs. Methods An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021. Results In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians’ work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks. Conclusion In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.

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Section: Discussionmentioning

confidence: 99%

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

Johnsgård,

Elenjord,

Holis

et al. 2024

BMC Emerg Med

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“…Medications have enabled physicians to treat diseases that were once untreatable. In recent years, advances in drug therapy have enhanced patient care, but have also caused an increase in Drug Related Problems (DRPs), which are unwelcome and unpleasant to patients 1,2 .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2024

IJPSR

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The advancement of drug therapy has undoubtedly elevated patient care standards. However, it has also led to an increase in Drug-Related Problems (DRPs), which can have a significant impact on health outcomes. In an 18-month prospective observational study involving 2,000 patients, we meticulously assessed DRPs using the Hepler and Strand classification system. These DRPs encompassed a range of issues, including adverse drug reactions (ADRs), untreated medical indications, non-compliance with prescribed regimens, improper drug selection, and more. Our data collection adhered to a well-validated and pre-tested format. Among 2,000 patients, 106 (5.3%) experienced 117 DRPs, averaging 1.1 per patient. Adverse drug reactions (ADRs) accounted for 47.01% of cases, non-compliance 35.89%, and drug use without indication 11.32%. ADR incidence was 2.75%, primarily affecting the Gastrointestinal (GIT) system. Antibiotics were frequently associated with ADRs in various drug classes. Vigilant monitoring, robust reporting mechanisms, and patient education are pivotal strategies in the prevention of drugrelated issues. Pharmacovigilance, the systematic monitoring and evaluation of drug safety and efficacy, plays a fundamental role in ensuring the delivery of high-quality healthcare. Through the effective implementation of robust pharmacovigilance practices, we can successfully diminish the occurrence of DRPs, leading to safer and more efficacious outcomes in drug treatment.

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Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population

Nymoen,

Pettersen,

Flatebø

et al. 2024

Int J Clin Pharm

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Background The process of identifying drug-related hospitalisations is subjective and time-consuming. Assessment tool for identifying hospital admissions related to medications (AT-HARM10) was developed to simplify and objectify this process. AT-HARM10 has not previously been externally validated, thus the predictive precision of the tool is uncertain. Aim To externally validate AT-HARM10 in adult patients admitted to the emergency department (ED). Method This retrospective cross-sectional study investigated 402 patients admitted to the ED, Diakonhjemmet Hospital, Oslo, Norway. A trained 5th-year pharmacy student used AT-HARM10 to assess all patients and to classify their ED visits as possibly or unlikely drug-related. Assessment of the same patients by an interdisciplinary expert panel acted as the gold standard. The external validation was conducted by comparing AT-HARM10 classifications with the gold standard. Results According to AT-HARM10 assessments, 169 (42%) patients had a possible drug-related ED visit. Calculated sensitivity and specificity values were 95% and 71%, respectively. Further, positive and negative predictive values were 46% and 98%, respectively. Adverse effects/over-treatment and suboptimal treatment were the issues most frequently overestimated by AT-HARM10 compared with the gold standard. Conclusion AT-HARM10 identifies drug-related ED visits with high sensitivity. However, the low positive predictive value indicates that further review of ED visits classified as possible drug-related by AT-HARM10 is necessary. AT-HARM10 can serve as a useful first-step screening that efficiently identifies unlikely drug-related ED visits, thus only a smaller proportion of the patients need to be reviewed by an interdisciplinary expert panel.

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Drug-related emergency department visits in older patients: an applicability and reliability study of an existing assessment tool

Cited by 5 publications

References 24 publications

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

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Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population

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