Facilitating Medication Misadventure Risk Assessment in the Emergency Medical Unit

Abstract

Background: The risk of medication misadventure is heightened in emergency settings. Identifying at-risk patients is integral to minimising medication-related adverse events. Aim: To pilot a medication misadventure risk assessment tool to identify at-risk patients most likely to benefit from targeted intervention by an emergency department pharmacist. Method: A prospective descriptive study was undertaken in an emergency medical unit over 2 weeks (June to July 2009). Patients were included if they were over 70 years of age, took ³ 5 regular medications, had ³ 3 comorbidities, and/or were newly started on warfarin or had been admitted to the emergency department as a result of a medication-related adverse event.Nurses were encouraged to use the medication misadventure risk assessment tool for all patients admitted to the emergency medical unit. The pharmacist provided targeted interventions to all patients who were identified as being at-risk by the nurses. The pharmacist also verified the accuracy of the risk assessments undertaken by the nurses using this tool. Main outcome measures were the sensitivity and specificity of the tool and the reliability of the nurses' risk assessment. Results: Nurses completed 115 medication risk assessments for 194 patients. The risk assessments were accurately completed in all but 10 patients. Of the 36 (31%) patients assessed as high risk, 18 required pharmacist intervention. Of the 79 patients assessed as low risk, 3 required pharmacist intervention. The tool was useful in identifying at-risk patients (specificity 78%, 95%CI 69-85; sensitivity 83%, 95%CI 60-94). Conclusion: Nurses in the emergency department used the risk assessment tool to identify patients at risk of medication misadventure and facilitate targeted interventions by pharmacists. J Pharm Pract Res 2011; 41: 108-12. INTRODUCTIONMedication misadventure, an iatrogenic hazard, is defined as any unexpected or undesirable event that is associated with the administration of medication. 1 Medication misadventure is a broad term incorporating adverse drug reactions, adverse drug events and medication errors. Adverse drug reactions are a noxious and/or unintended response at usual normal doses, whereas adverse drug events refer to injury caused by a medicine or lack of medicine. Adverse drug events encompasses all adverse drug reactions and also includes idiosyncratic and allergic RESEARCH

Emergency medicine pharmacy practice in Australia: a national survey

“…Although beneficial, there is less opportunity with this model of care for the EM pharmacist to contribute to early time‐critical review of undifferentiated patients before admission, potentially preventing errors before they occur. Understanding which patients to prioritise is an ongoing area of research …”

Pharmacy research in the emergency medicine environment

“…A number of studies have been conducted by its members, which have benefited many and provided much needed clinical and practical evidence used by EM pharmacists and their managers across the country . The most recent of these will build on previous work and help answer the age‐old problem faced by EM pharmacists: how should EM pharmacists prioritise patients to be seen in the ED? This has followed the model used by other professional groups to answer questions and enhance learning by harnessing peers at many hospital sites in different states for the greater good (e.g. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials group and, more recently, the model to be used by the SHPA National Translational Research Collaborative (NTRC) launched in 2017).…”

SHPA Standards of Practice in Emergency Medicine Pharmacy Practice

“…EM pharmacists may focus on patients being discharged from the ED who will not have another opportunity for hospital pharmacist review on the wards. A pilot study undertaken in a major metropolitan ED, with approximately 200 presentations daily, identified 40 patients presenting each day who would meet the Kumar criteria for being seen by a pharmacist. Anecdotally, often established EM pharmacy services will see approximately 10–15 patients per 8‐h shift with the equivalent of one full‐time pharmacist.…”

“…The quality assurance program should demonstrate that the EM pharmacy service is targeting and achieving optimal outcomes for patient groups at greatest risk for medicine misadventure. As limited work has been done to develop and validate the medicine misadventure risk‐screening tools, further work should focus on development and validation of robust, broadly applicable screening tools.…”