Medication errors in psychiatric patients boarded in the emergency department

Abstract

BACKGROUND: Patients boarded in the emergency department (ED) with psychiatric complaints may be at risk for medication errors. However, no studies exist to characterize the types of errors and risk factors for errors in these patients. OBJECTIVE: To characterize medication errors in psychiatric patients boarded in ED, and to identify risk factors associated with these errors. METHODS: A prospective observational study conducted in a community ED included all patients seen in the ED for primary psychiatric complaints and remained in the ED pending transfer to a psychiatric facility. An investigator recorded all medication errors requiring an intervention by an emergency pharmacist. RESULTS: A total of 288 medication errors in 100 patients were observed. Overall, 65 patients had one or more medication errors. The majority of errors (n = 256, 89%) were due to errors of omission. The final severity classification of the medication errors was: Insignificant (n = 77), significant (n = 152), and serious (n = 3). In the multivariate analysis (R-squared 19.6%), increasing number of home medications (OR 1.17, 95% CI 1.01 to 1.36; p = 0.035), and increasing number of comorbidities (OR 1.89, 95% CI 1.10 to 3.27; p = 0.022) were associated with the occurrence of medication errors. CONCLUSION: Psychiatric patients boarded in the ED commonly have medication errors that require intervention.

Implementation of clinical pharmacy service in a tertiary psychiatric hospital in Aseer region, Saudi Arabia: 15 month experience.

“…These findings are similar to what was found in previous studies whereas the most common interventions by the clinical pharmacist were originated from providing drug monitoring (baseline assessment and treatment follow-up), treatment recommendations, and patient education [22][23][24]. Moreover, the medication errors resulted from omission were the most common errors among psychiatric patients boarded in emergency department [25]. In this study, the overall prescriber's response rate for the clinical pharmacist's interventions has shown an improvement in accepted interventions from 18% to 54.13% at the last 12th rotation.…”

Impact of changes in community psychiatric service provision on mental health presentations to the emergency department

“…Numerous studies show that ED overcrowding is associated with poorer patient outcomes including higher mortality rates [10][11][12]17]. ED overcrowding is also associated with medication delays and errors [18,19] with one study finding that medication errors in psychiatric patients in the ED was as high as 65% [20]. Overcrowding is also associated with increased burnout in healthcare professionals [21], and the psychological wellbeing of clinicians in Ireland, as in many countries, is already at critical point [22].…”

Assessing psychiatric safety in suicidal emergency department patients

“…56 Patients who are voluntarily admitted may refuse further treatment and have their request to be discharged honored, which is sometimes referred to as being discharged against medical advice 60 Moreover, boarded psychiatric patients are more likely to experience medication errors and adverse events. 61 From an ethical standpoint, the fact that psychiatric patients are more likely to experience prolonged ED length of stay and longer boarding times is concerning, but of even greater concern is the disparity in these times related to specific groups of psychiatric patients. Older adults (age >65) were particularly at risk for prolonged length of stay (median length of stay = 16.2 hours), long boarding times, and increased risk of adverse events.…”

“…Data from the National Hospital Ambulatory Medical Care Survey (2008) demonstrated an 11.5% rate of boarding for all ED patients, compared to a 21.5% rate for psychiatric patients, and boarding times were found to be 2.78 hours longer for psychiatric patients . Moreover, boarded psychiatric patients are more likely to experience medication errors and adverse events . From an ethical standpoint, the fact that psychiatric patients are more likely to experience prolonged ED length of stay and longer boarding times is concerning, but of even greater concern is the disparity in these times related to specific groups of psychiatric patients.…”