The Impact of a Clinical Pharmacist in the Emergency Department of an Academic Hospital in the Kingdom of Saudi Arabia

Abstract

Introduction: The department of emergency medicine (DEM) has a high-risk environment due to its unique and complex workflow. Many high-risk medications are ordered and administered at patients' bedsides without being checked by a pharmacist first, which may lead to an increase in the incidence of patient medication errors (MEs). Objective: The current study evaluated the needs of the clinical pharmacy service in the DEM at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Methods: A cross-sectional retrospective study was conducted between Jan 2016 to Dec 2017 and the documentation of clinical pharmacist interventions was extracted from Esihi database. Results: A total of 2,255 interventions for 862 patients were documented. The recommended interventions were as follows: 645 (dose adjustments), 108 (therapeutic substitutions), and 354 interventions (initiating drug therapy). Adverse drug reactions (ADRs) were reported in 16 patients, and drug interactions were managed in 26 patients. The DEM responded to 713 information inquires and 290 pharmacokinetic consultations. Drug discontinuations included 39 incidents (where unjustified drug prescription occurred), 37 (where contraindications were involved), and 19 (where duplicate therapy was involved). The most common interventions were related to the following drugs: antibiotics (34%), anticoagulants (15%), and anticonvulsants (10%). The acceptance rates for the EM clinical pharmacist recommendations increased from 93.9% in 2016 to 99% in 2017. The most common outcome for interventions was to optimize the therapeutic effects of the drugs that were administered (73%). Reconciliation was done in 796 patients. Conclusions: The clinical pharmacy service plays a critical role in the management of patients in the emergency department (ED).