Impact of partnered pharmacist medication charting in the Royal Hobart Hospital emergency department on medication discrepancies and errors: preliminary results

Introduction. Medication errors are relatively common in settings with acutely ill patients and heavy workloads, such as the hospital emergency department (ED).<p> </p> Aims. To compare the impact of partnered pharmacist medication charting (PPMC) in the ED on the prevalence of medication discrepancies and errors, and their clinical significance.<p> </p> Methods. Adult patients aged ≥ 18 years who were admitted to the Royal Hobart Hospital’s acute medical units via the ED between 01/06/20 and 22/09/20 were included. The study compared the PPMC model (fast-tracked best-possible medication history [BPMH] early after ED presentation, mostly within two hours, followed by the PPMC approach) with early BPMH alone (fast-tracked BPMH early in the ED followed by the traditional medical officer medication charting approach) and usual care (BPMH in the ward by a pharmacist after the traditional medication charting approach in ED). A blinded independent expert panel, consisting of three multi-disciplinary clinicians, individually assessed intentionality of discrepancies and clinical significance of errors in randomly selected cases. Discrepancies likely to have been inadvertent were classified as errors by the panel. A blinded independent fourth senior clinician assessed any remaining panel differences. Kruskal–Wallis test with Dunn’s post hoc test was used for comparisons. <p> </p>Results. The analysis included 366 participants with 122 per study group. The proportion (95% confidence interval [CI]) of participants having at least one unintentional medication error was 5.7% (1.6% – 9.9%), 56.2% (46.4% – 66.0%) and 62.7% (51.9% – 73.4%) in the PPMC, early BPMH and usual care groups, respectively. The number of patients needed to be treated with the PPMC to prevent at least one additional error was 2.0 (95% CI: 1.8 – 2.2) and 1.8 (95% CI: 1.6 – 2.0) compared to the early BPMH and usual care groups, respectively. For every 100 prescribed medications, there were 0.9 (95% CI: 0.4 – 1.5), 14.1 (95% CI: 12.1 – 16.1) and 18.0 (95% CI: 15.8 – 20.2) errors in the PPMC, early BPMH and usual care groups, respectively. <p> </p>Discussion. The PPMC model demonstrated a significant reduction in undocumented medication discrepancies and clinically significant medication errors compared to early BPMH or usual care.