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).

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.

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.

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.

Discussion. The PPMC model demonstrated a significant reduction in undocumented medication discrepancies and clinically significant medication errors compared to early BPMH or usual care.