title: Medication errors recovered by emergency department pharmacists.
abstract: OBJECTIVE
  We assess the impact of emergency department (ED) pharmacists on reducing potentially harmful medication errors.
  
  
  METHODS
  We conducted this observational study in 4 academic EDs. Trained pharmacy residents observed a convenience sample of ED pharmacists' activities. The primary outcome was medication errors recovered by pharmacists, including errors intercepted before reaching the patient (near miss or potential adverse drug event), caught after reaching the patient but before causing harm (mitigated adverse drug event), or caught after some harm but before further or worsening harm (ameliorated adverse drug event). Pairs of physician and pharmacist reviewers confirmed recovered medication errors and assessed their potential for harm. Observers were unblinded and clinical outcomes were not evaluated.
  
  
  RESULTS
  We conducted 226 observation sessions spanning 787 hours and observed pharmacists reviewing 17,320 medications ordered or administered to 6,471 patients. We identified 504 recovered medication errors, or 7.8 per 100 patients and 2.9 per 100 medications. Most of the recovered medication errors were intercepted potential adverse drug events (90.3%), with fewer mitigated adverse drug events (3.9%) and ameliorated adverse drug events (0.2%). The potential severities of the recovered errors were most often serious (47.8%) or significant (36.2%). The most common medication classes associated with recovered medication errors were antimicrobial agents (32.1%), central nervous system agents (16.2%), and anticoagulant and thrombolytic agents (14.1%). The most common error types were dosing errors, drug omission, and wrong frequency errors.
  
  
  CONCLUSIONS
  ED pharmacists can identify and prevent potentially harmful medication errors. Controlled trials are necessary to determine the net costs and benefits of ED pharmacist staffing on safety, quality, and costs, especially important considerations for smaller EDs and pharmacy departments.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: William
authors.initials: W
authors.lastname: Churchill
authors.forename: Abbie
authors.initials: A
authors.lastname: Erickson
authors.forename: Kristin
authors.initials: K
authors.lastname: Munz
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Salzberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Lewinski
authors.forename: Rita
authors.initials: R
authors.lastname: Shane
authors.forename: Roshanak
authors.initials: R
authors.lastname: Aazami
authors.forename: John
authors.initials: J
authors.lastname: Patka
authors.forename: Rondell
authors.initials: R
authors.lastname: Jaggers
authors.forename: Aaron
authors.initials: A
authors.lastname: Steffenhagen
authors.forename: Steve
authors.initials: S
authors.lastname: Rough
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D002491:Central Nervous System Agents / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010595:Pharmacists / Q000592:standards; D011446:Prospective Studies
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D002491:Central Nervous System Agents; D005343:Fibrinolytic Agents