title: Impact of an emergency department pharmacy on medication omission and delay.
abstract: OBJECTIVE
  The objective of the study was to evaluate the impact of adding a clinical pharmacist within a pediatric emergency department (ED) on medication omissions and delays, as well as medication errors on patients with prolonged ED stays of 8 hours or greater.
  
  
  METHODS
  This is a retrospective review of medication omissions and delays on all patients admitted to a large, tertiary-care children's hospital through the ED during a month before the addition of a clinical pharmacist (April 2007), during a month immediately after the addition of a clinical pharmacist (April 2009), and 6 months after the addition of a clinical pharmacist (October 2009). The medication omissions and delays were separated for urgent and nonurgent medications. A subgroup was further analyzed to evaluate the rate of medication omissions and delays for admitted patients boarded within the ED for 8 hours or greater.
  
  
  RESULTS
  Medication omissions and delays decreased immediately after the addition of a clinical pharmacist for urgent medications (P = 0.007) and nonurgent medications (P < 0.0001). This decrease persisted 6 months after the addition of a clinical pharmacist approaching significance for urgent medications (P = 0.06) and statistically significant for nonurgent medications (P < 0.0001). For the patients who were boarded within the ED for 8 hours or greater, 52.8% experienced a medication omission or delay before the addition of a clinical pharmacist, compared with 28.6% and 36.2% experiencing an omission or delay in medications administration immediately after or 6 months after the addition of a clinical pharmacist, respectively.
  
  
  CONCLUSIONS
  Medication omissions and delays are common within the ED. Admitted patients boarded within the ED for 8 hours or greater are at an increased risk for medications omissions and delays. The addition of a clinical pharmacist within an ED may reduce the number of medication omissions and delays occurring.
authors.affiliation: Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA. gmarconi@chla.usc.edu
authors.forename: Greg P
authors.initials: GP
authors.lastname: Marconi
authors.forename: Ilene
authors.initials: I
authors.lastname: Claudius
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015141:Los Angeles; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D058996:Quality Improvement; D012189:Retrospective Studies; D012380:Role; D013997:Time Factors