title: Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey.
abstract: BACKGROUND
  As of 2015, Accreditation Canada's Qmentum program expects emergency departments (EDs) to initiate medication reconciliation for 2 groups of patients: (1) those with a decision to admit and (2) those without a decision to admit who meet the criteria of a risk-based, health care organization-defined selection process. Pharmacist-led best possible medication histories (BPMHs) obtained in the ED are considered more complete and accurate than BPMHs obtained by other ED providers, with pharmacy technicians obtaining BPMHs as effectively as do pharmacists. A current assessment of the role of pharmacy in BPMH processes in Canadian EDs is lacking.
  
  
  OBJECTIVE
  To identify and describe BPMH and medication reconciliation practices in Canadian EDs, including those performed by members of the ED pharmacy team.
  
  
  METHODS
  All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least a 0.5 full-time equivalent position). Different electronic surveys were then distributed to ED pharmacy team members (where available) and ED managers (all hospitals).
  
  
  RESULTS
  Survey responses were obtained from 60 (63%) of 95 ED pharmacy teams and 128 (53%) of 243 ED managers. Only 38 (30%) of the 128 ED managers believed that their current BPMH processes were adequate to obtain a BPMH for all admissions. Fifty-nine (98%) of the ED pharmacy personnel reported obtaining BPMHs (most commonly 6-10 per day), with priority given to admitted patients. Only 14 (23%) of the 60 ED pharmacy teams reported that their EDs had adequate staffing to comply with Accreditation Canada's requirements for obtaining BPMHs. This result is supported by the 104 (81%) out of 128 ED managers who reported that additional ED staffing would be needed to comply with the requirements. Numerous ED managers identified the need to expand ED pharmacy services and improve information technology support.
  
  
  CONCLUSIONS
  BPMH processes in Canadian EDs were variable and inadequately supported. Survey responses suggested that additional staff and significant improvements in structured processes would be required to meet Accreditation Canada standards.
authors.affiliation: BSc, BSc(Pharm), ACPR, PharmD, is a Clinical Pharmacy Specialist (Emergency Medicine), Pharmacy Department, Royal Jubilee Hospital, Island Health Authority, Victoria, British Columbia.
authors.forename: Richard
authors.initials: R
authors.lastname: Wanbon
authors.affiliation: BSc(Pharm), MHSA, is Coordinator of Professional and Membership Affairs, Canadian Society of Hospital Pharmacists, Ottawa, Ontario.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lyder
authors.affiliation: BPharm, MSc, PharmD, is a Clinical Pharmacist (Emergency Medicine), Pharmacy Department, McGill University Health Centre, Montreal, Quebec.
authors.forename: Eric
authors.initials: E
authors.lastname: Villeneuve
authors.affiliation: BSc(Pharm), ACPR, PharmD, FCSHP, is Clinical Coordinator, Pharmacy Department, Providence Healthcare, Lower Mainland Pharmacy Services, Vancouver, British Columbia. He is also a Clinical Professor with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Shalansky
authors.affiliation: BSc, BSc(Pharm), ACPR, PharmD, is Pharmacy Clinical Manager and Clinical Pharmacist (Emergency Medicine), Pharmacy Department, The Moncton Hospital, Horizon Health Network, Moncton, New Brunswick.
authors.forename: Leslie
authors.initials: L
authors.lastname: Manuel
authors.affiliation: BSP, ACPR, is a Clinical Pharmacist with the Emergency and Home Parenteral Therapy Program, Pharmacy Department, South Health Campus, Alberta Health Services, Calgary, Alberta.
authors.forename: Melanie
authors.initials: M
authors.lastname: Harding
keywords: emergency department; medication reconciliation; pharmacist; pharmacy; survey