title: Clinical relevance of pharmacist intervention in an emergency department.
abstract: OBJECTIVE
  To evaluate the clinical relevance of pharmacist intervention on patient care in emergencies, to determine the severity of detected errors. Second, to analyse the most frequent types of interventions and type of drugs involved and to evaluate the clinical pharmacist's activity.
  
  
  METHODS
  A 6-month observational prospective study of pharmacist intervention in the Emergency Department (ED) at a 400-bed hospital in Spain was performed to record interventions carried out by the clinical pharmacists. We determined whether the intervention occurred in the process of medication reconciliation or another activity, and whether the drug involved belonged to the High-Alert Medications Institute for Safe Medication Practices (ISMP) list. To evaluate the severity of the errors detected and clinical relevance of the pharmacist intervention, a modified assessment scale of Overhage and Lukes was used. Relationship between clinical relevance of pharmacist intervention and the severity of medication errors was assessed using ORs and Spearman's correlation coefficient.
  
  
  RESULTS
  During the observation period, pharmacists reviewed the pharmacotherapy history and medication orders of 2984 patients. A total of 991 interventions were recorded in 557 patients; 67.2% of the errors were detected during medication reconciliation. Medication errors were considered severe in 57.2% of cases and 64.9% of pharmacist intervention were considered relevant. About 10.9% of the drugs involved are in the High-Alert Medications ISMP list. The severity of the medication error and the clinical significance of the pharmacist intervention were correlated (Spearman's ρ=0.728/p<0.001).
  
  
  CONCLUSIONS
  In this single centre study, the clinical pharmacists identified and intervened on a high number of severe medication errors. This suggests that emergency services will benefit from pharmacist-provided drug therapy services.
authors.affiliation: Pharmacy Department, Hospital Universitario Virgen del Rocío, Seville. Spain.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Pérez-Moreno
authors.affiliation: Pharmacy Department, Hospital Son Llàtzer, Palma de Mallorca, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Rodríguez-Camacho
authors.affiliation: Pharmacy Department, Hospital Son Llàtzer, Palma de Mallorca, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Calderón-Hernanz
authors.affiliation: Emergency Department, Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Comas-Díaz
authors.affiliation: Emergency Department, Hospital Son Llàtzer, Palma de Mallorca, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Tarradas-Torras
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D059065:Medication Reconciliation / Q000379:methods; D008875:Middle Aged; D010595:Pharmacists; D024382:Professional Role; D011446:Prospective Studies; D013030:Spain; D016896:Treatment Outcome; D000078329:Workforce
keywords: emergency care systems, emergency departments; emergency department; errors; safety