Medication Reconciliation in an Emergency Department: How to Prioritize Patients ?

Emergency patients are at high risk of medication errors, for different reasons: emergency admission, patients who don't know their at-home treatment (polymedicated, cognitive disorders, etc) and who don't have their medical prescriptions available.

Medication reconciliation has proven its efficiency in improving patients' care, especially for emergency patients. However, prioritization is essential to ensure a better efficiency of pharmaceutical resources.

In our center, a pharmacy resident has been assigned to medication reconciliation in the emergency department since November 2017, in collaboration with a clinical pharmacist. Every morning, 3 to 4 patients benefit from medication reconciliation (patients who will be transfered to another unit within our hospital).

The main objective was to identify risk factors of unintended medication discrepancies (UMD) in order to prioritize patients who will benefit from this newly implemented activity.

Secondary objectives were to identify the number and type of UMD, correction rate of UMD and the impact of emergency department organisation on UMD.

All patients who beneficiated from medication reconciliation in the emergency department between November 2017 and April 2018 were included. Were not included patients with a medication reconciliation performed but transfered to another hospital right after the emergency department visit.

This was a retrospective, monocentric, observational study. Number of patients required was 200. Variables collected were:

• demographics (age, sex, lifestyle, comorbidities),
• emergency care variables (date and time of medical care beginning, ambulance arrival, adressing type, medical prescriptions availability, main diagnosis, date and hour of medical prescriptions in the emergency department, prescriber (pharmacy/doctor), destination unit of patients)
• organizational variables (number of daily emergency visits, number of patients hospitalized within the emergency department),
• medical notes information on at-home treatment (number of missing information, of incorrect information, number of prescriptions in at-home treatment)
• medication reconciliation variables (date of medication reconciliation, number of sources of information needed, number of actual prescriptions in at-home treatment, number of intended medication discrepancies, number and type of UMD, time needed for medication reconciliation).

Inclusion criteria

• All patients who beneficiated from medication reconciliation in the emergency department between November 2017 and April 2018

Exclusion criteria

• Patients transfered to another hospital right after the emergency department visit