Prescribing pharmacists' contributions to the identification and resolution of drug therapy problems in Alberta emergency departments: PHARMACIST-ED.

Abstract

Objectives: To describe the types of drug therapy problems (DTP) identified by emergency department (ED) pharmacists in Alberta and the interventions proposed to resolve them. In addition, to determine the proportion of proposed interventions implemented either through pharmacist independent prescribing or by other health care professionals, and the proportion addressing the patient's main reason for ED presentation.

Methods: This multicenter, retrospective chart review examined DTPs identified by pharmacists during ED visits between 15 October 2023 and 15 December 2023, across 13 hospitals in Alberta, Canada. A random sample was reviewed, and DTPs and associated interventions were classified using the Pharmaceutical Care Network Europe V9.1 system. Data were also collected about implementation and whether prescribing was performed independently by the pharmacist.

Key findings: Across 211 visits, 387 DTPs were identified. Medication reconciliation DTPs accounted for 26%, while non-reconciliation DTPs included adverse drug events (23%), suboptimal therapy (21%), and untreated indications (20%). Pharmacists proposed 316 prescribing interventions, most commonly to start, stop, or adjust medication doses. Overall, 73% of proposed interventions were implemented, including 39% through independent pharmacist prescribing. Among non-reconciliation interventions, 64% were related to the patient's presenting complaint, yet only 27% of these were resolved through pharmacist prescribing.

Conclusions: Prescribing pharmacists in Alberta EDs identified a broad range of DTPs, and while most proposed interventions were implemented, there is an opportunity to expand the use of independent prescribing.