4CPS-032 How to improve the appropriate prescription of anticoagulants during unexpected emergency room admittance to the hospital? A case series report using pharmacy practitioners

Background and importance Serious medication errors can be made during unexpected hospital admittance through the emergency ward. In particular, anticoagulants portray a great risk for patients when proper medication reconciliation is absent.We started using pharmacy practitioners (PPs) to improve this process on the emergency ward. We report here the results of two case series with respect to accuracy in the medication reconciliation on the emergency room (ER) ward. Aim and objectives To investigate if appropriate embedding of PPs in the process of medication reconciliation during unexpected admittance to the hospital could lead to fewer medication errors downstream in other hospital wards. Material and methods A PP was embedded in the ER ward team during office hours (08:00 to 17:00) to perform the medication reconciliation of unexpectedly admitted patients instead of ER physicians. The two case series of admitted patients were chosen in a post-propter design. As a zero measurement, a case series of patients (ZMCS) in a pilot phase was used (October-December 2019). This pilot phase was done to collect data on hospital administration in order to show that PPs could be embedded to do this task. This retrospective dataset consisted of 40 patients, unexpectedly admitted on the ER ward and for whom the ER physicians performed the medication reconciliation. A prospective case series of patients was then performed during the period October-December 2020 under the same conditions and used as the experimental case series (EXCS) to compare with the ZMCS. The number of medication errors in the EXCS divided by the number of medication errors during the ZMCS was our main outcome parameter expressed as a percentage. After ER admittance patients were transmitted to several other specialist wards. Results Our results showed a 40% reduction in medication errors downstream in the specialist wards when the PPs were involved in the medication reconciliation process in the EXCS compared to the medication reconciliation done by ER physicians in the ZMCS. Conclusion and relevance We conclude that PPs can make a valuable contribution to reduce the number of medication errors downstream in the hospital when embedded in the ER ward team.