Pharmacist Outpatient Prescription Review in the Emergency Department: A Pediatric Tertiary Hospital Experience

Objectives This study aimed to assess the frequency, type, and potential severity of errors intercepted by pharmacists on review of discharge prescriptions in a pediatric emergency department (ED). Methods This was a retrospective, observational study conducted in the ED of a pediatric teaching hospital. A daily report of prescriptions from the previous day was reviewed by a pharmacist for safety and efficacy. If an intervention was deemed necessary, the prescriber was contacted for clarification. In situations where patient harm could occur, the physician performing follow-ups was contacted by phone. The interventions were categorized based on type and potential severity. Physician response rates and intervention acceptance rates were assessed. Results Approximately 23,600 prescriptions were reviewed during a 1-year period with 60 interventions (0.25% intervention rate). Of the 60 interventions, 3% were estimated to have no severity, 80% were estimated to have minor, 12% moderate, and 5% major potential severity. The most common types of interventions were optimization of therapy, drug overdose, or dose omission at 33%, 32%, and 14%, respectively. Eighty-five percent of physicians responded; 73% accepted the intervention whereas 27% provided a rationale for their decision. More importantly, valuable information was gained, allowing for implementation of system fixes to prevent future errors. On an average, pharmacists spent 45 minutes reviewing and clarifying prescriptions each day. Conclusions Pharmacists in the ED can provide a valuable service by reviewing discharge prescriptions. A small amount of time dedicated to this service can lead to detection of clinically significant preventable medication errors and optimization of prescription therapy.