Pharmacist advice is accepted more for medical than for surgical patients in an emergency department.

INTRODUCTION: Pharmacists' advice may reduce medication errors in the emergency department (ED). However, pharmacists' recommendations are of little value if not acknowledged by physicians. The aim of the present study was to analyze how often and which categories of pharmacist recommendations were taken into account by the physicians in a Danish ED. Special attention is paid to problems of significant or vital importance. MATERIAL AND METHODS: Clinical pharmacists reviewed patient files within 24 hours of admission, described medication issues and made recommendations for solutions. It was subsequently noted whether the recommendations were taken into account by the physicians. Independent specialists in internal medicine and geriatrics reviewed the recommendations and assessed whether they were of minimal, moderate, significant or vital importance. RESULTS: Among the 301 recommendations made, 59% were followed by the physicians. The physician followed the recommendation made for patients admitted with medical problems significantly more often than the recommendations made for surgical patients (69% versus 51%, p = 0.002). In 47%, the recommendations were of significant or vital importance. Even these recommendations were acknowledged more by the physicians caring for medical patients than by physicians caring for surgical patients (78% versus 57%, p = 0.009). The difference remained significant in the multivariate analysis. CONCLUSION: Even though the pharmacists' recommendations were followed in many cases in an ED, there is still room for improvement, especially for the surgical patients. FUNDING: The Amgros Research Foundation covered the costs for the independent specialists who reviewed the patient files. TRIAL REGISTRATION: NCT01723462 (clinicaltrial.gov).

Medication problems are frequent and often serious in a Danish emergency department and may be discovered by clinical pharmacists.

INTRODUCTION: Transferring a patient from one health-care sector to another implies a risk of medication errors. It is of interest to evaluate whether a specialist in clinical pharmacy is beneficial for the patients in the emergency departments (ED). The aim of the present study was to report the incidence, categories and seriousness of medication problems discovered by clinical pharmacists in an ED and to evaluate if it is possible for pharmacists to identify those groups of patients who are most at risk of medication problems. MATERIAL AND METHODS: A pharmacist reviewed the patient files in the ED. If the pharmacists provided any kind of recommendations, a note was made describing the problem and a suggestion for a solution. After the study period, two medical specialists reviewed the files and rated the suggestions according to four levels of importance. RESULTS: A total of 1,696 patient files were reviewed after excluding patients who had received no medication. A total of 420 pharmacist notes were written, corresponding to 25% of all the included admissions. 47% of the pharmaceutical suggestions were considered serious. Increasing age and one drug as opposed to 2-9 drugs were associated with serious recommendations. In the multivariate analysis, only age above 70 years remained of significance for the identification of patients with a risk of a serious medication problem. CONCLUSION: A considerable amount of serious pharmaceutical problems were found in the ED. These problems had not been observed by the physicians and they were especially prevalent among the elderly and patients who were only prescribed a single drug. FUNDING: The Amgros research foundation financed salaries for the independent specialists who reviewed the patient files. TRIAL REGISTRATION: not relevant.