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Impact of proactive pharmacist-led interventions provided in the emergency department on quality use of medicines: A systematic review and meta-analysis

  • At: PPR SIG 2021 (2021)
  • Type: Digital
  • By: ATEY, Tesfay Mehari (University of Tasmania, Australia)
  • Co-author(s): Tesfay Mehari Atey, Gregory M. Peterson, Luke R. Bereznicki, Mohammed S. Salahudeen, Barbara C. Wimmer
  • Abstract:

    Introduction

    Pharmacists have an increasing role in providing clinical services in the emergency department (ED). However, the impact of proactive services provided within 24 hours of ED presentation is poorly understood.

    Objectives

    This systematic review aimed to synthesise evidence from studies examining the impact of proactive interventions provided by pharmacists on the quality use of medicines in adults presenting to ED.

    Methods

    A systematic literature search was conducted in MEDLINE, EMBASE, and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of early proactive interventions provided by pharmacists, to usual care, in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle–Ottawa tools were used for risk of bias assessments. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and subgroup analyses.

    Results

    Thirty-one studies involving 18,212 participants were included. Pharmacists were predominantly involved in structured clinical interviews, comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of drug-related problems, collaborative discussions, medication prescribing and charting, medication preparation and administration, and specialised interventions. The interventions reduced medication errors by 0.5 per patient (mean difference = -0.51, 95% confidence interval (CI): -0.74 – -0.28, I2 = 78.7%) and the risk of having at least one error by 76% (risk ratio (RR) = 0.24, 95% CI: 0.16 – 0.37, I2 = 95.0%). The interventions also resulted in more complete and accurate medication histories, increased appropriateness of prescribed medications by 31% (RR = 1.31, 95% CI: 1.12 – 1.55, I2 = 86.0%) and quicker initiation of time-critical medications.

    Conclusion

    The evidence indicates improved quality use of medicines when pharmacists are proactively deployed within 24 hours of ED presentation.

Last update 4 October 2019

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