Impact of Partnered Pharmacist Medication Charting (PPMC) on Medication Discrepancies and Errors: A Pragmatic Evaluation of an Emergency Department-Based Process Redesign

Abstract

Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies' clinical significance, with 'unintentional' discrepancies deemed 'errors'. Fewer patients in the PPMC group had at least one error (3.5%; 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4%; 95% CI: 42.5% to 56.3%) and usual care group (61.4%; 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.

Keywords: PPMC; co-charting; emergency department; medication charting; medication discrepancy; medication error; pharmacist.

Figure 1

The panel assessment rounds and internal moderation process.

Figure 2

Diagram illustrating the selection of study participants. Note: Abbreviations: AMU, acute medical unit; BPMH, best-possible medication history; ED, emergency department; MedRec, medication reconciliation; PPMC, partnered pharmacist medication charting. * BPMH was limited to within 48 h post-admission (i.e., until the MedRec time) in the usual care arm. † Examples include incomplete/unavailable discharge summary or medication chart information.

Figure 3

Patients who had at least one discrepancy/error and error bearing high/extreme risk. Abbreviations: BPMH, best-possible medication history; PPMC, partnered pharmacist medication charting. Error bars denote 95% confidence intervals.