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. 2024 Feb;59(1):110-117.
doi: 10.1177/00185787231194999. Epub 2023 Aug 29.

Regular Medications in the Emergency Department Short Stay Unit (ReMedIES): Can Prescribing be Improved Without Increasing Resources?

Aidan B Jackson  1 , Mark Lewis  2 , Robert Meek  2   3 , Jeniffer Kim-Blackmore  2 , Irim Khan  2 , Yong Deng  2   4 , Jaime Vallejo  2 , Diana Egerton-Warburton  2   3
Affiliations

Regular Medications in the Emergency Department Short Stay Unit (ReMedIES): Can Prescribing be Improved Without Increasing Resources?

Aidan B Jackson et al. Hosp Pharm. 2024 Feb.

Abstract

Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of -11% (95% CI: -23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints.

Keywords: drug prescriptions; emergency department; medication error; observation unit; short stay unit.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Pre-intervention patient flow regarding medication prescription and (b) post-intervention patient flow regarding medication prescription. Note. SSU = short-stay unit; CSM = clinically significant medication; n-CSM = non-clinically significant medication.
Figure 2.
Figure 2.
Frequency of number of CSMs not prescribed for individual patients. Note. CSM = clinically significant medication.
See this image and copyright information in PMC

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