Impact of an emergency department pharmacy on medication omission and delay.

OBJECTIVES: The objective of the study was to evaluate the impact of adding a clinical pharmacist within a pediatric emergency department (ED) on medication omissions and delays, as well as medication errors on patients with prolonged ED stays of 8 hours or greater.
METHODS: This is a retrospective review of medication omissions and delays on all patients admitted to a large, tertiary-care children's hospital through the ED during a month before the addition of a clinical pharmacist (April 2007), during a month immediately after the addition of a clinical pharmacist (April 2009), and 6 months after the addition of a clinical pharmacist (October 2009). The medication omissions and delays were separated for urgent and nonurgent medications. A subgroup was further analyzed to evaluate the rate of medication omissions and delays for admitted patients boarded within the ED for 8 hours or greater.
RESULTS: Medication omissions and delays decreased immediately after the addition of a clinical pharmacist for urgent medications (P = 0.007) and nonurgent medications (P < 0.0001). This decrease persisted 6 months after the addition of a clinical pharmacist approaching significance for urgent medications (P = 0.06) and statistically significant for nonurgent medications (P < 0.0001). For the patients who were boarded within the ED for 8 hours or greater, 52.8% experienced a medication omission or delay before the addition of a clinical pharmacist, compared with 28.6% and 36.2% experiencing an omission or delay in medications administration immediately after or 6 months after the addition of a clinical pharmacist, respectively.
CONCLUSIONS: Medication omissions and delays are common within the ED. Admitted patients boarded within the ED for 8 hours or greater are at an increased risk for medications omissions and delays. The addition of a clinical pharmacist within an ED may reduce the number of medication omissions and delays occurring.