Polypharmacy is common within the geriatric population due to the commonality of multiple comorbidities and use of multiple providers. The emergency department (ED) is a prime location to capture these patients, especially when they present with chief complaints which may be medication related. Much of this population is prescribed potentially inappropriate medications which increases their risk for adverse drug reactions. Pharmacist review of patient home medication lists has been shown to decrease the number of potentially inappropriate medications, as well as medication-related problems, such as therapeutic duplications and drug interactions. These reductions can increase patient safety. The goal of this project was to evaluate the impact of a comprehensive home medication list review performed by a pharmacist for patients 65 years or older within the ED, in conjunction with ED provider education on potential interventions.
This retrospective study compared the average number of home medication modifications made per patient by ED providers at baseline compared to intervention implementation of provider education and pharmacist home medication list review. Additionally, the rate of return to the ED was also compared. Data were collected through manual chart review. Secondary outcomes include total number of pharmacist recommendations, average number of pharmacist recommendations per patient, total number of Medication Management Services (MMS) referrals, total number of MMS consults completed, and total number of MMS interventions.
There was a statically significant increase in the average number of medications changes per patient on discharge between the two groups with an average of 0.1 changes (SD 0.3, 0.0-2.0) in the pre-intervention group and 0.7 changes (SD 1.5, 0.0-7.0; p<0.001) in the post-intervention group. There also was a statistically significant increase in the percentage of patients with a home medication change on discharge, with 6.0% in the pre-intervention group and 25.7% in the post intervention group (p<0.001). There was a similar rate of return to the ED within 72 hours between the pre- and post-intervention groups, 6.7% and 8.1% (p=0.694), respectively. A total of 48 pharmacist recommendations were made during the pilot with an average of 0.62 recommendations made per patient. Most of the recommendations made were most appropriate to be addressed by a primary care provider (PCP). A subgroup analysis was completed to compare the preimplementation group to the post-implementation patients who discharged from the ED. The subgroup analysis showed similar data between both groups in regard to number of home medication changes and rate of return to ED within 72 hours.
Pharmacists are well positioned to evaluate home medication lists and make therapeutic recommendations based on a patient’s medical history, current condition, and labs. However, the ED may not be the most appropriate place for this evaluation to occur. Additional studies are needed to evaluate sustainability of this evaluation in other areas of pharmacy practice, as well as to evaluate the implementation of pharmacist recommendations for PCPs