Facilitating Medication Misadventure Risk Assessment in the Emergency Medical Unit

Abstract

ABSTRACTBackgroundThe risk of medication misadventure is heightened in emergency settings. Identifying at‐risk patients is integral to minimising medication‐related adverse events.AimTo pilot a medication misadventure risk assessment tool to identify at‐risk patients most likely to benefit from targeted intervention by an emergency department pharmacist.MethodA prospective descriptive study was undertaken in an emergency medical unit over 2 weeks (June to July 2009). Patients were included if they were over 70 years of age, took 3 5 regular medications, had 3 3 comorbidities, and/or were newly started on warfarin or had been admitted to the emergency department as a result of a medication‐related adverse event. Nurses were encouraged to use the medication misadventure risk assessment tool for all patients admitted to the emergency medical unit. The pharmacist provided targeted interventions to all patients who were identified as being at‐risk by the nurses. The pharmacist also verified the accuracy of the risk assessments undertaken by the nurses using this tool. Main outcome measures were the sensitivity and specificity of the tool and the reliability of the nurses' risk assessment.ResultsNurses completed 115 medication risk assessments for 194 patients. The risk assessments were accurately completed in all but 10 patients. Of the 36 (31%) patients assessed as high risk, 18 required pharmacist intervention. Of the 79 patients assessed as low risk, 3 required pharmacist intervention. The tool was useful in identifying at‐risk patients (specificity 78%, 95%CI 69–85; sensitivity 83%, 95%CI 60–94).ConclusionNurses in the emergency department used the risk assessment tool to identify patients at risk of medication misadventure and facilitate targeted interventions by pharmacists.