Aim To improve medication history accuracy and reduce prescribing errors for unscheduled patients admitted via the emergency department (ED).

Design A prospective observational study of 100 adult unscheduled admissions with 50 patients in both pre and post-intervention groups. One investigator completed the required information including patient demographics, admitting speciality, number and types of any medication errors detected. In the post-intervention group, the investigator (a pharmacist independent prescriber) completed systematic medicine reconciliation in the ED before patient transfer and initiated the original inpatient prescription chart, as appropriate.

Background and Setting The ED in a busy district general hospital with an emergency admission rate of 24 000 patients per annum.

Key Measures for Improvement An increase in medicine reconciliation and initial prescribing within the ED with a reduction in prescribing error rates.

Strategies for Improvement Change needed to be communicated to all staff involved in process: ED medical and nursing staff; appropriate clinical directors; pharmacy staff.

Effects of Change Medicine reconciliation completed within 24 h of admission increased from 50% to 100% and prescription chart initiation in the ED increased from 6% to 80%. The prescribing error rate was reduced from 3.3 errors to 0.04 errors per patient (difference 95% CI 2.5 to 5.1).

Lessons Learnt Streamlining the admission process for unscheduled patients leads to improvement in care, decreases prescribing errors and reduces either potential or actual harm. Moving pharmacists' work to the ED better aligns their input to the patient journey and utilises their knowledge and skills to the patient's benefit.