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Abstract
Background Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised.
Objective This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED.
Methods A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses.
Results Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI −0.42 to −0.23, I2=51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I2=85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I2=95%) and quicker initiation of time-critical medications.
Conclusion The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams.
PROSPERO registration number CRD42020165234.
- emergency department
- medication errors
- systematic review
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplementary information. All data generated and analysed in this review are included in this article and its online supplementary information files.
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Data availability statement
All data relevant to the study are included in the article or uploaded as online supplementary information. All data generated and analysed in this review are included in this article and its online supplementary information files.
Footnotes
Handling editor Edward Carlton
Twitter @TesfayMehari
Contributors Concept and design: TMA, BCW, GMP, LRB and MSS. Study screening and selection, and risk of bias assessment: TMA, BCW, GMP, LRB and MSS. Analysis and interpretation of data: TMA, BCW, GMP, LRB and MSS. Drafting of the manuscript: TMA. Critical revision of the manuscript for important intellectual content: TMA, BCW, GMP, LRB and MSS. Guarantor: TMA.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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