4CPS-240\u2005A qualitative study on how clinical pharmacists preform medication reconciliation in the emergency department

Abstract

Background An accurate drug history is an essential part of patient assessment at admission to hospital. Studies show that pharmacists obtain a more accurate medication history than other health professionals. In many countries clinical pharmacists work in the emergency department (ED) performing medication reconciliation (MR). Although many quantitative studies describe the effect of clinical pharmacists in the ED, to our knowledge, there are no qualitative studies on how clinical pharmacists preform MR and which factors they perceive to affect their work. Purpose The aim of this study was to describe how clinical pharmacists perform MR in an ED and to identify barriers and factors influencing all steps of MR such as preparation, patient interview and documentation. Material and methods The study was conducted in the ED in a hospital with 173 beds. A non-participating observational method was used and a standardised observation form was developed based on existing procedures. Seven hospital pharmacists were included and 61 MR were observed over 10 days. Based on the findings from the observation study, a semi-structured focus group interview with five hospital pharmacists was conducted. Data from the observation study was described in relation to the existing procedure, and together with data from the interview, analysed using Systematic Text Condensation. Results Variations were observed and influencing factors identified and organised in three themes: the patient, the clinical pharmacist and the workflow in the ED. The complexity of the patient’s medication history affected how the pharmacists prepared for, and conducted, the interview. The patients’ relatives and the general condition of the patient also had an impact on the questions asked. The degree of clinical experience and training influenced the clinical pharmacists’ decisions in all phases of the MR, as well as the clinical pharmacists’ assertiveness. The clinical pharmacy service was not fully integrated in the ED workflow, and although the clinical pharmacists felt integrated, they seemed to perform their service in parallel with other healthcare professionals. Conclusion Several factors have an impact on how clinical pharmacists conducts MR in an ED and influence their choices. This study shows that the service provided by the clinical pharmacists are not optimal and should be further developed. References and/or acknowledgements No conflict of interest.