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Evaluating and classifying pharmacists' quality interventions in the emergency department.

PURPOSE
The results of an evaluation of the impact of pharmacists' medication-related interventions on quality of care in the emergency department (ED) setting are reported.


METHODS
Using data from a previously published observational study of medication errors intercepted by ED pharmacists at four academic medical centers, trained reviewers retrospectively analyzed 130 additional pharmacist interventions (those not categorized as medication errors in the primary study) over a specified four-month period to identify "quality interventions" (QIs), defined as those that (1) prevented misuse, underuse, or overuse of medications or (2) improved adherence to quality standards or evidence-based medicine (EBM) standards. The study included an evaluation of the medication classes associated with QIs and the acceptance of pharmacist-recommended QIs.


RESULTS
The reviewers identified a total of 91 pharmacist QIs at the four sites during the study period (2.3 QIs per 100 patients or about 1 QI per 100 medication orders). About 45% of the identified QIs improved adherence with EBM or national quality standards; other QIs prevented medication underuse (34%), misuse (14%), or overuse (6%). Pharmacists' QIs most often pertained to antiinfective agents (39%), cardiovascular agents (13%), and anticoagulants and thrombolytics (12%). The overall rate of acceptance of pharmacists' QIs was 93.4%.


CONCLUSION
A secondary analysis of data from a previously published study at four medical centers indicated that ED pharmacists often recommend interventions that improve the quality of medication use and adherence to EBM and national quality standards.