Medication-related visits to the emergency department: a prospective study

OBJECTIVE: To assess the prevalence, preventability, category, and severity of drug-related problems; medications involved; common causes of preventable medication-related visits (MRVs); and cost of MRVs. METHODS: In this prospective, observational study of emergency department visits, patients were identified as having MRVs by use of a questionnaire. The patients or their representatives were interviewed to assess whether the emergency department visit was caused by a medication-related problem. Patient selection was consecutive. A blinded panel of pharmacists and one physician was used to assess study objectives. RESULtS: Of the 253 patients interviewed, 71 patients (28.1%) presenting to the emergency department had a medication-related reason for their visits. Of the 71 MRVs, 50 (70.4%) were judged to be preventable and 21 (29.6%) nonpreventable. The data showed that MRVs are most often caused by an adverse drug reaction, followed by overprescribing of the correct medication. The severity of MRVs was most often classified as moderate. The most common medications involved were cardiovascular agents. The preventable MRVs were mostly due to noncompliance issues, inappropriate prescribing, inappropriate monitoring, and lack of patient education. The average cost to the institution was approximately $1444 per preventable MRV. CONCLUSIONS: In our study, the prevalence of MRVs was higher than in previous studies due to the prospective nature of the study and the assistance of drug experts in identifying and classifying the incidents. Areas identified for improvement included compliance issues with patients, education of healthcare workers regarding prescribing and monitoring of medications, and patient education.