UK
Clinical Pharmacy
Association
UK
Clinical Pharmacy
Association
The fast-paced, high-volume environment of emergency care makes medication errors more likely—particularly for patients requiring TCM such as Parkinson’s medicines, insulin, or antiepileptics. Missed or delayed doses can avoidable deterioration, longer hospital stays, and in some cases, severe harm or death. The importance of this issue has been reinforced nationally, with the Royal College of Emergency Medicine (RCEM) highlighting it as a priority in the 2023 National Quality Improvement Programme (QIP). Within this context, ED pharmacists are well placed to intervene early, identify high-risk patients, and help reduce dosing errors.
The audit set out to develop and test a pharmacist prioritisation tool that would allow patients on time critical medications to be identified quickly. The goal was to enable earlier interventions that would reduce the number of doses given in error, improve patient safety, and strengthen the role of pharmacists as key members of the ED team.
Data collection took place across three consecutive four-week blocks. In the baseline stage, the team measured length of stay while identifying TCM prescriptions using existing criteria. In the second stage, the prioritisation tool was introduced. This tool allowed ED pharmacists to categorise patients by their risk of harm: P1 (high risk), where same-day harm was possible and patients received a full medicines reconciliation and screening; P2 (moderate risk), where harm could occur within a week and patients received allergy confirmation, a chart check, and a blood result review; and P3 (low risk), where there was minimal risk and no pharmacist review was required. In the final stage, a Symphony referral system was added, enabling ED prescribers and nurses to flag patients on critical medicines such as Parkinson’s treatments, insulin, and antiepileptics directly to pharmacists. This structured process ensured that interventions were targeted where they were most needed.
Over the 12-week period, ED pharmacists reviewed 501 TCM prescriptions. At baseline, 106 prescriptions were identified. Once the prioritisation tool was introduced, this number rose to 166. When Symphony referrals were added, it increased further to 229. Medication errors were most frequently associated with Parkinson’s medicines, which accounted for 17% of moderate-to-severe errors, most of them omissions (58%). Insulin-related errors represented 13% of the total, with omissions again responsible for 68%. Antimicrobials had the highest overall error rate, with 63% linked to incorrect dosing or frequency. By focusing on high-risk categories, pharmacists were able to reduce the number of doses given in error and improve communication around medicines within the ED team.
The introduction of a pharmacist-led prioritisation tool in the ED doubled the number of TCM prescriptions reviewed, allowed earlier identification of patients at high risk of harm, and strengthened communication between pharmacists, nurses, and prescribers. The results show that structured prioritisation improves patient safety and helps prevent avoidable harm related to time critical medications.
The next priority is the implementation of Electronic Prescribing and Medicines Administration (EPMA) in the ED, which will help further reduce missed TCM doses by generating automated alerts. In addition, ongoing collaborative quality improvement projects with ED clinicians will focus on optimising TCM management and reducing time-to-administration.
Time critical medications require urgent attention in emergency care. This audit highlights the vital role of ED pharmacists in safeguarding patients, reducing avoidable errors, and supporting clinical teams through innovative prioritisation tools.
By embedding these systems into practice, hospitals can take a proactive step towards safer, more reliable delivery of medicines in emergency settings.
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Emma Clifton, Callum Taylor, and Emma Daly are Clinical Pharmacist at the Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust
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