Implementation and impact of a pharmacy service in the emergency department to improve patient safety, medicines optimisation and medicines governance

Abstract

Introduction: Emergency departments are high-risk environments for medicines-related incidents due to their fast-paced nature and complex patient presentations.Delays in medicines reconciliation, poor stock control, and governance issues can compromise patient safety and care continuity. In response to persistent safety concerns and to enhance Care Quality Commission preparedness, a four-week pharmacy-led pilot was initiated within the Emergency Department (ED) of a large acute NHS hospital 1,2]. Aim(s): This study aimed to evaluate the impact of a multidisciplinary pharmacy service in the ED on medicines reconciliation, clinical decision-making, and adherence to medicines governance standards. Methodology: A team comprising a clinical pharmacist, Medicines Management Pharmacy Technicians (MMPTs), and a Medicines Management Assistant (MMA) was embedded in the ED from April 2025. The pharmacist attended posttake ward rounds, resolved prescribing queries, and supported clinical decision-making. MMPTs completed drug histories and facilitated medicines reconciliation at admission, improving medication accuracy. The MMA performed daily stock reviews and audits across several ED zones to address compliance with the medicines management policy at the Trust. All interventions were recorded prospectively over four weeks using Microsoft Forms. Ethical approval was not required as this was a service evaluation that did not involve identifiable patient data or deviate from routine care, in accordance with NHS Health Research Authority guidance 3]. Result(s): During the 4-week trial, MMPTs completed 135 drug histories and 167 patient's own drug checks, reducing the workload on downstream units by ensuring early reconciliation and subsequently reducing the risk of omitted medications. The pharmacist made over 70 clinical interventions, including resolution of 27 prescribing queries, 15 discharge medication issues, and 9 cases of suboptimal venous thromboembolism prophylaxis. The pharmacist's interventions supported timely decision-making and reduced medication delays, including correcting insulin prescribing errors and ensured guideline-based antibiotic optimisation. A total of 300 bleep calls were managed during the trial period, 35 of which required clinical input. The MMA completed 28 medicines management audits, identified over 80 waste items (expired or unlabelled stock), and returnedmore than 35 items to pharmacy, directly mitigating potential administration errors. Governance concerns identified included unlocked or broken cupboards, missing temperature records, and improperly stored temperature-sensitive drugs 2,4]. Discussion(s): This pilot demonstrated that embedding a pharmacy team in ED significantly improves patient safety through early medicines reconciliation, timely clinical interventions, and improved adherence to governance standards. The MMA's presence in treatment areas addressed unsafe storage and removed expired stock, reducing the risk of medication-related incidents.MMPTs ensured early medicines reconciliation, allowing for medication discrepancies to be identified and resolved earlier, reducing the risk of administration and medication errors. Clinical pharmacists intervened in real-time during ward rounds, preventing prescribing delays andmissed administration, particularly for time-critical medications such as insulin, anti-Parkinson's agents, and antiepileptics. These interventions are essential, as missed doses of such medications can lead to severe consequences including seizures, hyperglycaemia, or neurological deterioration 5]. Limitations of the study include the short duration and possible underreporting of interventions. Longer-term evaluation is warranted to assess long-term impact and cost-effectiveness.