Pharmacist tracking and correction of medication errors: An improvement project in the observation ward of the emergency department.

OBJECTIVE: The risk of medication errors is high in emergency departments. Implementation of medication reconciliation activity complemented by pharmaceutical analysis of prescription is an effective way to reduce drug related problems. This study aimed to assess the potential clinical impact of these activities to prevent medication errors for the observation ward patients. The secondary objective was to assess these activities' cost-avoidance and benefit-to-cost ratio. MATERIAL AND METHODS: This study was conducted in a 16-bed unit, over a 5-month period. The patients' demographic and treatment details, and data from pharmaceutical activities were collected and analyzed by a pharmacist. Two pharmacists and an emergency physician assessed the potential clinical impact of medication errors. RESULTS: Medication reconciliation for 250 patients (15.7% of 1589 admitted patients) and pharmaceutical analysis of prescription for 302 patients (19%) were performed by the pharmacist. Medication reconciliation detected 752 errors in 197 patients; 19% were related to high-risk medications and 14% had a potential clinical impact assessed as major, critical or fatal. Pharmaceutical analysis of prescription revealed 159 drug related problems in 118 patients; of which 26% involved high-risk medications and 24% had a potential clinical impact assessed "at least major". In total, 16% of pharmacist interventions had a potential clinical impact assessed "at least major" in 33% of patients: this represents 1.8 pharmacist interventions formulated per day. CONCLUSION: The presence of a pharmacist in the observation ward of the emergency department is useful in detecting iatrogenic drug related problems and reducing their medical impact. The benefit-to-cost ratio is favorable for the hospital.

Tendon rupture as an adverse effect of rasagiline.

A 66-year-old woman with advanced Parkinson disease (PD) was referred to our center for an adjustment of her antiparkinsonian medication. To reduce daily off-time, we introduced rasagiline 1 mg/d. Three days after starting this new treatment, she presented with intense arthralgia that symmetrically affected the shoulders, hands, and hips without myalgia. Ten days later, while walking, she experienced acute pain on the inner side of her right thigh, with the absence of any trauma. Findings of ultrasonography confirming the diagnosis of partial avulsion of the right harmstrings. Rasagiline was stopped immediately, and the arthralgia disappeared within 48 hours and did not recur. To our knowledge, this is the first reported case of a spontaneous tendon rupture possibly caused by rasagiline. Our observation emphasizes that, although often well tolerated, rasagiline may cause muscle and joint complications that could increase disability in patients with PD.