Your ED patient may be taking duplicate meds

If your ED patient is taking multiple medications, he or she may have no idea what they are for. "They may tell us they are taking them because they were prescribed, without knowing what the purpose is or if the dosage changed recently," says Jocelyn Cajanap, RN, ED educator at Glendale (CA) Adventist Medical Center.

The ED surveyed 100 patients over a three-month period in 2010, who were taking four or more prescription medications, to measure their compliance and knowledge. Patients were asked to name the drug, dose, frequency, duration, and why they were taking the medication.

"We found that patients often knew when to take it or how many to take, but when we asked them the open-ended question, 'What's the reason you are taking this medication,' they didn't know the answer," says Romic M. Eskandarian, PharmD, director of the department of pharmaceutical services.

Problems identified

Triage nurses make an extra effort to obtain as much information from the patient as they can, says Cajanap, while at the same time, the ED pharmacist does additional research including contacting the patient's pharmacy.

Before administering any type of medications, ED nurses need to quickly assess the patient's allergies and update the system with this information, says Eskandarian. "But at times, taking the time to talk to the patient and get all that information is very challenging, due to time pressure," he says.

ED pharmacists help ED nurses to reconcile the patient's medications, says Eskandarian, so the ED physician knows which medications to continue or discontinue.

"We can recognize the appropriate dosage or maximum dosage for a patient," says Eskandarian. "If a patient comes in with a laundry list of meds, we are oftentimes able to identify duplicate medications right off the bat."

For instance, the ED pharmacist can identify if certain medications taken together might be causing a patient's adverse reaction, says Eskandarian. "Patients may be seeing multiple doctors who are prescribing the same medication or one of the same drug class," he says. "A patient may be taking a beta-blocker for hypertension and also for thyroid disorder."

Some of the most common adverse reactions seen in the ED are anaphylactic reactions, says Eskandarian, due to patients taking multiple medications.

Patients are sometimes taking medications they were supposed to discontinue, or may be taking asthma medications, as needed, when they're supposed to be taking them twice a day, says Eskandarian. "If the patient is drinking alcohol or is taking other pain medications concurrently, this can cause respiratory depression or syncopal episodes, which can lead to falls," he adds.

Length of stay is about 20 minutes less during the hours ED pharmacists work, according to a pilot study done by the ED. "We are able to help with medication reconciliation while the nurse takes care of the patient," explains Eskandarian. (See clinical tip, below, on how nursing time is saved.)


For more information on medication reconciliation in the ED, contact:

  • Romic M. Eskandarian, PharmD, Director, Department of Pharmaceutical Services, Glendale (CA) Adventist Medical Center. Phone: (818) 409-8437. Fax: (818) 545-1839. E-mail:

Clinical Tip

Save 40 minutes of ED nursing time

Previously, it took about 20 minutes for an ED nurse to do a patient's medication reconciliation, then the unit nurse took another 20 minutes to complete any missing elements, explains Gwen Matthews, RN, chief nursing officer at Glendale (CA) Adventist Medical Center. "The pharmacist was having to spend another 20 minutes clarifying and finalizing," she says.

To reduce delays, an ED pharmacist now does medication reconciliation while the ED nurse takes care of the patient. "The pharmacist step was moved to the ED at the front of the process," says Matthews. "This saves 40 minutes of nursing time."