Right place, right practitioner, right time: development of emergency department triage to support the identification and management of drug related problems

Daniel Greenwood, Anglia Ruskin University


About one third of people who visit A&E  have a problem with their medicines. These medicines have been prescribed by their GP or bought from a pharmacy/shop. For example, patients may have side effects that make them feel unwell, like stomach upset, while other people feel their medicine may not be working and want to try something else. In these examples, the people may be aware that they have a problem with their medicine, but sometimes people may not even know their medicines are the cause of the problem. For example, someone could visit A&E with bad stomach ache and not realise the ibuprofen tablets they have been taking regularly could be the cause of a stomach ulcer. Sometimes, the healthcare professionals working in A&E might not even realise that medicine might be the cause the problem! Asking questions about the medicines people are taking is often missed when patients speak to a nurse or doctor because they are more concerned with the problem at hand. This means that problems with patient’s medicines may not be resolved during their visit to A&E and patients may have to put up with the problem and suffer longer. The first part of this project will help A&E staff find any problems that patients might have with their medicines.

If a problem with a patient’s medicine is found then the problem should be fixed by a healthcare professional who is an expert in medicine. This could be a doctor or nurse, but a pharmacist who works in A&E might be the best person to help. Pharmacists do not usually work in A&E, but there are at least 20 hospitals across the UK that do have one. They help with all things that involve medicines, for example, looking over doctor’s prescriptions to check they are safe, or helping nurses understand how to give medicines to a person with swallowing problems. While we know that pharmacists are experts in medicines, we do not yet know which patients could benefit most from a pharmacist helping to care for them. The second and final part of this project will help to make sure that patients who have a problem with their medicines are helped by pharmacists.

For the project, we will talk to doctors, nurses and pharmacists in A&E to get their views on what would be a good way to find patients who have problems with medicines, and how to ensure these patients get the best care available in A&E.