Duplicate prescriptions in the emergency department: a retrospective cohort study.
Johannes Heck, Benjamin Krichevsky, Adrian Groh, Martin Schulze Westhoff, Hans Laser, Swetlana Gerbel, Patrick-Pascal Strunz, Carsten Schumacher, Martin Klietz, Dirk O Stichtenoth, Christoph Höner Zu Siederdissen, Olaf Krause
Author Information
Johannes Heck: Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. heck.johannes@mh-hannover.de. ORCID
Benjamin Krichevsky: Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany. ORCID
Adrian Groh: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany. ORCID
Martin Schulze Westhoff: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany. ORCID
Hans Laser: Center for Information Management, Hannover Medical School, Hannover, Germany. ORCID
Swetlana Gerbel: Center for Information Management, Hannover Medical School, Hannover, Germany. ORCID
Patrick-Pascal Strunz: Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Würzburg, Würzburg, Germany. ORCID
Carsten Schumacher: Center for Clinical Trials, Hannover Medical School, Hannover, Germany. ORCID
Martin Klietz: Department of Neurology, Hannover Medical School, Hannover, Germany. ORCID
Dirk O Stichtenoth: Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. ORCID
Christoph Höner Zu Siederdissen: Emergency Department, Hannover Medical School, Hannover, Germany. ORCID
Olaf Krause: Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany. ORCID
PURPOSE: To determine the nature and frequency of duplicate prescriptions (DPs) in the emergency department (ED) by utilization of a novel categorization of DPs which differentiates between appropriate DPs (ADPs) and potentially inappropriate DPs (PIDPs). METHODS: In this retrospective cohort study, adult patients who presented to the ED for internal medicine of a large university hospital in northern Germany in 2018 and 2019 were screened for the presence of DPs. Descriptive statistical methods were used to characterize the nature and frequency of PIDPs compared to the frequency of ADPs. RESULTS: A total of 4208 patients were enrolled into the study. The median age of the study population was 63 years (interquartile range (IQR) 48-77), 53.9% were female. The patients took a median of 5 drugs (IQR 3-9). 10.9% of the study population were affected by at least one PIDP (at least one grade-1 PIDP: 6.1%; at least one grade-2 PIDP: 4.5%; at least one grade-3 PIDP: 1.1%). Non-opioid analgesics accounted for the majority of grade-1 PIDPs, while inhalatives were most frequently responsible for grade-2 and grade-3 PIDPs. Nearly half of the study population (48.6%) displayed at least one ADP. CONCLUSION: PIDPs pose a frequent pharmacological challenge in the ED. The medication review should comprise a systematic screening for PIDPs with a particular focus on non-opioid analgesics and inhalatives. ADPs were detected more frequently than PIDPs, questioning the predominant notion in the medical literature that DPs are exclusively deleterious.
