Prioritising medication management criteria to identify emergency department patients with potential medication-related harm: Nominal Group Technique workshops with clinicians.

introductionPharmacist involvement in the emergency department (ED) and early in a patient's hospital stay improves clinical outcomes and reduces medication errors. Because EDs are high-pressure settings with limited pharmacist staffing, pharmacists cannot review every patient. Instead, they must focus on identifying and prioritising patients who may be at risk of potential medication-related harm.

aimTo establish and prioritise consensus-based medication management criteria to identify patients with potential medication-related harm within the ED setting for early pharmacist review.

methodWe used Nominal Group Technique (NGT) methodology to rank the most important criteria for identifying whether a patient's presentation may be due to medication-related harm or whether they may be at risk of developing medication-related harm in the ED. Participants were purposively recruited ED clinicians including pharmacists, doctors and nurses who worked at the ED of either the Gold Coast University Hospital or Robina Hospital on the Gold Coast, Queensland, Australia, during May-June 2025.

resultsA total of 14 participants comprising six pharmacists, five nurses and three doctors participated in two 1-h NGT workshops. Participants ranked 12 criteria from a list of 34 during NGT Round 1. They subsequently ranked six criteria from the list of 12 during NGT Round 2. The weighted rankings of the criteria across both groups were combined to determine the top six criteria which were, in order from 1 to 6 (1 = most relevant): (1) medication-related admission or thinks medicine responsible for admission; (2) bleeding and falls; (3) poor historian (unable to provide reliable history)/suspected non-adherence or poor compliance; (4) carbidopa/levodopa (entacapone), co-beneldopa; (5) unverified medicines; and (6) medicines requiring therapeutic drug monitoring/medicines with narrow therapeutic index. The first four criteria were ranked within the top six in both NGT workshops.

conclusionThis study has provided a concise list of six medication-related criteria that expert consensus agreed were the most important for prioritising patients with potential medication-related harm. This forms the basis for the development of information gathering strategies to be incorporated into clinicians' workflows early in patients' ED journey.