Impact of restricting medication auto-verification on patient safety in the emergency department
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Publication Date
4-29-2026
Keywords
oregon, ppmc, ppmc gme, ppmc gme pharmacy
Disciplines
Medical Education
Abstract
Abstract: When Providence Portland Medical Center (PPMC) first transitioned to an electronic health record system, most Emergency Department (ED) medication orders were signed by licensed prescribers and bypassed pharmacist review. Only a small list of high‑risk medications required pharmacist verification prior to dispensing. While this workflow supported rapid medication availability, it also introduced potential patient‑safety risks due to limited pharmacist oversight. In August 2024, PPMC revised its ED medication verification policy. Under the new process, nearly all medications require pharmacist review before dispensing, with exceptions for a small group of low‑risk, time‑sensitive emergent agents that may still be auto‑verified. This change aimed to enhance medication safety while preserving ED efficiency. However, the impact of this policy shift has not been evaluated. This IRB‑approved, single‑center pre–post observational study assessed the effects of this revised process. A preliminary review of reports from Providence’s medication event reporting system identified ceftriaxone as the medication most frequently associated with safety events at PPMC’s ED. We included and compared ED ceftriaxone orders for adults (≥18 years) that were auto‑verified between August 2023–August 2024 and pharmacist‑verified ceftriaxone orders between August 2024–August 2025. Orders were excluded if the patient did not receive ceftriaxone in the ED or was younger than 18 years from our analysis. Primary outcomes included surrogate safety measures: total medication safety events associated with ceftriaxone pre and post revised verification process. Secondary outcomes included ceftriaxone safety events per 1,000 medication orders or ED visits, safety event type (duplication, incorrect dose, incorrect indication, incorrect timing), number of number of documented pharmacist antimicrobial stewardship interventions number and percentage of ED orders prospectively reviewed by a pharmacist, and time from verification to ceftriaxone administration pre and post implementation. This study is currently ongoing. Results and conclusions will be shared when the project is completed. Presentation Category: Medication safety/quality improvement
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
