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Background/Aim: Despite the introduction of the German nationwide standardized medication plan (Bundeseinheitlicher Medikationsplan, BMP) and increasing digitalization in hospitals, the prevalence of drug-related problems (DRPs) remains high. In particular, at the interface between outpatient and inpatient care, incomplete information and communication issues across different healthcare professions may increase the risk of DRPs. Clinical pharmacy interventions have been shown to reduce DRPs; however, in most hospitals, pharmaceutical services are primarily provided in the context of elective medication reconciliation. In Germany, structured pharmaceutical care for patients entering the hospital through the emergency department (ED) is still not widely established.

The aim of our project was to investigate and improve the medication process within the ED of our main hospital through the continuous presence of a clinical pharmacist, as well as to identify DRPs at an early stage and resolve them in collaboration with the medical staff.

Methods: Clinical pharmacy services were provided for eight hours per day, during five weekdays per week. For patients admitted to hospital through the ED (mean age 78.5 years), current medication, the quality of medication plans brought to the hospital, admission diagnosis, and estimated glomerular filtration rate (eGFR) were systematically recorded. In addition, structured medication reconciliation and medication review were performed directly with the patient, and necessary medication adjustments, including substitution according to the hospital formulary, were made. Identified DRPs were discussed directly with the medical staff and appropriate interventions were initiated.

Results: Between September 2025 and September 2026, 495 patients received clinical pharmacy review. In approximately 70% of patients, at least one intervention was performed due to at least one identified DRP. The most frequent interventions were pause or stop of a medication/substance and dose adjustment. More than 90% of the pharmacists’ recommendations were accepted and implemented by physicians.

The analysis of the source documents for medication information revealed only 50% of patients had a BMP available on admission. Only approx. every second BMP document could be correctly implemented into software by means of a scanner (read of the BMP QR-code). Other information sources have been: medication plans, paper notes provided by patients or relatives, interviews (with and without sufficient knowledge about correct dosing), photographs and brown bag analysis.

In an additional evaluation survey, ER-physicians reported a substantial reduction in their workload, corresponding to an estimated average time saving of 25 minutes per patient, as well as a relevant contribution of the clinical pharmacy service to medication safety.

Discussion/Conclusion: Our findings demonstrate the added value of the integration of a clinical pharmacist into the ED medication processes, particularly with regard to a substantial improvement of medication safety and reduction of the physicians’ workload. Based on these results, we plan to extend the operating hours of this clinical pharmacy service. Furthermore, the project may serve as a model for establishing clinical pharmacy services in the emergency departments of non-university hospitals.