What are the key risk factors for drug-related problems in Emergency Departments? A multinational modified Delphi study

Abstract Introduction Drug-related problems (DRP) are common in emergency departments (ED) and may compromise patient safety, highlighting the need to identify patients at greatest risk and prioritize pharmaceutical care. Aim To determine the levels of multidisciplinary consensus on the relevance of candidate factors for identifying patients at risk of DRP in ED, and on the real-time availability and ease of retrieval of the corresponding data in clinical practice. Method Multinational, multidisciplinary consensus study using a modified Delphi method (RAND/UCLA Appropriateness Method) involving healthcare professionals from a wide range of hospitals, predominantly in Spain, with additional representation from Australia and the United States. Participants were recruited from secondary and tertiary care settings across different healthcare systems, providing a diverse representation of emergency care practice. A total of 51 healthcare professionals with expertise in emergency medicine and pharmacotherapy were invited to participate. Response rates were 75% (n=38) during the open consultation, 84% (n=43) in Round 1, and 78% (n=40) in Round 2. The panel included hospital pharmacists, physicians, nurses, and other healthcare professionals involved in emergency care. The primary outcome was consensus on the appropriateness of each DRP risk factor, defined using the RAND/UCLA method based on median scores and interpercentile range analysis. Secondary outcomes included the assessment of real-time data availability and ease of data retrieval in clinical practice. Participants were selected based on their clinical expertise and active involvement in emergency care. Results Following an open consultation, 53 risk factors were evaluated. Participants added 22 new factors, modified 1, and excluded 2. After Round 2, 1 factor (employment status) was classified as inappropriate, 7 as uncertain, and disagreement was observed in 21 factors. High-risk prehospital drug administration, pharmacist intervention requests, and chronic drug use identified by STOPP criteria were among the most relevant factors. Conclusion This study provides a consensus-based set of clinically relevant DRP risk factors in ED. The variability in agreement highlights the complexity of DRP risk stratification and underscores the need for prospective validation studies. These findings support the future development of screening tools to prioritise pharmaceutical care in emergency settings.