Provider Safety Net: Characterizing Pharmacist Safety Activities for Pediatric Emergency Medication Orders

Professional societies recommend pharmacists' integration into pediatric emergency department (PED) teams due to the high risk of medication errors in this setting. Data on pharmacists' activities related to PED medication orders are limited. We aimed to quantify and identify factors associated with pediatric pharmacists' activities in an urban academic ED.

We retrospectively reviewed pharmacists' activities (actions beyond routine order verification) as voluntarily reported in the electronic health record for ED patients <18 years old from 9/1/2022-8/31/2025. Our primary outcome was the proportion of medication orders with a pharmacist activity. Secondary outcomes were medication order volume, pharmacist activity volume, and pharmacist activity frequency by activity type, therapeutic class, time, patient age, and provider specialty, compared using Pearson’s chi-square test.

Non-routine pharmacists' activities were documented in 2.53% (95% CI, 2.46-2.61) of 162,279 medication orders. The most common activity types were dosing recommendations (28.7% of activities), order clarification (19.9%; e.g., discussion of order with provider), and resolution of duplicate therapy (8.8%). The most frequently involved therapeutic classes were antimicrobials (41.3% of activities, 10.6% of orders), CNS drugs (8.6%, 1.4%), and analgesics (7.4%, 8.4%) (p<0.001). Order volume, activity volume, and activity frequency (by order volume) each followed a diurnal pattern. Peak and nadir medication orders, activity volume, and activity frequency occurred at 20:00 and 07:00, 20:00 and 08:00, and 05:00 and 14:00, respectively (p<0.001). Activity frequency by order volume varied minimally by age (0 to <1, 2.7%; ≥1 to <6, 2.2%; ≥6 to <12, 2.9%; ≥12 to <18, 2.6%; p<0.001). Activity frequency by order volume differed by specialty (general pediatrics, 3.4%; general emergency medicine, 2.2%; and pediatric emergency medicine, 2.1%; p<0.001).

Non-routine pharmacist activities were documented in approximately 1 in 40 orders, disproportionately involved antimicrobials, and clustered in nighttime hours. These findings inform pharmacist staffing models and targeted medication safety efforts. Voluntarily documented activities likely represent a minimum estimate.