ER pharmacists aim to cut drug errors in new pilot study

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Adults (aged 18 years or more) discharged from the ED with at least one of the following: * Polypharmacy: Five or more scheduled prescription medications for chronic illnesses (i.e., chronic maintenance medications, even if such medications were not refilled during the index ED visit) * Discharged with a new prescription of high-risk medication, including: * Drugs with the potential of withdrawal symptoms upon abrupt discontinuation such as antipsychotics, antiepileptics, antidepressants, and tapering glucocorticoids. * Insulin (initiation or intensification of therapy) * Oral hypoglycemic agents * Visiting ED for an exacerbation of chronic illness (e.g., exacerbation of asthma, COPD, CHF, uncontrolled diabetes mellitus, hypertension urgency, uncontrolled epilepsy) Exclusion Criteria: * The following patients will be excluded: * Presenting with acute minor illnesses * Lack of decision-making capacity (including documented moderate or severe dementia, altered mental status, unstable psychiatric illness, altered consciousness level, lack of orientation to person/place/time as reported in EHR, delirium, patients seen in the ED for a psychiatric evaluation) * Language barrier, i.e., inability to communicate in either English or Arabic as the intervention will be provided by English/Arabic speaking clinical pharmacists * Expected length of stay in Qatar of \<30 days post discharge (including transit passengers) * Substance use disorders (e.g., alcoholism, opioid dependency) or drug-seeking behavior, as reported in EHR * Prisoners who are serving an active sentence * Patients presenting for non-medical, socially driven reasons (e.g., seeking shelter, support, or resources) with no identifiable acute medical condition, and known to the ED team as recurrent visitors. * Discharge to a location other than home (e.g., patients transferred to another hospital, long-term or skilled nursing facility) * Study pharmacists unavailable to deliver the intervention if the patients were randomized to the intervention arm * Pregnant women * Patients seen for trauma or planned surgery * Terminally ill patients * Patients discharged from ED with watchful waiting (e.g., expected to be readmitted for an intervention such as surgical intervention if conservative management failed) * Patients who are admitted to the hospital after enrollment (i.e., following consent but prior to ED discharge)