Background Little is known about how pharmacists think and act in the situation when they need to prioritize patients without prioritization tools.

Aim To understand the individual pharmacist professional’s analytic processes when prioritizing patients for medication review in an emergency department.

Method A mixed-methods study with pharmacists working in one emergency department in Denmark. Qualitative participant observations of all seven pharmacists who work at the emergency department were carried out. Semi-structured interviews with six of the pharmacists were held closely in time to the observations. Observations for each pharmacists’ patients were analysed inductively looking for patterns and themes. The interviews were audiotaped, transcribed verbatim and analysed inductively seeking to understand pharmacists’ analytic processes when prioritizing patients for medication review.

Results Observations showed that non-clinical prioritization rules had been implemented according to the wishes of the ward management, which affected how the pharmacists prioritized patients. The ways pharmacists prioritized was more targeted with more clinical experience. In the interviews, pharmacists told how they used the rules set out by ward management, how their collaboration with physicians was vital to prioritization, and how the pharmacy profession could better contribute to the ward team.

Conclusion Although the ward-established rules increased efficiency, it was not deemed the best way to detect the clinically meaningful patients for the pharmacists working at the Emergency Department. A prioritization tool and sitting closer to the physicians at the ward would help pharmacists be further integrated into patient care and improve prioritization of patients for medication reviews.