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Pharmacists Enhancing Patient Safety During Trauma Resuscitations.

Sarah J. Kelly-Pisciotti, Pharm.D., Daniel P. Hays, Pharm.D., BCPS, Thomas E. O'Brien, Pharm.D., M.S., FASHP, Mark Gestring, M.D., FACS , RJ Fairbanks, M.D., M.S., Matthew Metz, M.D.

 

University of Rochester Medical Center
Strong Memorial Hospital
Rochester, New York

 

Purpose

This report describes the clinical pharmacy specialist's role in responding to trauma resuscitations in the emergency room.

Description of the Program

The addition of Clinical Pharmacy Specialists in clinical environments has shown benefits including overseeing proper medication use, providing medication information and education, and designing efficient and safe drug delivery systems. Our institution currently employs two full-time Emergency Medicine (EM) Clinical Pharmacy Specialists (CPS). Their duties include clinical consultation, resuscitation response, medication order screening, preparation and dispensing, and provision of education programs for health care professionals. Our institution is the regional trauma center that services approximately 2000 trauma patients per year utilizing a standard tiered trauma response, with 700 patients requiring activation of the trauma resuscitation team. The Emergency Department (ED) has 100+ emergency beds, 7 critical care beds - including 3 trauma bays, and treats approximately 90,000 patients per year.

The trauma team response to the ED is an excellent example of a multi-disciplinary team as it involves trauma surgeons, emergency physicians, emergency nurses, respiratory therapists, radiology technicians, patient care technicians, and an EM CPS. The goals of the EM CPS during the trauma resuscitation period in the ED are to:

  1. Reduce medication errors;
  2. Provide safe, timely and appropriate medications for patients.

The duties of the EM CPS during trauma resuscitations include: preparation of medications, insurance of proper drug selection and dosing, assistance with Advanced Cardiac Life Support (ACLS) algorithms, and the relaying of patient needs to the pharmacy or clinical pharmacists. The EM CPS also serves as a resource for all trauma team members.

Experience with the Program

A retrospective review was conducted to evaluate the pharmacist's involvement in trauma resuscitation response. The objectives were to evaluate each case for possible adverse drug events and medication errors, and appropriate medication selection, dosing, and timing of administration during the trauma resuscitation period. Two hundred patient charts were reviewed. The EM CPS was present for 25/178 traumas evaluated. Adverse drug events were recorded in 9 patients in the control group and no patients in the EM CPS group. A total of 17 documentation errors were identified in the control group: 11 patients had unapproved abbreviations, 4 patients had errors in medication units, and 2 patients had the incorrect medication name documented. No documentation errors were recorded in the EM CPS group. The time to medication administration was assessed for time to administration of rapid sequence intubation, the first sedative, analgesic, paralytic and antibiotic. The pharmacist improved the time to medication delivery and time to administration by an average of 7 minutes. A total of 39 control patients were chemically paralyzed after intubation. Among this group, 2 patients did not receive supplemental sedatives and 9 patients were given supplemental sedatives only after the paralytic dose was administered. In the EM CPS group, 14 patients received chemical paralysis. One patient did not receive supplemental doses of sedative medication due to clinical decline and initiation of ACLS measures.

Conclusion

The EM CPS decreased preventable adverse events, helped to decrease documentation errors, and reduced time to medication delivery during trauma resuscitations. The EM CPS has shown improvements in patient care by reducing errors and providing another layer of patient safety during a critical resuscitation period.

References

Brent RJ, Poltorak I. The pharmacist as a trauma team member. Hosp Pharm. 1987;22(2):152-5.

Hafner JA, Belknap SM, Squillante MD, Bucheit KA. Adverse drug events in emergency department patients. Ann Emerg Med. 2002;39(3):258-67.

Kohn LT, Corrigan JM, Donaldson MS et al. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, D.C.:; National Academy Press, 2000.

Leape LL. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282(3):267-70.

Nuss KE, Dietrich AM, Smith GA. Effectiveness of a pediatric trauma team protocol. Pediatr Emerg Care. 2001; 7(2):96-9.

Vernon DD, Furnival RA, Hansen KW et al. Effect of a pediatric trauma team response team on emergency department treatment time and mortality of pediatric trauma victims. Pediatrics. 1999;103(1):20-4.

View a pdf of the poster from the Midyear Meeting (3.9mb).