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A Prescription for Advancing Pharmacy Services in the Emergency Department

Rolla T. Sweis, Pharm.D., Zahra Khudeira, Pharm.D., Beverly Tuck, B.S., M.B.A., Donald Morath, M.D.

 

Advocate Christ Medical Center, Oak Lawn, Illinois

Clinical pharmacists improve drug therapy, decrease medication costs, prevent adverse drug events, and promote medication safety. However, placing clinical pharmacists in the Emergency Department (ED) is a new practice.  There are currently about 55 Emergency Department clinical pharmacists in the nation.  The value of the ED pharmacist has been documented in several articles.   Based on this, the creation of ED pharmacy positions is a growing direction in pharmacy practice. .  The impetus is patient safety.

The Joint Commission’s Medication Management 4.10 requires pharmacist review of all prescription or medication orders prior to dispensing unless a physician is present and controls the ordering, preparation, and administration of the medication. Pharmacy services in the ED improve the continuity of care and improve the care for patients.  Two of every three patients are admitted through the Emergency Department. 

The ED Clinical Pharmacist position began in January, 2005.  The efforts of the ED pharmacist improved drug therapy, reduced medication errors, reduced adverse events, decreased medication costs, promoted medication safety, provided medications to the indigent, conducted experimental research, adhered to formulary medications, provided renal dosing, and encouraged guideline adherence.

ED pharmacy services at this institution improved patient safety and reduced costs significantly.  Since the inception of the program, over one million dollars in costs were avoided through documented interventions.  Additionally, several interventions were not documented.  These interventions include identifying the wrong nitroglycerin tubing used in the institution, intravenous to oral medication switches, and order clarifications for overdoses or under-doses.   The results show that, not only is there a definite cost savings in terms of drug costs, but there is an even greater impact involving medication safety and therapeutic recommendations.  Evidence that the ED Pharmacy Services Program is successful lies in the ED medical director’s insistence that pharmacy services be provided 24 hours a day, seven days a week.

With this in mind, one of the initiatives that over 3,000 hospitals are taking part in is the 100K Lives Campaign.  The components of this campaign include Rapid Response Teams, Acute Myocardial Infarction Care, Preventing Surgical Site Infections, Preventing Central Line Infections, Preventing Ventilator Associated Pneumonia, and Preventing Adverse Drug Events (ADEs).  The prevention of ADEs is begun in the ED by a process called medication reconciliation.  Medication reconciliation is defined as a formal process of obtaining a complete and accurate list of each patient’s current home medications and comparing the physician’s admission, transfer, and/or discharge orders to that list.  ED pharmacy services complete the home medications list before admission to the hospital.  The staff of the ED has made a great effort in working with other units to achieve these goals.

An ED pharmacist position improves patient care, decreases medication costs, reduces re-admissions, saves time for nursing and pharmacy staff, and provides continuity of care.  The aging patient population, complex drug regimens, and the constant stream of new medications make emergency department pharmacists valuable.   The ED pharmacist is a valuable addition to the ED health care team.

View a pdf of the poster from the Midyear Meeting (516KB).