Implementing a Comprehensive Emergency Department Pharmacist Program (EDPP)
Victoria E. Aldridge, Pharm.D., Helen K. Park, Pharm.D., Mark Bounthavong, Pharm.D., Anthony P. Morreale, Pharm.D., BCPS, M.B.A.
VA San Diego Healthcare System (VASDHS), San Diego, California
Patient safety improvement is of paramount importance in today’s medical climate. Since most Emergency Department (ED) patients receive multiple medications that traditionally have not been prospectively screened for compatibility, patient allergies, drug interactions, or appropriate dose, significant opportunity exists to introduce medication errors into the system. In 2006, Joint Commission standards mandated prospective order review of all medication orders prior to administration, including those written in the ED. The VA San Diego pharmacy service recognized this as an opportunity to improve clinical pharmacy services provided in the ED setting.
A business plan to secure funding for the implementation of a comprehensive 24-hour, 7-days-a-week Emergency Department Pharmacy Program (EDPP) was submitted by the pharmacy service. The proposal identified several key areas and processes that could be improved to optimize patient safety and medication management. Primary targets were identified from these, including prospective medication order review, medication reconciliation, pass-down communication for admissions from the ED, drug accountability, documentation of administered doses, and formulary management. The EDPP was officially launched in September 2007. Pharmacist-initiated interventions which would be used to measure the program’s impact, as referenced in literature, were identified prior to implementation of the EDPP. Each intervention was documented in a computerized log.. During the initial 6-month period, ED pharmacists recorded 9,568 interventions which were then used to assess the safety components and estimate the cost avoidance of the pharmacists’ activities. Moreover, a staff satisfaction survey was created to assess the pharmacists’ impact on providers and nurses, as well as their effect on workflow in the ED.
The EDPP has proven to be a successful program that has achieved and surpassed the goals first identified for this project. The many benefits achieved by the EDPP include improved quality of care provided to patients, decreased medication errors and wait times, improved medication reconciliation process, enhanced formulary management, ensured prospective medication order review, and increased overall patient safety as evidenced by the documented interventions and staff satisfaction survey. During data analysis, reviewers selected interventions that had a high probability of preventing serious harm which would have resulted in cost or resource expenditures. Based on a previous study (1), with adjustments for inflation, the estimated potential cost avoidance was extrapolated to an annual cost savings of $1,691,184 resulting in a 1:2.7 cost benefit ratio. Staff surveys demonstrated an overwhelmingly positive acceptance and integration of the program into the Emergency Department.
Instituting an EDPP improved patient safety, decreased medication errors, and conferred a net cost savings to the VASDHS. Implementation of the EDPP has helped our facility to minimize the risks for patient harm and optimize the delivery of quality patient care. The program has become an invaluable asset not only to the pharmacy service but to the medical center as a whole.
Lee AJ, Boro MS, Knapp KK et al. Clinical and economic outcomes of pharmacist recommendations in a Veterans Affairs medical center. Am J Health-Syst Pharm. 2002; 59:2070-7.
View a pdf of the poster from the Midyear Meeting (331KB).