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Pharmacists in the Emergency Department Prove to be an Integral Part of the Healthcare System

Rolla T. Sweis, Pharm.D., M.A., James Jensen, B.S., Pharm.D., Zahra Khudeira Pharm.D., Beverly Tuck, R.Ph., M.B.A.

 

Advocate Christ Medical Center, Oak Lawn, Illinois

Placing clinical pharmacists in the Emergency Department (ED) is a new practice.  The value of an ED pharmacist has been documented in several articles and focuses primarily on cost avoidance.   Not much is published or documented with regards to the ED pharmacist’s effects on patient safety and overall department outcomes.

Our ED clinical pharmacist position was established in January 2005 and a second position was added in May 2007.  ED pharmacists are present Monday-Friday 0800-2330.  The efforts of the ED pharmacists have improved drug therapy, reduced medication errors, reduced adverse drug events, decreased medication costs, promoted medication safety, and helped to improve patient outcomes in the treatment of disorders such as congestive heart failure, pneumonia, ischemic stroke, and sepsis.

Every program needs to prove its value through some type of cost savings, especially if it is a new program.  Cost containment provides the impetus for the program to grow and solidify. In 2005 and 2006 our cost avoidance was over one million dollars.  After the second pharmacist position was added in 2007, cost avoidance increased to over 3 million dollars. 

Patient safety is promoted by identifying medication errors in the department on a monthly basis.  The cause of the errors or near misses is investigated.  Potential system improvements are researched and implemented to avoid future errors.  The number of errors has decreased by over 70% due to the implementation of several safety initiatives.  These initiatives include implementation of smart pump technology and the use of alerts in the automated dispensing cabinets.  Not only was there an impact on medication and patient safety, but there was also an improvement in treatment at the bedside resulting in improved care overall.  For example, implementation of the sepsis protocol helped nurses and physicians at the bedside achieve pharmacologic therapy within 6 hours.  Appropriate titration of nitroglycerin improved the care of congestive heart failure patients.  Implementing revised standing orders and a step by step approach to the dosing and use of alteplase in the treatment of ischemic stroke resulted in a dosing error rate of zero.  Finally, improvement in the timing of antibiotics and appropriateness of the regimen chosen for the treatment of pneumonia,has been demonstrated.

The aging patient population, complex drug regimens, constant stream of new medications, and overcrowding all contribute to making ED pharmacists valued members of the ED health care team.  Our results show that not only is there a definite cost savings in terms of drug costs, but that there is an even greater savings in patient safety and therapeutic outcomes which directly impact the institution.

 View a pdf of the poster from the Midyear Meeting (600 KB).