Placing Pharmacists in the ER Equals Better Patient Care
One of the biggest impacts a pharmacist can make in the hospital setting is in the emergency department.
One of the biggest impacts a pharmacist can make in the hospital setting is in the emergency department (ER).
There has been a growing interest and trend in placing pharmacists in the ER to review both home medications and those administered in the ER to ensure correctness and cut down on medication errors and drug interactions that contribute up to 7000 deaths annually in the United States. A pharmacist in the ER can review real-time orders that are typically bypassed by staff pharmacists due to the urgency of an ER patient.
Pharmacists can improve the flow of patients through the ER, educate prescribers and staff about medications and their costs, and use the ER as a place to precept and mentor students and residents. Pharmacists can also participate in codes and help with admissions in home medications and discharge medication reconciliation. Pharmacists in the ER can also be involved with providing presentations, publications, and other activities to the department.
Pharmacists can monitor the use of expensive medications to make sure use is consistent with approved criteria (Factor VII, alteplase, etc.) and conduct MUEs in the ER setting. These pharmacists could also be involved with microbial culture follow-up. The ER is usually a place of unpredictability in acute illnesses and patient volume. High-risk medications are used more often and carry greater odds for a medication error reaching the patient.
Currently, most hospitals use a clerk to fill out a home medication sheet which typically can include errors in drug name, strength, and directions. Many times, staff pharmacists are clarifying home medications later than what is optimal. I have personally witnessed mistakes in high-risk medications like warfarin that are discovered days later. In short, when patients are admitted, they are prescribing for themselves with no oversight from a pharmacist, and physicians do not want to take ownership of what patients take at home since they are presenting with something acute that may have nothing to do with the herbals they take on the side.
The American Society of Health-System Pharmacists believes every hospital pharmacy department should provide its ER with the pharmacy services that are necessary for safe and effective patient care. The Joint Commission also has compliance requirements that can be met with a pharmacist in the emergency department (MM.4.10. requires that all medication orders be evaluated by a pharmacist prior to administration of the first dose and MM 7.10 identifies high-risk or high-alert medications and all the processes involved from procuring to monitoring and medication reconciliation). In fact, 1 of the National Patient Safety Goals is to accurately and completely reconcile medications across the continuum of care, which would include the first stop in the ER.
One of the most common reasons why hospitals do not employ ER pharmacists is cost. Small hospital pharmacies are staffed at a bare minimum. Most hospitals do not realize that pharmacists working in the ER can reduce readmissions, medication errors, and drug interactions to save money, but more importantly, increase patient safety while being treated for an acute illness.
1. Impact of a prescription review program on the accuracy and safety of discharge prescriptions in a pediatric hospital setting. J Pediatr Pharmacol Ther. 2008 Oct;13(4):226-32. doi: 10.5863/1551-6776-13.4.226.
2. Levy DB. Documentation of clinical and cost saving pharmacy interventions in the emergency room. Hosp Pharm. 1993;28:624-627,630-634,653.
3. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness. Am J Health Syst Pharm. 2003; 60:1993-5.
4. Cohen V, et al. Effect of clinical pharmacists on care in the emergency department: a systematic review. — Am J Health-Syst Pharm. 2009;66;1353-1361.