The Emergency Pharmacist

The Emergency Pharmacist (EPh): A Safety Measure in Emergency Medicine

The Ideal Emergency Department
No patient feels forgotten
Every nurse and every doctor has adequate support
Every resident and student receives appropriate supervision
All patients rest secured that there are no adverse medication events….

In reality, the Ideal Does Not Exist
Unique Environment - the ED is Vulnerable
High volume and diversity of patients
Patient history often not readily available
More frequent interruptions/distractions for all staff compared to other areas of hospital
Medication ordering, dispensing, and administering at point of care
High risk intravenous medication usage
Fast paced environment
Frequent verbal orders
No routine pharmacy review
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Patient Safety is at Risk
Established safety mechanisms are normally not available in the ED
pharmacy review for ED medications
pharmacy oversight for verbal orders
pharmacy preparation of medications
pharmacist involvement in clinical decision making

Medication Error in the Emergency Department
A higher prevalence of preventable adverse events
Medication-related events
3.6% of ED patients receiving inappropriate medication
5.6% receiving inappropriate discharge prescription

Pediatric Safety is at Risk
ED’s are not well equipped to manage pediatric care
Nationwide, only 6% of ED’s are prepared for pediatric patients
Pediatric patients make up 27% of ED visits
Pediatric patients are not just small adults
All children need weight based dosing, which increases the risk of an adverse event.

Pediatric ADE’s in the ED
Estimated 100 prescribing errors and 39 administration errors per 1000 pediatric visits.
22% of APAP doses ordered incorrectly according to therapeutic standards

Risks are Preventable
The ED has the highest rate of preventable adverse events in the US
110 million people visit the ED per year in the US
5% of patients experience potential events
This equals 550,000 potential events per year
70% of these are PREVENTABLE
Equaling 38,500 preventable events

At the Breaking Point
ED Crowding
Over the past decade, ED visits increased 26%
The number of EDs declined 9% and hospitals closed 198,000 beds
As space decreases and volume increases, the capacity to deliver safe care declines
Boarding of inpatients
Patients board for long periods of time in ED
Contribute to an overcrowded, high risk environment

Safety Benefits of EPh Program
EPh adds extra layer of protection
Available to immediately review high risk medication orders
Pediatric orders < 1 year of age and/or less than 10 kg Responds to all traumas, resuscitations, and critical patients Consults with physicians regarding medication choice Educates medical staff Focuses coverage on high volume periods Provides immediate accessibility to healthcare team

Joint Commission Compliance
EPh Improves JC compliance
High yield medication orders and prescriptions are reviewed
The effects of medication(s) on patients are monitored
High degree of communication with nurses and physicians [1]
The hospital develops processes for managing high risk or high alert medications

Valued Staff Member
It has been shown that staff value the EPh
26 item survey to random ED staff with 82% responding.
99% felt EPh improves quality of care.
96% felt EPh was an integral part of ED team.
95% indicated they had consulted with EPh at least a few times during last 5 shifts.

ICU Success with Dedicated Pharmacist
The ICU study concluded that participation of the pharmacist on medical rounds can be a powerful means of reducing the risk of ADE’s.
In the ICU 99% of pharmacist recommendations to medical staff were well accepted.
An existing pharmacist participated in rounds as a member of the patient care team.
The cost of pharmacist intervention required no additional resources; instead it represented a different use of existing pharmacists’ time.

The EPh – A Safe Measure in Emergency Medicine
Presence in the ED improves process measures such as:
Time to cath lab, abx in pna, pain management, etc [1]
Ensures a needed layer of safety in a vulnerable ED environment [2]
Is a cost saving benefit to the ED


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