The past few years have highlighted the extraordinary value pharmacists deliver to patient care teams and to the overall patient experience. The presence of a pharmacist specializing in ED services improves patient safety, advances antimicrobial stewardship and sepsis outcomes, and may also improve the efficiency of the medication use and delivery process. (1-3)
Clinical pharmacy’s role in the emergency department (ED) is rapidly growing
Recently, we explored how to optimize the pharmacists’ role in the emergency department and discovered the importance of leveraging technology to intervene early in the patient admission process to improve outcomes. Let’s examine tangible steps to continue increasing and optimizing pharmacists’ involvement in the ED.
Three ways to increase clinical pharmacy involvement in the emergency department:
1. Support a culture of safety in the emergency department
EDs are high-risk environments more prone to errors that result in patient or staff harm. Pharmacists can help support a culture of safety in simple ways:
- Share examples of adverse drug events from the Institute of Safe Medication Practices (ISMP) and/or local data during staff meetings
- Participate in rapid response, sepsis and/or other urgent collaborative team efforts in cohort with our nursing and physician colleagues
- Leverage technology to identify the potential for drug optimization via solutions, such as Sentri7® Pharmacy.
- Utilize software solutions to swiftly identify admitted patients requiring additional attention to reconcile home medications
- Engage in policy and procedure creation surrounding clinical care pathways such as sepsis, opioid stewardship, cardiac care, and antimicrobial stewardship.
An example of the significant impact of pharmacist services within an ED shared via an observational study conducted by Acquisto et al., at a large tertiary care center evaluating opioid use outcomes before and after a targeted reduction program over 25 months. They achieved a successful outcome through targeted protocol development and implementation, clinician education, and leveraging technology to improve opioid dose optimization. This clinical pharmacist-led opioid reduction program resulted in more than a 50% reduction in ED opiate orders and discharge prescriptions. The involvement of a pharmacist during the opiate administration process has proven to result in advantageous outcomes for both patients and healthcare facilities. Examples include:
- participation in the development of inpatient opioid therapy protocol development
- providing recommendations for pain management of opioid-dependent patients both admitted and discharged
A multidisciplinary approach to pain management in the inpatient setting, along with clinician education, improves patient safety across a continuum.
2. Educate and share learnings across care teams to optimize emergency care
Pharmacy practice is constantly shifting. With continually evolving literature, it’s essential to remain on the pulse of the latest data and share it across teams. How can pharmacists interact more with the Emergency Department?
- Participate in monthly staff education to network and share ideas.
- Establish brief presentations before the start of a shift from simple posters or handouts created by the pharmacists, interns, or students.
- Attend educational sessions with the physicians, or create brief written or verbal education tools to lead to constructive dialogue.
The role of the clinical pharmacist in the emergency department continues to expand and evolve. Establishing strong connections across care teams is essential to meeting the needs of more complex patients and improving patient care.
3. Engaging at the point of care to improve Antimicrobial Stewardship outcomes
Pharmacists are in a unique position to begin engaging with prescribers within hours of the patient receiving a diagnosis requiring antimicrobial therapy. As medication experts, we are poised to conduct assessments and provide therapy recommendations that will serve the patient, thereby increasing the expediency of access to medications and potentially reducing cost and the length of stay.
Payne-Cardona and colleagues conducted a study at a single-center tertiary academic medical center after the implementation of an expanded ED pharmacist scope of practice. They studied nearly 200 high-risk, adult patients after a first dose of antibiotics in the ED. Subsequent antimicrobial therapy was ordered by ED pharmacists, resulting in a significant reduction in delays of antibiotic administration and decreased incidence of mortality.
Giruzzi and colleagues conducted a retrospective, quasi-experimental study evaluating the impact of an Antimicrobial Stewardship pharmacist culture review service within the ED. Clinicians included nearly 800 patients in the analysis and used Sentri7 as part of this assessment. Their research resulted in a five-day decrease in median time to modification of inadequate therapy and an eight-day decrease in time to culture review. The rate of combined ED revisits and readmissions was unchanged.
Pharmacist’s involvement in the ED positive impacts patient care
There are multiple avenues to begin positively impacting the patient care experience within the emergency department. Our nursing and physician colleagues welcome the pharmacology expertise and fresh perspectives. Monthly education is one of the most straightforward pathways to establishing this relationship in facilities that do not have a dedicated ED pharmacist. Attending emergencies as part of a multidisciplinary team improves patient safety and add significant expertise during intensified moments when pharmacists are very much needed.
