{"id":3681,"date":"2016-05-17T17:00:11","date_gmt":"2016-05-17T22:00:11","guid":{"rendered":"http:\/\/kbicblog.com\/blog\/pharmacy\/?p=3681"},"modified":"2016-09-14T18:34:59","modified_gmt":"2016-09-14T23:34:59","slug":"more-pharmacists-in-er-mean-better-patient-care","status":"publish","type":"post","link":"https:\/\/kbicblog.com\/pharmacy\/industry-news\/more-pharmacists-in-er-mean-better-patient-care\/","title":{"rendered":"More Pharmacists in ER Mean Better Patient Care"},"content":{"rendered":"

\"More<\/a>IMAGINE A HOSPITAL EMERGENCY ROOM (ER) with no radiology services available. To emergency physician Tim Meehan, M.D., MPH, an ER or ED without an on-site pharmacist makes about as much sense.<\/p>\n

\u201cI don\u2019t think you can provide appropriate emergency care without pharmacists present, or, at the very least, with 24-hour access to a pharmacist\u201d if the facility is too small to support a dedicated ED position, said Dr. Meehan, who practices primarily at the University of Illinois Hospital in Chicago. \u201cI find them to be indispensable team members. During periods when we didn\u2019t have a dedicated ED pharmacist, it was rough going.\u201d<\/p>\n

A Growing Trend<\/strong><\/p>\n

Dr. Meehan\u2019s assessment of the critical role that pharmacists play in the ED reflects a rising consensus among healthcare providers in hospitals and health systems across the country. Although pharmacists have long provided medication consultations to ED healthcare teams, the push for dedicated pharmacist positions within the setting itself is a growing trend.<\/p>\n

\u201cAs members of interdisciplinary ED healthcare teams, pharmacists improve patient outcomes by ensuring appropriate and cost-effective medication use and leading system changes to reduce or eliminate medication errors,\u201d said Erika L. Thomas, MBA, B.S.Pharm, director of ASHP\u2019s Section of Inpatient Care Practitioners, adding that ASHP believes every hospital should include pharmacy services in the ED.<\/p>\n

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\"More<\/p>\n

Katelyn Dervay, Pharm.D., BCPS<\/p>\n<\/div>\n

The addition of pharmacists to the ED or ER is often the result of other healthcare practitioners\u2019 requests. After witnessing the range and scope of standard pharmacy services, ER staff at Tampa General Hospital asked for an augmented pharmacy presence, according to Katelyn Dervay, Pharm.D. BCPS, a clinical pharmacy specialist in emergency medicine and incoming chair of the ASHP Section Advisory Group for Emergency Care.Now, at least one ER pharmacist is on duty around the clock, and a satellite pharmacy serves the department, which treats more than 85,000 patients annually.<\/p>\n

In addition to ensuring safe and effective medication use, Dr. Dervay and her colleagues assume less common tasks as well, such as geriatric consultations.\u00a0Those consultations have twice revealed that a patient\u2019s symptoms resulted from medication misuse, not illness. Her assessment precluded unnecessary tests and admission to the hospital.<\/p>\n

\u201cIt\u2019s always a big change for nurses who are new to our ER and aren\u2019t used to having pharmacists on staff,\u201d said Dr. Dervay. \u201cAt first, there\u2019s a sense of losing control, but soon they realize the benefits that we provide and appreciate the fact that we free them up to focus on other acute duties while the pharmacist handles medication issues.\u201d During a typical 24-hour weekday last spring, pharmacists conducted 45 consults, including medication adjustments, IV\/PO conversions, and attending traumas and strokes.<\/p>\n

The pharmacists also serve as information conduits\u2014informally by answering drug-related questions from other ER staff, and more formally through inservices for nursing staff, residents, and staff physicians. In addition, she and her colleagues monitor antibiotic regimens and ensure that prescribed drugs are the best choices to treat\u00a0a particular\u00a0condition.<\/p>\n

\u201cHybrid\u201d Roles Showcase What Pharmacists Can Do<\/strong><\/p>\n

Megan Musselman, Pharm.D., BCPS, a clinical pharmacist specialist in emergency medicine and critical care, is the only ER pharmacist on staff at North Kansas City Hospital in Kansas City, MO, which treats more than 100,000 patients annually.<\/p>\n

\u201cI\u2019m in a hybrid role and split my time between the ER and intensive care. It\u2019s a great way to show the value of the ER pharmacy services,\u201d said Dr. Musselman.<\/p>\n

\"More<\/a><\/p>\n

Megan Musselman,
\nPharm.D., BCPS<\/p>\n<\/div>\n

Dr. Musselman sometimes feels like a frontline medication safety officer in a high-risk arena. \u201cThere are huge medication safety issues in the ER. It\u2019s a fast-paced, high-acuity area. You need to be quick on your feet and recognize situations in which medication errors are likely to arise,\u201d she said.<\/p>\n

From April through June 2014, Dr. Musselman participated in an average of 202 interventions monthly.Another key responsibility is procuring drugs that may be in short supply. \u201cIf a medication is unavailable, and we need a different but equally effective choice, I research the options, put the medications in place, and educate other healthcare providers about how to use them safely and effectively,\u201d she said.<\/p>\n

Quantifying the Value of ED Pharmacy Services<\/strong><\/p>\n

Showing the C-Suite that pharmacists make a difference in patient outcomes can be challenging, according to Dr. Musselman, because the monetary impact often comes primarily through cost avoidance, such as preventing an adverse drug event, vs. income.<\/p>\n

But increasingly, hospitals recognize that ED pharmacists lead to more robust patient care and income statements, said Brenda Darling, Pharm.D., clinical pharmacy manager at Children\u2019s Medical Center in Dallas.<\/p>\n

The ER at Children\u2019s treats more than 140,000 patients annually and employs 10 full-time emergency pharmacists, more than any hospital in the country.<\/p>\n

\u201cIf a pharmacist catches one potentially serious error before it reaches the patient, that alone justifies their entire salary,\u201d said Dr. Darling.<\/p>\n

Rustin Morse, M.D., a pediatric emergency medicine physician and the hospital\u2019s chief quality officer, has practiced for more than 15 years and joined the ER at Children\u2019s two years ago. This is the first time that he has worked in an ER where pharmacists work side by side with physicians around the clock.<\/p>\n

\u201cThey\u2019re in the same locations, they see and talk to the patients and\u00a0their families, so they have a full understanding of the clinical situation, instead of simply reviewing charts,\u201d said Dr. Morse. \u201cThere\u2019s also a world of difference between having a personal relationship with a pharmacist vs. just talking to him or her by phone.\u201d<\/p>\n

Sometimes that depth of understanding encompasses small details that make big differences, noted Dr. Darling, citing examples such as when a pharmacist learned that a child was more likely\u00a0to take a crucial medication when it was mixed with applesauce, or that a drug prescribed for nighttime dosing caused fewer side effects if it was taken in the afternoon.<\/p>\n

Such knowledge can be gleaned only by direct interaction with patients and families, according to Dr. Morse.<\/p>\n

\u201cED pharmacists also\u00a0play an important role in ensuring that the right medication gets to the right patient at the right time,\u201d said Vicki Basalyga, Pharm.D., BCPS, director of ASHP\u2019s Section of Clinical Specialists & Scientists.<\/p>\n

ED pharmacists can ensure that important medications such as first-dose antimicrobials in septic-appearing patients are available, dosed, and administered correctly, she said. When speaking with patients, a pharmacist obtaining \u00a0a medication history can identify time-sensitive medications such as anti-epileptics and avoid potential adverse events if a dose is missed, Dr. Basalyga added.<\/p>\n

And the benefits to the patient and fellow healthcare providers don\u2019t stop there, according to Dr. Morse, adding that oral-to-intravenous dose conversions calculated by pharmacists are invaluable, time-saving measures for medical residents. ER pharmacists at Children\u2019s train with respiratory therapists and conduct pre- and post-respiratory therapy assessments as well as review all positive bacterial cultures that originate in the ER and recommend suitable antibiotic treatment.<\/p>\n

\u201cSomeone with this kind of expertise makes my life a lot easier by recommending the appropriate antibiotics,\u201d said Dr. Morse.<\/p>\n

The benefits of having pharmacists in the ER or ED can be as individual as the care setting and as dynamic as the healthcare problem that a patient is presenting. For example, Dr. Meehan at the University of Illinois Hospital in Chicago values many of the contributions of his ER pharmacist, including:<\/p>\n