Using Clinical Pharmacists to Improve Your Emergency Department

Emergency medicine pharmacists can do a lot more than just dispense medications.

Deploying clinical pharmacists in emergency departments can ease staffing shortages, improve patient safety, increase efficiency, and operate cost effectively, recent research shows.

A new generation of emergency medicine (EM) clinical pharmacists can do far more than the medication distribution role that hospital pharmacists have played historically, according to the authors of a research article published in the American Journal of Emergency Medicine.

"EM clinical pharmacists aid in medication selection, optimal dosing and delivery, provision of drug information to patients and the interprofessional medical team, research and scholarly activities, and administrative and operational responsibilities to optimize the efficiency of care delivered to ED patients," the researchers wrote.

1. Staffing shortages: The corresponding author for the research article told HealthLeaders this week that EM clinical pharmacists help ease ER staffing shortages in several ways.

"In an already busy emergency department, emergency medicine pharmacists can help streamline overall pharmacotherapy-related care. Instead of physicians or nurses having to call the central pharmacy with questions, the pharmacist is right in the department and can provide consultation at the bedside. This minimizes phone calls and interruptions," said Nicole Acquisto, PharmD, an associate professor in the Department of Emergency Medicine at University of Rochester Medical Center in Rochester, New York.

EM clinical pharmacist also can take medication burdens off other ER staff members, she said.

"The EM pharmacist also understands the needs of the ED regarding medication availability and order entry in the electronic medical record and can optimize these functions to make overall drug selection, distribution, and administration easier."

2. Patient safety: Acquisto and her coauthors say medication errors are common in the ER setting in processes including prescribing, dispensing, and administration. EM clinical pharmacists can limit many of these errors, they wrote.

"Including clinical pharmacists on the ED team leads to increased error interception and fewer medication errors. ED pharmacists are well equipped to correct the majority of prescription-related errors, especially those containing multiple medication orders and those prescribed by EM residents. A prospective multicenter study of four geographically diverse academic and community EDs found EM pharmacists caught 364 medication errors during a 1000-hour study period."

3. Increased efficiency: There are multiple opportunities to insert EM clinical pharmacists into an ER workflow and realize efficiency gains, the researchers wrote.

These workflow opportunities include: drug therapy consultation after the ER physician has evaluated a patient, medication procurement and preparation for critically ill patients, drug therapy monitoring after the administration of medication, recommendations for discharge prescriptions, and patient education and counseling at time of discharge.

4. Cost-effectiveness: A study cited in the American Journal of Emergency Medicine research indicates that interventions by EM clinical pharmacists such as avoided medication errors significantly reduce ER costs. The study over a six-month period found 9,568 interventions by EM clinical pharmacists generated cost savings of $845,592.

Acquisto told HealthLeaders that EM clinical pharmacists cut costs on several fronts: cost avoidance from optimizing pharmacotherapy and preventing medication errors and adverse effects, preventing readmissions through antimicrobial stewardship and culture follow-up, and streamlining care to improve physician and nurse productivity.

Acquisto said EM clinical pharmacists also improve hospitals organizationally.

"Since the ED collaborates with several consult services throughout the hospital in addition to emergency medicine—trauma, critical care, infectious disease, neurology, toxicology, and cardiology—the EM pharmacist can act as the pharmacy liaison. As the expert on the medication use system and related workflow in the ED, the EM pharmacist can contribute to organizational initiatives," she said.