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Pharmacy involvement makes difference
The most commonly documented interventions made by pharmacists caring for emergency department patients included provision of drug information, dosage adjustment recommendations, responses to questions from nursing staff, formulary interchanges, and suggestions on initiating drug therapy, researchers found. An analysis indicated potential cost avoidance attributable to the study period pharmacist interventions was more than $1 million.
The study was conducted at Detroit Receiving Hospital, a 340-bed, university-affiliated, urban Level 1 trauma center for adult patients in Detroit, MI. Emergency medicine pharmacy services are provided through an emergency department satellite where pharmacists are equipped to dispense commonly prescribed oral medications and prepare necessary IV medications. Types of services provided by pharmacists include drug information consultations, pharmacokinetic consultations, anticoagulation services, medical staff inservices, emergency resuscitation team participation, antimicrobial surveillance, patient recruitment for research, order entry and dispensing of medications, formulary interchange, and sample medication provision to indigent care patients.
All pharmacists working in the hospital emergency department prospectively documented interventions that were accepted by physicians and nursing staff weekly between September 1, 2003, and December 31, 2003.
During the four-month study, 2,150 interventions were documented. Some 31% were on the day shift, 33% on the afternoon shift, and 36% during the night shift. A cost avoidance model extrapolated to a full year indicated a potential cost avoidance of just over $3 million.
A beneficial effect of having a clinical pharmacist involved in emergency department patient care was observed in the study, based on the number of accepted pharmacist interventions and the potential cost avoidance, the authors concluded. In addition to the financial benefits, they say, current trends in medicine highlight the necessity of clinical pharmacists in busy emergency departments, which coincides with the heightened public awareness of adverse medication events that have occurred in emergency departments. "The pharmacist's role in medication safety is integral," the authors note. "The pharmacist can potentially minimize medication errors and adverse events, answer general medication questions, and recommend cost-saving equivalent therapies, as well as provide patient-specific medication education.
They concede several limitations in their study, including pharmacists' comfort levels with making recommendations, since pharmacists rotate shifts and are not consistently in the emergency department. Still, after more than 20 years of emergency department clinical services at the hospital, the pharmacists are maintaining a high level of quality interventions, the report says, ensuring patient safety, and continually containing costs. Addition of a clinical emergency medicine pharmacy specialist and an emergency medicine-trained pharmacist will foster collaboration with other emergency department staff to improve overall performance and care while optimizing a safer and more productive environment for all patients and members of the healthcare team. They recommend that future emergency medicine research should focus on development and subsequent validation of an economic model for evaluating pharmacist-provided emergency care.
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