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Pharmacists in ED benefit clinical care
[Editor's note: This is the second in a two-part series on placing pharmacists in the ED. In our last installation, we examined the performance improvements that the University of Rochester (NY) Medical Center achieved as the result of placing a pharmacist inside the ED. In addition, we discuss how a pharmacist's recommendations to dispense a medication orally instead of using an IV enabled the ED to save a considerable amount of money while at the same time improving patient safety. In this issue, we look at additional benefits these pharmacists offer, from the perspective of ED nurses and physicians.]
Having a pharmacist in the ED offers many benefits, especially for the most seriously ill and injured patients, notes Rollin J. (Terry) Fairbanks, MD, MS, FACEP, assistant professor of emergency medicine and of community and preventive medicine at the University of Rochester (NY) School of Medicine and an ED physician at the University of Rochester Medical Center. For that reason, the pharmacist's office at University of Rochester Medical Center is located in the critical care/resuscitation area of the ED.
"It's where we feel their help is most useful. It's where we give the most dangerous meds with the most potential to hurt people if they are given the wrong dose or meds that can have harmful side effects," says Fairbanks, who works closely with the ED pharmacist. "The other reason is that it's where we need to give the timeliest meds, where there's a need for urgency. We find pharmacists are crucial in those situations."
Nicole M. Acquisto, Pharm D, BCPS, the emergency medicine clinical pharmacy specialist, says, "It's faster because with a multi-discipline team, you have someone focused just on meds, safety, and expediting administration. You have an extra person just focused on meds while the nurse is packaging the patient up and the doctor is reviewing the therapy."
Nurses and physicians voice different, but equally important, reasons to appreciate the pharmacist, says Fairbanks. "Physicians have lot of expertise and they prescribe many drugs, but this is all the pharmacists do, and they are truly the experts," he says. "When there's a trauma alert, for example, and we're taking care of patients and worried about getting them blood, often the pharmacist may suggest a pain medication we perhaps did not think about."
Fairbanks considers the ED pharmacist a clinical consultant and advisor. "They're much more than a dispenser of meds," he says.
As for nurses, they love the notion that the pharmacists can anticipate the needs of the team and have everything ready when needed, Fairbanks says. He was particularly struck by the quote of one nurse who commented for a staff survey he was conducting. "She was overwhelmed one time when she was the only nurse in the CT scan area and had a critical trauma peds patient," he says. The doctor had written orders for multiple drips of three medications, Fairbanks says.
"She was trying to process the order and figure out how she could possibly get it all together, when the pharmacist walked in with an IV pump and all three orders filled," he says. "All she had to do was press start."
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