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AAP Advocates Placing Outpatient Pharmacies in Emergency Departments

By Jonathan Springston, Editor, Relias Media

The American Academy of Pediatrics (AAP) published a technical report in which the authors detailed the pros and cons of offering around-the-clock outpatient pharmacy services inside emergency departments (EDs).

The report authors noted ED visits occur at all hours of the day; if such visits occur at night, there might not be a local pharmacy open where parents could fill needed prescriptions for their children. Beyond this, the technical report authors identified other current gaps, including lack of transportation; language barriers; scant health literacy, misunderstanding of treatment plans, or disagreements about treatment options; and cultural barriers.

“[A] benefit of dispensing medications at the site of service is that the inability to pay can be identified immediately and a no-charge compassionate care provision can be applied to provide patients with the needed medications,” the AAP explained in a press release issued at the time the report was published. “Supplying medications from an emergency outpatient pharmacy gives healthcare providers additional opportunities to reinforce medication instructions and their importance, including the use of low-literacy materials that ensure families understand what they should do to administer medications safely to children once they get home.”

However, the technical report authors detailed several potential problems with a 24/7 model, including how to afford to staff an around-the-clock operation. There also is the matter of navigating state and insurance company regulations, along with challenges associated with keeping patients flowing through the department while managing a possible influx of additional patients seeking this 24/7 pharmacy service.

“Dispensing important and necessary medications from the ED outpatient pharmacy in selected instances, if logistically, legally, and financially possible, allows medication to be provided more conveniently, reliably, and in a manner more proximate to the encounter,” the report authors concluded.

The model described in the AAP report does exist in certain forms at some medical facilities, usually at huge EDs with more financial and human resources and many patients to serve. Investigators have published related papers on the subject. For example, one group of researchers established a discharge pharmacy within a busy urban ED. During the first year of the program, 10,230 prescriptions were filled for 5,703 patients. The authors suggested this pharmacy model could be “a potential solution to issues surrounding medication noncompliance.”

Where around-the-clock pharmacy service is unavailable, clinicians might offer "starter packs" of common medications, especially antibiotics, to patients to take at home until they can fill a proper prescription in an open pharmacy. This is a valuable tactic for overnight, weekend, and holiday encounters, when local pharmacies likely are closed.

Also, emergency clinicians might administer the first dose of antibiotics to patients in the ED, before the patient is discharged.

Among the various healthcare providers who work in EDs, emergency medicine pharmacists (EMPs), who might be certified with the designation “BCEMP,” can play a key role in emergency pharmacy administration. The American College of Emergency Physicians believes these specialists “should serve as a well-integrated member of the ED multidisciplinary team who actively participates in patient care decisions, including resuscitations, transitions of care, and medication reconciliation to optimize pharmacotherapy for ED patients.”

In its most recent guidelines, published in 2021, the American Society of Health-System Pharmacists (ASHP) said the EMP is “a unique and vital component” of emergency medicine. ASHP offers this comprehensive practice resource for emergency medicine leaders looking to establish and improve pharmacy services in their departments.

For more on this and related subjects, be sure to read the latest issues of ED Management, Emergency Medicine Reports, the “Pharmacology Update” feature that appears in each edition of Internal Medicine Alert, and Pediatric Emergency Medicine Reports.