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ACEP Resolution Gives Boost to Trend of Pharmacists in EDs

PISCATAWAY, NJ – A quiet trend going on for decades received a boost this fall with the passage of a resolution by the American College of Emergency Physicians (ACEP) recognizing and supporting the use of pharmacists in emergency departments.

Noting that EDs have “been identified as a hospital department with high rates of preventable adverse drug events,” ACEP resolved to “create a policy statement that supports clinical pharmacy services in emergency departments and collaboration among emergency medicine providers to promote safe, effective, and evidence-based medication practices, to conduct emergency-medicine-related clinical research, and to foster an environment supporting pharmacy residency training in emergency medicine.”

The news was characterized as “historic” on the “Emergency Medicine PharmD” blog launched by Craig Cocchio, PharmD, BCPS, a professor in the Emergency Medicine Pharmacy program at Rutgers, The State University of New Jersey, in Piscataway.

“For the first time, ACEP is now recognizing and supporting the presence and various roles EM pharmacists as members of the multidisciplinary team in the emergency department,” writes Nadia Awad, PharmD, BCPS, a Rutgers pharmacy professor who also serves as the blog’s associate editor.

Awad notes, however, that the reaction was “a ‘Duh!’ moment for many folks. For a service that has been around for 40-some years, this is quite a feat and has actually made some folks wonder why ACEP never officially recognized us EM pharmacists up until this moment. I think if you speak to any provider who has a dedicated EM pharmacist, he or she will sing praises related to the value of their EM pharmacist[s] within their department. But to have an official non-pharmacy body recognize us as valued clinicians in the emergency department – and our own EM physician colleagues at that – well, it is pretty amazing, to say the least.”

The ACEP resolution, introduced by the group’s New York chapter, points out that the acute nature of the patient population in the ED can make it difficult to use traditional medication use system safety mechanisms such as pharmacist prospective review, medication cabinet, patient profiling, medication preparation and labeling by the pharmacy department and bar code medication administration.

It also cites “a substantial body of literature” for more than 40 years indicating a reduction in the number of medication errors when a clinical pharmacist is present in the emergency department compared to staff pharmacist oversight delivered from a remote area of the hospital or elsewhere.

Other advantages to having dedicated pharmacists in the ED include lower costs, greater ED staff satisfaction and leadership initiatives, research and scholarly activities, according to the resolution.

Resolution supporters pointed out that, a decade ago, The Joint Commission proposed a standard that called for a prospective review by a pharmacist prior to medications being administered to hospital patients, including those in the ED. After ACEP expressed significant concern about the impact of the proposed prospective review by a pharmacist and the medication reconciliation standards on timely care in the ED, The Joint Commission allowed an exception, reading, in part, “Before dispensing or removing medications from floor stock or from an automated storage and distribution device, a pharmacist reviews all medication orders or prescriptions unless …a delay would harm the patient in an urgent situation (including sudden changes in a patient’s clinical status), in accordance with law and regulation.”

The American Society of Health-System Pharmacists, on the other hand, maintains that “… every hospital pharmacy department should provide its emergency department [ED] with the pharmacy services that are necessary for safe and effective patient care.”

Supporters of the resolution argue that “providing pharmacy services in the ED to meet identified institutional needs rather than mandating pharmacist review prior to administration of medications in the ED” would be most desirable.

ACEP budgeted funds to encourage pharmacy residency training in emergency medicine.