Objectives & Background UK urgent and emergency care (UEC) services are facing significant increased patient demand alongside a shortage of medical and nursing staff. From the early 2000's pharmacy services have been developing to support service provision in EDs with similar roles to in-patient clinical pharmacists but clinical pharmacists skills are still underutilised in UEC provision. To optimise ED skill mix and support medicines management a ED role was developed. Such a service would ensure medicines reconciliation for high risk ED patients, transcription of drug charts, increase use of patients own drugs (PODs) with potential cost savings, provide review for changes in medicines (including advice, patient information, antibiotic stewardship, high risk medicines) and direct support for transfer of changed medication and medicines information on discharge from ED (liaison with GP, community pharmacist, care homes) as well as reducing reattendance due to non-adherence.
Methods Pharmacy secured funding for one whole time equivalent clinical pharmacist. The clinical pharmacy service (CPS) ran from 29.09.14–31.03.15, with hours 13–21.30 Fri/Sat/Sun, 12–18:00 Mon & 18–21:30 Mon-Fri.
This review aims to demonstrate the impact of a clinical pharmacist in the ED.
1. Quantify operational workload undertaken by the clinical pharmacist(s)
2. Identify drugs staff request support/information for
3. Identify main reason for drug support/information request
Activity and specific drug data were collected for every shift. A standard operational data collection proforma was piloted and amended for use.
Results 149 shifts (802hrs) were completed. 10 patients on average per shift, (five tasks completed in 32 mins). Staff requested support/information for 388 individual drugs. The most common reason - safety to prevent an ADR 60% followed by efficacy 32%, length of stay 10%, compliance/concordance 16%. Six percent (24/388) were for safety in relation to an ADR. Most requests where for medicines acting on the CNS 26%, CVS 23% or to treat infection 21%.
Conclusion ED Pharmacists ensured medicines quality and safety and released ED clinician time. This was achieved by Key pharmacist safety inputs
1. allergy confirmation, providing a medicines safety barrier supporting safer prescribing in a high risk environment
2. reduction in missed or delayed doses through early DH identification, MR and supply of non-stock medicines
3. avoidance of ADRs
4. provision of specific, timely drug advice
- emergency departments
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