Pharmacist in ED slashes medication errors by 50%
Turnaround accomplished in just six months
By placing a pharmacist within the department to review medications being given to patients, the ED at Huntington Hospital in Pasadena, CA, has achieved more than a 50% reduction in errors in six months.
The clinical pharmacist, Jill Hara, PharmD, approached the director of the pharmacy department at Huntington with the idea about two years ago. "I was coming out of a specialty training program for ED pharmacists," she reports. The proposal had several objectives: to help the ED comply with The Joint Commission requirements for review of medication, to monitor contrast administration within radiology, to improve medication safety, and to increase communication between the pharmacy and the ED.
Jeanette Abundis, RN, MN, the ED's clinical director, was supportive — which was essential because the ED pays Hara's salary. "I thought it would be of benefit since a lot of our medical management oversight of meds was occurring based on the practitioner's history with a product," Abundis notes. "They may not have been considering more recent meds or meds that were more effective, more cost-efficient, and with fewer side effects."
In addition, she says, Hara's presence has allowed the ED to streamline and control practice patterns and to create more consistency in how certain diagnoses are treated, based on her recommendations. "Physicians regularly recommend antibiotics or pain control meds, but it helps when you have a pharmacist on board to look at other drugs and potential interactions, as well as past meds, because she knows the literature and [the latest information on] drug-drug interaction," Abundis explains.
Two-level review
On a daily basis Hara reviews all orders, prospectively and retrospectively. "I'll look at any medications given on previous shifts, and of course as they are being ordered," says Hara, who works Monday through Thursday from 7 a.m. until 5:30 p.m. They established those hours because there is a large administrative component to the position, she explains. "I can't impact all shifts, but by the revamping of protocols and improvement in medication safety in the daytime hours, where I can be most efficient, I can impact the department as a whole," Hara says.
Hara also is available for any drug-related questions ED physicians or nurses may have. "Lots of times, if I'm not on, they will save questions for me," she says. "I had someone come to me the other day and ask me if I thought what they had done earlier was the best possible treatment."
Abundis says that Hara's role in standardizing the products used and implementing more consistent dosing has helped regulate practice patterns. "It's very beneficial from an administrative standpoint and very cost-effective, because if you standardize practice and products instead of offering 20 different versions of one type of drug, you can consolidate it down to five," she says. "Jill will tell you at what dose a drug is most effective, which of two equivalent drugs costs less, and what we should and shouldn't stock." In addition, she notes, the medications that are needed are always readily available for conditions with standardized treatment, such as community-associated pneumonia.
The ED staff were excited to have Hara on board, Abundis recalls. "Before, if they had questions they either had to call the pharmacy, go online, or refer to the PDR [Physician's Drug Reference]," she notes. "A live body is much more readily available." Hara made herself even more accessible with a cell phone and trauma pager.
Having Hara in the ED also saved the staff time, says Abundis. "Previously, if we did not have a particular drug, we would have to put in a requisition and wait for the pharmacy to send it, which meant a treatment delay of up to half an hour," says Abundis, pointing out that some intravenous medications, for example, have to be mixed. "If you standardize, you can increase your inventory and make sure common treatment meds are readily available in Pyxis," she explains.
Hara's position also helps limit liability, Abundis asserts. "Considering that the environment of practicing medicine in the ED is very litigious, this is one way to control your risk," she says. In an evaluation of pediatric high-risk medication orders in the six months prior to and subsequent to Hara's hiring, 22 errors in miscalculation or reconstitution of the amount administered were found prior to her hiring, while only nine were found in the six months after she came on board.
"I highly recommend this approach for EDs," says Abundis. "In fact, we are pushing for 24-hour coverage." To make more department-based pharmacists available, the hospital is establishing a specialty residency program, she says.
Sources
For more information on adding a pharmacist to your ED staff, contact:
- Jeanette Abundis, RN, MN, Clinical Director; Jill Hara, PharmD, Clinical Pharmacist, Emergency Department, Huntington Hospital, Pasadena, CA. Phone: (626) 397-5000.
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