Hospital expands pharmacy coverage in ED
Focus is on safety, efficiency, cost-savings
A hospital's emergency department (ED) is the gateway for many hospital admissions, and it's an area in which safety issues loom large.
So it makes sense from a quality perspective for hospital pharmacists to have a presence in the ED, says Chris Kutza, PharmD, pharmacy manager of Advocate Lutheran General Hospital in Park Ridge, IL.
"A pharmacist's role in the ED could be to enhance safety, efficiency, and cost control," Kutza says.
Since making the change to include pharmacists in the ED about five years ago, the ED staff noticed improvements in how they take care of patients with a pharmacist present, Kutza says.
"They recognized errors they once made that they wouldn't have if they had a pharmacist on site, or delays in medications that are complicated to give to patients," Kutza adds.
The problem is that staffing an ED requires resources that hospitals might already have committed elsewhere.
"We justified getting additional FTEs based on a need for more staff pharmacists," Kutza says. "It was a cost-neutral move."
The hospital already had pharmacist coverage in its operating room satellite, so those services were expanded.
"We justified the additional FTEs through a need to provide more extensive service," Kutza says.
Also, the pharmacist coverage was gradually increased over the past five years. At first, there was weekday coverage of about 8.5 hours per day.
"As time went on we had a better handle of the workflow needs and now we have a pharmacist in the ED roughly 16 hours per day," Kutza explains.
Advocate Lutheran General Hospital found a way to expand pharmacy coverage in the ED after a number of years of recognizing this as a need.
"We have had for many years an operating room pharmacy satellite, dispensing to surgery areas," Kutza says. "Hospital leadership thought it might be helpful to use that as a launching pad to get some pharmacy services into the ED."
Kutza conducted a project that looked at what the pharmacist's role would be in the ED and whether it was feasible for a clinical pharmacist to work in the ED site.
"I did part of an elective, eight-week rotation in the ED," Kutza says. "My residency project was to figure out if it was justified to have an ED clinical pharmacist."
Kutza documented everything he did during this rotation, including the major tasks to the miniscule.
He found there were significant cost savings as far as redirecting formulary options, but patient safety was the biggest outcome.
For instance, an ED pharmacist can conduct chart reviews of the high-risk patients and ensure the appropriateness of their medications, Kutza says.
"We try to keep track of every patient to see what treatments they're being prescribed," he explains. "The ED recently went to an electronic medical record, so there's a lot of information on the computer."
As a result of Kutza's project about eight years ago, the hospital now has seven pharmacists who are trained to work in the ED and who provide full coverage from 7 a.m. to 11 p.m. on weekdays and slightly shorter coverage on weekends.
"We're still looking at the optimal times to match the patient workload," Kutza says. "We don't have anyone in the actual ED at the midnight shift, but we have two midnight shift pharmacists who cover the entire hospital, and any pharmacy issues would go to those pharmacists."
The results have been very positive, including some successful initiatives generated as a result of the pharmacy presence in the ED, Kutza says.
One of the earliest projects making use of the ED pharmacists involved optimizing antinausea therapy, Kutza says.
The hospital has saved hundreds of thousands of dollars in a more efficient use of antinausea drugs, he notes.
The ED pharmacists help physicians optimize the choice of antinausea therapy, suggesting drugs that are more specific to treating the patient's type of nausea, he says.
Previously, physicians would prescribe a type of antinausea medication that is very expensive and not necessary in every case.
"So we educated the physician and RN staff about how to treat nausea and vomiting and what the causes are," Kutza says. "They might make one choice for treating post-op nausea and another choice for treating gastroenteritis."
Instead of defaulting to the most expensive medication, physicians were trained to select the best matching drug for a particular patient.
ED pharmacists would follow-up and review patients' antinausea prescriptions. If they felt the physician had not made the best selection, they'd talk to the doctor about it, Kutza explains.
"The doctor might say, 'Fine, let's change it,' or if they had a good reason for using this medication, they might continue it," Kutza says.
"We did a baseline assessment, an intervention, and then followed up before, during, and after data collection," Kutza says.
"Over time there were FDA changes too in some of the drugs used, and that changed habits, as well," he adds.
A hospital's emergency department (ED) is the gateway for many hospital admissions, and it's an area in which safety issues loom large.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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