Role of Clinical Pharmacist in Emergency Department

Role of clinical pharmacist in emergency department of a hospital

1. ROLE OF CLINICAL PHARMACIST IN EMERGENCY DEPARTMENT

2. PRESENTED BY Samam Wasiq (13660) Faisal Zubair (13606) Mujahid Nadeem (13612) Ali Raza (13621) Arslan Tahir (13635)

3. PRESENTED TO Dr. Ikram Ullah Khan

4. SEMESTER 7 TH FACULTY OF PHARMACEUTICAL SIENCES G.C.U.F

5. CONTENTS Introduction Evidence To Support Value Of Clinical Pharmacist Strategies To Optimize The Emergency Pharmacist’s Role Staff Perceptions Of The Emergency Pharmacist Program Education And Training Requirements Activities Of Clinical Pharmacist In Emergency Department Emergency Pharmacist Job Description Conclusion

6. Introduction

7. CLINICAL PHARMACIST Clinical pharmacists work directly with physicians, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes. Clinical pharmacists practice in health care settings where they have frequent and regular interactions with physicians and other health professionals, contributing to better coordination of care.

8. Duties of Clinical Pharmacist Assess the status of the patient’s health problem. Evaluate the appropriateness and effectiveness of the patient’s medications. Recognize untreated health problems that could be improved or resolved with appropriate medication therapy. Follow the patient’s progress to determine the effects of the patient’s medications on his or her health.

9. Duties of Clinical Pharmacist (Cont.) Consult with the patient’s physicians and other health care providers in selecting the medication therapy Advise the patient on how to best take his or her medications. Support the health care team’s efforts to Educate the patient on other important steps to improve or maintain health, such as exercise, diet, and preventive steps like immunization. Refer the patient to his or her physician or other health professionals to address specific health, wellness, or social services concerns as they arise.

10. EMERGENCY DEPARTMENT The department of a hospital responsible for the provision of medical and surgical care to patients arriving at the hospital in need of immediate care. Emergency department personnel may also respond to certain situations within the hospital such cardiac arrests. The emergency department is also called the emergency room or ER. https://www.mEmmergency Departmenticinenet.com/script/main/ art.asp?articlekey =12156

11. Conditions Handled In ED Cardiac arrest Heart attack Trauma Asthma and COPD Mental illness

12. Emergency Medicine Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with caring for undifferentiated patients with illnesses or injuries requiring immediate medical attention. Different models for emergency medicine exist internationally.

13. Evidence To Support The Value Of A Clinical Pharmacist

14. EVIDENCE TO SUPPORT THE VALUE OF A CLINICAL PHARMACIST Medication Errors In Emergency Department High-risk Environment Of Emergency Department Clinical Pharmacist As A System Level Solution Model For An Emergency Pharmacist Program Optimization Of Emergency Pharmacists’ Role In Medication Safety Needs Of Emergency Department With Regards To Pharmacist

15. I. Medication Errors In Emergency Department Prevalence of preventable adverse events in the emergency department is high CDC’s National Hospital Ambulatory Medical Care Survey (1992-2000) Another study  3.6% of patients were prescribed inappropriate medication in the emergency department An Austrian study  5.4% of patients who received medication had the potential for an ADR A recent study  38% of patients in emergency departments worried that a medication error might affect them

16. II. High-risk Environment Of Emergency Department Medications ordered, dispensed and administered at the point of care Higher prevalence of verbal orders No access to patient’s complete medical record A large no. of medication orders to be covered in limited time Increased use of higher risk IV infusion medications (such as inotropes, sedatives) Hospital crowding and boarding of inpatients in ED

17. III. Clinical Pharmacist As A System Level Solution Error reduction in medicine by individual health professional rather than the system Outmoded and counterproductive method of improving patient safety over time Two-fold approach to the objective of system design for safety Active prevention of adverse medication events ADRs by screening physician’s orders Inpatient and ambulatory clinical pharmacist positions in many hospitals Potential of a clinical pharmacist largely goes unrealized in emergency department

18. IV. Model For An Emergency Pharmacist Program Reported estimates of potential savings related to pharmacist interventions in emergency department Emergency Pharmacist Program  Potentially cost effective United States  110M patients in EDs each year Underutilized intervention so far

19. V. Optimization Of Emergency Pharmacists’ Role In Medication Safety Mounting momentum to increase number of EDs that utilize clinical pharmacist No study yet to develop an optimized role for emergency pharmacist

20. VI. Needs Of Emergency Department With Regards To Pharmacist Visibility of the Emergency Pharmacist Involvement in direct patient care Involvement in teaching Surveillance of medication orders Identification of the Emergency Pharmacist as a resource for the ED staff

21. Strategies To Optimize Emergency Pharmacist’s Role

22. STRATEGIES TO OPTIMIZE EMERGENCY PHARMACIST’S ROLE Maintain High Visibility Focus Attention On ED Patients Serve As An Educational Resource Be Present In ED During Peak Volume Hours Maintain Surveillance Of Providers Respond To All Trauma And Medical Restrictions In The ED Limit Time Out Of Unit

23. STRATEGIES TO OPTIMIZE EMERGENCY PHARMACIST’S ROLE (Cont.) I. Maintain High Visibility Increased visibility in pediatric and non-acute areas of ED Posting of signs Review of medication instructions related to patient discharge II. Focus Attention On ED Patients Responsibility for boarding patients be assigned to inpatient pharmacy personnel

24. STRATEGIES TO OPTIMIZE EMERGENCY PHARMACIST’S ROLE (Cont.) III. Serve As An Educational Resource Role in assisting staff Contribution in medication-related articles IV. Be Present In ED During Peak Volume Hours Shift in coverage from weak days to hours that coincide with peak patient volume V. Maintain Surveillance Of Provider Orders Surveillance of medication orders with a focus on higher risk medications

25. STRATEGIES TO OPTIMIZE EMERGENCY PHARMACIST’S ROLE (Cont.) VI. Respond To All Trauma And Medical Restrictions In The ED Be present at all resuscitations Nurses’ assistance in preparing medication for administration Physicians’ clinical advice and improved efficacy of medication delivery system VII. Limit Time Out Of Unit Limit time for administrative responsibilities

26. Education and Training Requirements for an Emergency Pharmacist

27. EDUCATION AND TRAINING REQUIREMENTS FOR AN EMERGENCY PHARMACIST Successful completion of PGY-1 (pharmacy practice residency or equivalent experience) Successful completion of PGY-2 in critical care or emergency medicine (General Pharmacotherapy PGY-2 acceptable) Highly desired: BCPS certified. Required: ACLS and PALS course completion Highly desired: ATLS Course Completion (audit).

28. EDUCATION AND TRAINING REQUIREMENTS FOR AN EMERGENCY PHARMACIST Well-versed in medication management and pharmacology in the following areas: 1. Airway management 2. Sedation. 3. Ambulatory care. 4. Cardiology. 5. Critical care. 6. General medicine. 7. Infectious diseases. 8. Pediatrics. 9. Toxicology/drugs of abuse/overdose

29. EDUCATION AND TRAINING REQUIREMENTS FOR AN EMERGENCY PHARMACIST Some background in disaster management is preferred An understanding of medication-related quality measures applied in the emergency medicine setting https://www.ncbi.nlm.nih.gov/books/NBK43767/

30. Activities Of Clinical Pharmacist In The Emergency Department

31. ACTIVITIES OF CLINICAL PHARMACIST IN THE EMERGENCY DEPARTMENT Medication Review And Counselling Therapeutic Drug Monitoring (TDM) Adverse Drug Reactions (ARDs) Medication Review Toxicology Education Protocols Preparation Of Drugs

32. ACTIVITIES OF CLINICAL PHARMACIST IN THE EMERGENCY DEPARTMENT (Cont.) I. Medication Review And Counselling Review of medications a patient was taking prior to admission Review of current medications Counselling regarding dosing, optimum administration time, possible adverse effects etc. II. Therapeutic Drug Monitoring (TDM) Monitoring of antibiotics such as aminoglycosides or vancomycin in ED Dose adjustments in consultation with medical staff

33. ACTIVITIES OF CLINICAL PHARMACIST IN THE EMERGENCY DEPARTMENT (Cont.) III. Adverse Drug Reactions (ADRs) Medication-related events  many admissions in to an ED Education of patient and prescriber Counselling and providing patients with ADR cards Adverse Drug Reactions Advisory Committee IV. Medication Review Problems related to polypharmacy Liaise with treating team to make appropriate changes Review drugs and forward suggestions to patient’s local prescriber

34. ACTIVITIES OF CLINICAL PHARMACIST IN THE EMERGENCY DEPARTMENT (Cont.) V. Toxicology Management of drug overdoses and poisoning Identification of a product, treatment options, or supply of an antidote Organize supply and optimize dosing VI. Education Regular meetings with medical and nursing staff Pharmacist  new drugs, new protocols, new pharmaceutical delivery devices, revision of drug therapy protocols Address subjects including drug identification, dose and pharmacology of new drugs, methods of administration and alternative drug therapies

35. ACTIVITIES OF CLINICAL PHARMACIST IN THE EMERGENCY DEPARTMENT (Cont.) VII. Protocols Drug protocols  vital for smooth working Developed and implemented jointly by pharmacist, medical and nursing staff VIII. Preparation Of Drugs Prepare infusions Draw up ‘stat’ drugs or prepare intubation agents Double check IV drugs prepared by nursing staff Advice regarding IV administration rates and time for drugs which require specific infusion methods

36. Emergency Pharmacist Job Description

37. EMERGENCY PHARMACIST JOB DESCRIPTION The Emergency Pharmacist is responsible for providing comprehensive clinical pharmacy services for the emergency department and all associated areas e.g., pediatrics, trauma, urgent care including pharmacokinetic and therapeutic consultation. Specific responsibilities include, but are not limited to:

38. EMERGENCY PHARMACIST JOB DESCRIPTION (Cont.) Provide pharmacy review of high-risk medication orders prior to administration. Provide patient-specific medication use teaching for discharge medications when appropriate. Focus on cost avoidance and cost savings due to medication use in the ED Facilitate proper information transfer with regard to medication use for patients converted to inpatient registry from ED

39. EMERGENCY PHARMACIST JOB DESCRIPTION (Cont.) Work collaboratively with other clinicians and health care providers to implement and maintain innovative disease management programs and clinical pharmacy services Participate in the development of medication management programs within the institution, including clinical guidelines, critical pathways, disease management, and drug use programs Participate in providing didactic and experiential training in clinical pharmacy for Pharm. D students and clinical pharmacy residents

40. EMERGENCY PHARMACIST JOB DESCRIPTION (Cont.) Actively participate in clinical research projects Participate in the professional development and competency of clinical staff. Function as an educational resource for pharmacy staff Assist in the development, implementation, and evaluation of critical care and emergency medicine pharmacy residency programs

41. EMERGENCY PHARMACIST JOB DESCRIPTION (Cont.) Keep informed of the actions, side effects, and proper use of all new drugs as they are made commercially available, as well as of all investigational drugs being studied at this institution Maintain awareness of contemporary trends in the profession through the professional literature and regular attendance at professional meetings, institutes, and seminars

42. EMERGENCY PHARMACIST JOB DESCRIPTION (Cont.) Participate collegially in the development of new programs, services, and practices in the education activities of the department and the management and administration of the department Perform other related duties as required https://www.ncbi.nlm.nih.gov/books/NBK43767/

43. Conclusion

44. CONCLUSION The clinical pharmacist's role in our ED continues to grow and develop Both nursing and medical staff request (or demand) more pharmacist time to be given to the department ED pharmacist can help to relieve pressure on other staff and add to the effectiveness of patient care http://onlinelibrary.wiley.com/doi/10.1002/jppr2001314303/pdf

45. THE END

46. Q & A

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