Assessing the impact on workflow of placing a pharmacy team in an emergency department

Abstract

Abstract Introduction The ED in our tertiary referral Hospital was working at capacity and invited pharmacy to send a team for a period to assess the impact they might have on workflow and doctor time, by carrying out detailed (level 2) medicine reconciliations and resolving medicine related issues at the outset. Aim To assess the impact that allocating an experienced pharmacist (Independent prescriber) together with a pharmacy technician might have on workflow and patient safety in ED. Methods The pharmacy team were directed to managing patients’ medicines carrying out the more comprehensive level 2 (1) medicines reconciliation (MR). This is a more thorough level of MR than that usually carried out on admission by a doctor (Level 1 MR). The time taken to conduct each MR was recorded. Interventions made were categorised by the clinical pharmacist using the MERP index. Five doctors were surveyed and asked how long they usually took to conduct a level 1 MR. Results 132 MRs were carried out over 5 days. The pharmacist conducted 65 MRs mean time per MR 13.8 minutes SD 6.84 CI 90% (+/- 0.11) and the technician conducted 67 MRs mean time 23.73 minutes SD 11.07 CI 90% (+/- 0.17). The doctor group took 15 minutes (estimated) to conduct a level 1 MR SD 34.85 CI 90% (+/- 0.81). 1013 interventions were made, 15 were judged to be significant in terms of harm or potential harm and a further 128 related to non-prescribing of critical items (see table). A 90% Confidence interval was used reflecting the significant variance in time that a medicine reconciliation can take. Conclusion This project had limitations; it was brief, and the number of doctors surveyed few. However, it was adjudged to be a success in terms of doctor time saved (33 hours) and patient safety identifying 14 harm or potential harm occurrences and 128 critical medicines omissions at the outset of the patient journey. Following the project, the trust recognised the impact the team had and has subsequently funded an ED pharmacy team. References (1) Improving the Quality of Meds Reconciliation: A Best Practice Resource and Toolkit: V1.1 June 17 Specialist Pharmacy Service. Accessed Oct 2021 Medicines_Reconciliation_Best_Practice_Standards_Toolkit_Vs1.1_June-15-links-updated-Aug-17.pdf (sps.nhs.uk) (2) Types of Medication Errors | NCC MERP, accessed 7/10/2021. https://www.nccmerp.org/types-medication-errors