Evaluation of pharmacy services in emergency departments of Veterans Affairs Medical Centers.

Abstract

In 2008, the American Society of Health-System Pharmacists (ASHP) published a national survey that revealed only 6.8% of hospitals surveyed had a pharmacist assigned to the emergency department (ED) for any period of time. This survey was distributed among general and children's medical-surgical hospitals in the United States and did not include any Veterans Affairs (VA) Medical Centers. To date, there have been no identified survey studies describing the prevalence of pharmacy services within VA EDs. The objectives of this study are to determine the prevalence of dedicated pharmacy services within VA EDs, categorize the types of pharmacy services, determine if interventions/outcomes related to pharmacy services were collected, and assess the desire for pharmacy services in facilities that did not currently have dedicated pharmacy services. The study was designed as a cross-sectional survey study conducted between January 14, 2010 and March 29, 2010. The study population included Pharmacy Clinical Coordinators employed at a VA facility. An initial email containing a link to the web-based survey was distributed via the national Pharmacy Clinical Coordinator listserv. Results of the survey were analyzed using descriptive statistics. The survey was distributed to 153 VA Medical Centers and a total of 33 (21.6%) responses were received. Of the responses, 24 facilities (72.7%) documented the presence of an ED, and of those, 5 (20.8%) indicated that they had a pharmacist dedicated to providing pharmacy services to the ED. The most common pharmacy services provided included medication reconciliation, patient education/ counseling, pharmacotherapy recommendations, ED staff education, precepting activities, adverse drug reaction (ADR) reporting, and ensuring formulary compliance. Three of the 5 facilities documented interventions, with 1 facility documenting ADRs prevented and cost avoidance in addition to interventions. Of the 19 facilities that did not have a pharmacist dedicated to the ED, 16 (84.2%) indicated a desire for such services. A greater prevalence of ED pharmacy services was reported in VA facilities compared with a national sample of non-VA facilities. Despite the high prevalence and variety of dedicated pharmacy services provided to the ED, documentation of these services remains an area in need of improvement.