Emergency Medicine Pharmacist Research Articles

Collaboration by emergency medicine pharmacists and prehospital services providers.

Collaboration by emergency medicine pharmacists and prehospital services providers.

Emergency medicine pharmacist market perceptions: Emergency medicine residency program directors and directors of pharmacy

ObjectiveGraduating pharmacists are applying to postgraduate year 1 (PGY-1) and postgraduate year 2 (PGY-2) programs at a rate that is outpacing the number of programs available. Emergency department (ED) PGY-2 programs are gaining popularity, and competitions are increasing for applicants. Demand for ED pharmacists seems to be steady, although this has not yet been formally evaluated. This survey seeks to clarify current expectations from the ED pharmacist job market and those currently graduating from a PGY-2 ED program. DesignElectronic surveys were sent via e-mail from January 2019 to February 2019. Setting and participants: Directors of pharmacy (DOPs) and residency program directors (RPDs) of all PGY-2 ED programs available in the American Society of Health-System Pharmacists directory. Outcome measuresIncluded residency position forecast and trends, program development, pharmacist position forecast and trends, perceptions of pharmacist market, and salary. ResultsRPDs stated that the number of PGY-2 ED resident applicants has increased over the past 5 years. Although RPDs did not plan to expand the number of PGY-2 ED resident positions in their program for the 2019-2020 cycle, they had strong plans to expand in the next 5 years. Although RPDs projected growth in the number of resident positions over the next 5 years, DOPs anticipated the number of full-time equivalents openings for ED pharmacists to remain constant over the next 5 years. ConclusionA survey involving PGY-2 ED program RPDs and DOPs found that the market was perceived to be stable by DOPs with more anticipation of growth by RPDs in the number of PGY-2 ED resident positions. Salaries have increased, and demand was perceived to at least be in balance with supply, with RPD respondents generally believing it was easy to find ED pharmacist employment and most PGY-2 ED program graduates finding employment in ED positions following residency.

Feasibility of pharmacists to contribute to multicenter emergency medicine research

ObjectivesA flexible, rapid, and scalable multicenter network is needed for pharmacotherapy research in emergency medicine (EM). The objective of this study was to evaluate the types of studies EM pharmacists are willing to conduct in multicenter research.MethodsThis was a cross‐sectional national survey conducted in the United States. The survey was developed using an iterative process to establish face and content validity. Members of the American College of Clinical Pharmacy EM Practice and Research Network were invited to complete the survey using Research Electronic Data Capture. Online consent was obtained prior to survey completion. The survey consisted of 14 questions, which was expected to take less than 5 minutes to complete. Data were descriptively evaluated.ResultsThere were a total of 637 potentially eligible participants for the survey. Of these, 98 completed the survey (15% response rate). In terms of types of studies, 91 (93%) would participate in studies involving retrospective acquisition of data, 83 (85%) in observational studies not requiring patient consent, 48 (49%) in observational studies involving a patient consent procedure, and 26 (27%) in implementing and conducting a clinical trial. Overall, 85 (87%) would participate without funding and 66 (67%) would participate without receiving authorship.ConclusionsA substantial number of EM pharmacists are willing to participate in multicenter research. The number of participants decreases without provision of authorship or for studies involving patient consent.

Direct patient care activities and interventions of emergency medicine pharmacists.

Background Emergency medicine (EM) pharmacists are increasingly recognized as integral team members in the care of emergency department (ED) patients but there is variability in the scope of direct patient care services. Objectives The primary objective was to categorize direct patient care activities and drug therapy recommendations. The secondary objectives were to categorize recommendations based on drug class and to determine the proportion of recommendations associated with Institute for Safe MedicationPractices (ISMP) high-alert medications. Methods This retrospective, single-center, chart review was conducted in an academic ED with 65,000 annual visits. EM pharmacists documented direct patient care activities in the electronic health record. Documented activities from 1/1/2015 through 3/31/2015 were abstracted electronically for analysis by a trained reviewer. Results There were 3567 interventions and direct patient care activities documented. The most common activities were facilitation of medication histories (n = 1300) and drug therapy recommendations (n = 1165). Of 1165 drug therapy recommendations, 986 were linked to a drug class such as antimicrobial agents (31.9%), cardiovascular agents (16.6%), and analgesic agents (13.2%) and 20% of these interventions were associated with ISMP high-alert medications. Conclusion EM pharmacists documented several types of direct patient care activities with the majority being drug therapy recommendations and medication histories.

Assessment of dose capping in phenytoin loading practices in the emergency department and the impact of an emergency medicine pharmacist

ObjectivesPhenytoin is a common anticonvulsant used for the acute treatment of seizures in the emergency department (ED). Certain patient populations, such as the obese, have been shown to present dosing challenges. Often doses are arbitrarily “capped” for fear of overdosing. Emergency medicine pharmacists (EPhs) have been shown to optimize the care of patients receiving phenytoin therapy in other settings, demonstrating reductions in seizure activity, duration of therapy, and cost.MethodsRecords of patients presenting to the ED that were at least 18 years old and were prescribed intravenous phenytoin were reviewed. Patients weighing 100 kg or more were compared with those less than 100 kg. To evaluate the impact of an EPh, intravenous phenytoin orders placed during the EPh's hours were compared with those placed outside of those hours.ResultsA total of 117 patients were included, 42 (36%) weighed 100 kg or more. No significant difference was found in the achievement of target (10‐20 μg/mL) postload concentrations between the two groups (P = 0.795). Patients weighing 100 kg or more received significantly lower weight‐based phenytoin doses (16.0 vs 18.6 mg/kg, P = 0.0001). Those 100 kg or more who received less than 15 mg/kg were found to have significantly lower postload concentrations than those that received 15 mg/kg or more regardless of total dose (11.5 vs 16.5 μg/mL; P = 0.003). The presence of an EPh was found to result in significantly higher rates of postload concentrations within the therapeutic range across all groups (72.4% vs 53.7%; P = 0.04).ConclusionsThe available data suggest that artificial total dose limitations in patients yield significantly lower postload concentrations, potentially delaying seizure control in the acute setting. The presence of EPhs at the bedside increases the success of initial phenytoin dosing strategies in this population.

Variability in training, practice, and prioritization of services among emergency medicine pharmacists

The purpose of this survey-based research project is to identify factors, including prior training, institution demographics, and pharmacist prioritization of services that may impact variability in practice among emergency medicine (EM) pharmacists. An electronic survey was available for 6 weeks. Participants were contacted through professional membership directories. Survey questions addressed EM pharmacist training and institution demographics. Pharmacists were asked to define the frequency with which they performed ASHP-identified best practice services. Responses were received by 208 pharmacists (response rate = 9.4%) who were primarily from academic (48.1%) or community (47.6%) emergency departments (EDs). Pharmacists working in an academic ED were more likely to have EM postgraduate year 2 training (27.8%) compared to a community ED (11.2%) (p = 0.0182). Pharmacists practicing in an academic emergency department (ED) reported participating in traumas, care for boarded patients, and performing scholarly activities more frequently (p < 0.01) and medication reconciliations less frequently (p < 0.01) than those in a community ED. Most EM pharmacists reported postgraduate year 1 training (45.7%) as compared to postgraduate year 2 EM (18.3%) or critical care (13.7%) pharmacy residency training. Institution and ED demographics as well as pharmacist level of training can affect the frequency of services provided in the ED setting.

Perceptions regarding vasopressin use and practices in septic shock, and cost containment strategies.

Clinician preferences and practices regarding appropriate vasopressin use in light of its increased acquisition cost secondary to rebranding has not been evaluated or described since the most recent iteration of the Surviving Sepsis Campaign Guideline was published. To assess vasopressin cost containment initiatives and pharmacists' opinions regarding appropriate vasopressin use. A scenario-based survey was distributed to critical care and emergency medicine pharmacists. Responses were characterized using frequency and descriptive statistics. Categorical variables between those who implemented changes (Vasopressin Cost Consideration) and those who did not (Usual Care) were compared using chi-square or Fisher's exact tests. McNemar's test was used to compare responses in clinical scenarios between Vasopressin Cost Consideration and Usual Care groups. Among 1757 pharmacists surveyed, 200 (11.3%) responded. When respondents considered vasopressin cost and evidence (vs evidence alone), fewer respondents would use vasopressin adjunctively with norepinephrine (21% vs 26.6%, P = 0.031), to raise mean arterial pressure compared with epinephrine (65.2% vs 72.3%, P = 0.012), or to reduce norepinephrine infusion rates (71.4% vs 81.4%, P < 0.001), but would use with steroids (62.4% vs 28.3%, P < 0.001). Most (72%) respondents had implemented vasopressin cost containment and/or education initiatives. The Vasopressin Cost Consideration group respondents were more likely to initiate vasopressin at 0.03 units/minute without titrating (47.9% vs 33.9%, P = 0.045). Since vasopressin was generically rebranded, most institutions have implemented at least one initiative to reduce vasopressin use and/or educate clinicians about its appropriate use. When vasopressin acquisition costs were considered, pharmacists recommended its use less frequently, particularly in clinical scenarios where its use is controversial.

Implications of the presence of an emergency medicine pharmacist during critical care trauma patient resuscitation

PurposeThe available literature has shown that the presence of an Emergency Medicine Pharmacist (EMP) is associated with decreased time to medication procurement, a reduction in medication errors, and overall cost avoidance. However, there is limited literature that systematically evaluates the impact of EMPs in the treatment of critically ill trauma patients presenting to the emergency department (ED).MethodsThis study was a retrospective chart review evaluating 1082 adult patients presenting to the critical care area (CCA) of the ED at the University of Louisville Hospital in Louisville, Kentucky for trauma evaluation from July 2014 to December 2014. The study group consisted of patients presenting to the CCA when an EMP was present. Primary outcomes included time to administration of antibiotics, analgesia medication, sedation medication, rapid sequence intubation (RSI), and anticoagulation reversal. Secondary outcomes included time to administration of appropriate antibiotics at an appropriate dose and vaccination administration.ResultsThe presence of an EMP was associated with a statistically significant decreased median time from triage to the administration of an analgesic medication (11 minutes [interquartile range (IQR) 8‐27] vs 13 minutes [IQR 8.5‐20], P = 0.04). There was no statistically significant difference in triage time to antibiotic administration, RSI, sedation medication administration, or anticoagulation reversal. Patients in the EMP group were more likely to receive appropriate empiric antibiotics compared with the control group (80.7% vs 52.2%, P = 0.01).ConclusionThe presence of an EMP was associated with decreased time to analgesia medication administration as well as an increased likelihood of the administration of appropriate empiric antibiotics in critically ill trauma patients.

Medical and Nursing Staff Education Reduces Use of Prophylactic Ondansetron With Opioids in the Emergency Department

IntroductionWe aimed to evaluate the effect of a pharmacist-led educational intervention on administration of ondansetron in patients receiving IV opioid analgesia in the emergency department. MethodsThis study is a retrospective chart review undertaken in a single-community emergency department. During October and November 2015, emergency medicine pharmacists completed an educational initiative targeting medical and nursing staff designed to reduce prophylactic administration of ondansetron. The multifaceted educational initiative comprised of a link to an animated video, posters at strategic locations in the department, e-mail reminders, brief presentations during shift change, and 1-on-1 discussion (see https://www.youtube.com/watch?v=Uvx8zKJBCCI). All patients who received IV morphine or hydromorphone during September and December 2015 were identified using pharmacy dispensing records, and 150 patients from each period were randomly selected for retrospective chart review. The primary outcome was the change in the proportion of prophylactic administration of ondansetron with IV opioids for acute pain in the emergency department. ResultsThe proportion of patients administered prophylactic ondansetron decreased from 41% in the preintervention period to 26% in the postintervention period (difference 95% confidence interval [CI] 4.8 to 25.9, P = 0.005). Therapeutic use for documented nausea or vomiting upon presentation decreased marginally from 44% to 35% (difference 95% CI –2.3 to 19.7, P = 0.1). An overall decrease in the incidence of administration of ondansetron from 85% to 61% was observed (difference 95% CI 14.4 to 33.6, P < 0.001). No patient required rescue antiemetic administration. ConclusionsMedical and nursing staff education yielded a significant reduction in the administration of prophylactic ondansetron for patients receiving IV opioids in the emergency department.

Impact of an emergency medicine pharmacist on empiric antibiotic prescribing for pneumonia and intra-abdominal infections

PurposeIt is critical to engage ED providers in antimicrobial stewardship programs (ASP). Emergency medicine pharmacists (EMPs) play an important role in ASP by working with providers to choose empiric antimicrobials. This study aimed to determine the impact of an EMP on appropriate empiric antibiotic prescribing for community-acquired pneumonia (CAP) and intra-abdominal infections (CA-IAI). MethodsA retrospective cohort study was conducted evaluating adult patients admitted with CAP or CA-IAI. The primary outcome of this study was to compare guideline-concordant empiric antibiotic prescribing when an EMP was present vs. absent. We also aimed to compare the impact of an EMP in an early-ASP vs. established-ASP. Results320 patients were included in the study (EMP n = 185, no-EMP n = 135). Overall empiric antibiotic prescribing was more likely to be guideline-concordant when an EMP was present (78% vs. 61%, p = 0.001); this was true for both the CAP (95% vs. 79%, p = 0.005) and CA-IAI subgroups (62% vs. 44%, p = 0.025). Total guideline-concordant prescribing significantly increased between the early-ASP and established-ASP (60% vs. 82.5%, p < 0.001) and was more likely when an EMP was present (early-ASP: 68.3% vs. 45.8%, p = 0.005; established-ASP: 90.5% vs. 73.7%, p = 0.005). Patients receiving guideline-concordant antibiotics in the ED continued appropriate therapy upon admission 82.5% of the time vs. 18.8% if the ED antibiotic was inappropriate (p < 0.001). ConclusionThe presence of an EMP significantly improved guideline-concordant empiric antibiotic prescribing for CAP and CA-IAI in both an early and established ASP. Inpatient orders were more likely to be guideline-concordant if appropriate therapy was ordered in the ED.

Roles of the emergency medicine pharmacist: A systematic review.

Results of a systematic literature review to identify roles for emergency medicine (EM) pharmacists beyond traditionally reported activities and to quantify the benefits of these roles in terms of patient outcomes are reported. Emergency department (ED)-based clinical pharmacy is a rapidly growing practice area that has gained support in a number of countries globally, particularly over the last 5-10 years. A systematic literature search covering the period 1995-2016 was conducted to characterize emerging EM pharmacist roles and the impact on patient outcomes. Six databases were searched for research publications on pharmacist participation in patient care in a general ED or trauma center that documented interventions by ED-based pharmacists; 15 results satisfied the inclusion criteria. Six reported studies evaluated EM pharmacist involvement in the care of critically ill patients, 5 studies evaluated antimicrobial stewardship (AMS) activities via pharmacist review of positive cultures, 2 studies assessed pharmacist involvement in generating orders for nurse-administered home medications and 2 reviewed publications focused on EM pharmacist involvement in management of healthcare-associated pneumonia and dosing of phenytoin. A diverse range of positive patient outcomes was identified. The included studies were assessed to be of low quality. A systematic review of the literature revealed 3 key emerging areas of practice for the EM pharmacist that are associated with positive patient outcomes. These included involvement in management of critically ill patients, AMS roles, and ordering of home medications in the ED.

Sexually Transmitted Infection Review for the Acute Care Pharmacist

Purpose: Review selected sexually transmitted infections (STIs) and treatment recommendations for pharmacists and providers practicing in the acute care setting. Summary: In 2015, the Centers for Disease Control and Prevention (CDC) published an updated guideline on the treatment of STIs with an emphasis on prevention and new diagnostic strategies to combat the growing problem of STIs in the United States. Despite this guidance, the incidence of infection has continued to grow. In October 2016, an in-depth analysis reported that 20 million new infections occur annually in the United States. With this growing burden of disease, it is pertinent that health-care providers optimize their treatment strategies to improve upon the management of STIs. Focusing on identification of asymptomatic- and symptomatic-infected persons, treatment, education, effective follow-up, and counseling for patients and sexual partners, emergency medicine pharmacists and providers can help minimize the negative long-term health consequences of STIs. Conclusion In the emergency department setting, clinical pharmacists and providers can play a crucial role in preventing and treating STIs and should continue to expand and keep current their knowledge of this topic.

Clinical pharmacy services in the emergency department

The emergency department (ED) is a fast-paced, high-risk, and often overburdened work environment. Formal policy statements from several notable organizations, including the American College of Emergency Physicians (ACEP) and the American Society of Health-System Pharmacists (ASHP), have recognized the importance of clinical pharmacists in the emergency medicine (EM) setting. EM clinical pharmacists work alongside emergency physicians and nurses at the bedside to optimize pharmacotherapy, improve patient safety, increase efficiency and cost-effectiveness of care, facilitate antibiotic stewardship, educate patients and clinicians, and contribute to scholarly efforts. This paper examines the history of EM clinical pharmacists and associated training programs, the diverse responsibilities and roles of EM clinical pharmacists, their impact on clinical and financial outcomes, and proposes a conceptual model for EM clinical pharmacist integration into ED patient care. Finally, barriers to implementing EM clinical pharmacy programs and limitations are considered.

Impact of an emergency medicine pharmacist on initial antibiotic prophylaxis for open fractures in trauma patients

BackgroundTargeted antibiotic treatment reduces the infection risk of open fractures when soft tissue and bone are exposed to the environment. The risk of infection increases with higher degrees of injury. The Gustilo-Anderson system was developed to identify the degree of injury of open fractures and can be utilized to guide initial antibiotic therapy. Few studies have been published evaluating the potential impact of emergency medicine pharmacists in trauma, and currently no study has evaluated a pharmacist's influence on antibiotic selection and timing for open fractures. ObjectiveThe objective of this study was to determine the impact of an emergency medicine pharmacist on initial antibiotic selection and timing in trauma patients with open fractures. MethodsThis was a retrospective cohort study. Trauma alerts with open fractures from May 1, 2014 to June 30, 2016 were eligible for inclusion. The primary outcome was to determine if pharmacist participation during trauma resuscitation was associated with an increased proportion of initial antibiotic selection meeting guideline recommendations. The secondary outcome was the door-to-antibiotic administration time during resuscitation. ResultsInitial prophylactic antibiotic recommendations were met in 81% of trauma resuscitations when a pharmacist was present versus 47% without a pharmacist present (p<0.01). The median door-to-antibiotic time was 14min in the PHARM group versus 20min in the NO-PHARM group (p=0.02). ConclusionsThe participation of an EM pharmacist during initial trauma resuscitation resulted in improved initial antibiotic selection and faster door-to-antibiotic administration times in trauma patients with open fractures.

Emergency Medicine Pharmacist Impact on Door-to-Needle Time in Patients With Acute Ischemic Stroke.

Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department. A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality. A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; P = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; P = .047). The EMP involvement in initial stroke care was associated with a significant improvement in DTN time.

Antimicrobial Therapy for Pneumonia in the Emergency Department: The Impact of Clinical Pharmacists on Appropriateness.

IntroductionPneumonia impacts over four million people annually and is the leading cause of infectious disease-related hospitalization and mortality in the United States. Appropriate empiric antimicrobial therapy decreases hospital length of stay and improves mortality. The objective of our study was to test the hypothesis that the presence of an emergency medicine (EM) clinical pharmacist improves the timing and appropriateness of empiric antimicrobial therapy for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP).MethodsThis was a retrospective observational cohort study of all emergency department (ED) patients presenting to a Midwest 60,000-visit academic ED from July 1, 2008, to March 1, 2016, who presented to the ED with pneumonia and received antimicrobial therapy. The treatment group consisted of patients who presented during the hours an EM pharmacist was present in the ED (Monday-Friday, 0900–1800). The control group included patients presenting during the hours when an EM clinical pharmacist was not physically present in the ED (Monday–Friday, 1800–0900, Saturday/Sunday 0000–2400 day). We defined appropriate empiric antimicrobial therapy using the Infectious Diseases Society of America consensus guidelines on the management of CAP, and management of HCAP.ResultsA total of 406 patients were included in the final analysis (103 treatment patients and 303 control patients). During the hours the EM pharmacist was present, patients were significantly more likely to receive appropriate empiric antimicrobial therapy (58.3% vs. 38.3%; p<0.001). Regardless of pneumonia type, patients seen while an EM pharmacist was present were significantly more likely to receive appropriate antimicrobial therapy (CAP, 77.7% vs. 52.9% p=0.008, HCAP, 47.7% vs. 28.8%, p=0.005). There were no significant differences in clinical outcomes.ConclusionThe presence of an EM clinical pharmacist significantly increases the likelihood of appropriate empiric antimicrobial therapy for patients presenting to the ED with pneumonia.

Impact of an Emergency Medicine Pharmacist on Appropriate Empiric Antibiotic Prescribing for Community-Acquired Pneumonia and Intra-Abdominal Infections

BackgroundAntibiotics are the second most common drug class prescribed in the Emergency Department (ED); therefore, it is critical to engage ED providers in antimicrobial stewardship programs (ASP). Emergency medicine pharmacists (EMP) play an important role in ASP by working with providers to choose the most appropriate antimicrobial agent, dose, and duration. This study aimed to determine the impact of an EMP on appropriate empiric antibiotic prescribing for community-acquired pneumonia (CAP) and community-acquired intra-abdominal infections (CA-IAI).MethodsA retrospective cohort study was conducted evaluating adult patients admitted with a diagnosis of CAP or CA-IAI. The primary outcome of this study was to compare guideline-concordant empiric antibiotic prescribing when an EMP was present vs. absent. We also aimed to compare the impact of an EMP in a new ASP (2014) vs. established ASP (2016). Secondary outcomes included in-hospital mortality and hospital-acquired Clostridium difficileinfection (CDI).Results320 patients were included in the study (EMP n = 185; no-EMP n = 135). Empiric antibiotic selection was more likely to be guideline-concordant when an EMP was present (78% vs. 61%, P = 0.001). Guideline-concordant empiric prescribing occurred more often when an EMP was present in the subgroup of CAP patients (95% vs. 79% P = 0.005) as well as in the subgroup of CA-IAI patients (62% vs. 44% P = 0.025). Overall guideline-concordant prescribing significantly increased between the new ASP and established ASP (60% vs. 82.5%, P < 0.001) and was more likely when an EMP was present (new ASP: 68.3% vs. 45.8%, P = 0.005; established ASP: 90.5% vs. 73.7%, P = 0.005). Patients receiving guideline-concordant antibiotics in the ED were continued on appropriate therapy on admission 82.5% of the time vs. 18.8% if the ED antibiotic was inappropriate (P < 0.001). The presence of an EMP did not impact hospital-acquired CDI (1.1% vs. 1.5%, P = 1.0) or in-hospital mortality (4.3% vs. 1.5%, P = 0.2).ConclusionThe presence of an EMP significantly improved guideline-concordant empiric antibiotic prescribing for CAP and CA-IAI. This impact was demonstrated in both a new and established ASP. Inpatient orders were more likely to be guideline-concordant if appropriate therapy was ordered in the ED.Disclosures All authors: No reported disclosures.

Barcode technology and emergency medicine pharmacy

AbstractBackgroundThe emergency medicine pharmacist (EMP) represents a new field of pharmacy practice in many hospitals and at St Vincent's Hospital Sydney the EMP visits the emergency department (ED) daily Monday to Wednesday (MW), with other pharmacists providing services on Thursday and Friday. Because newer practice areas need to justify services, barcode technology offers an efficient means to collect service provision data.AimThe aim of this study was to determine whether barcode scanning could be used to efficiently describe and quantify EMP services, including the time involved in undertaking activities.MethodThe Activity BarCoding (ABC®) system is a commercially available software package that involves using a portable barcode scanner to collect and present data as an activity profile. The ABC® data generated for the EMP were reviewed for September 2012–March 2013.ResultsThe MW EMP spent 124.5 h undertaking ED clinical care activities (1.48 h/day). In all, 634 patients were seen and, on average, the MW EMP spent 8.94 min with each patient (range: 6.97–9.93 min). Both clinical and non‐clinical activities could be described, with time allocation and interventions easily quantifiable.DiscussionBarcode technology accurately recorded the variety of and time required for activities performed by the EMP and demonstrated EMP involvement in ED patient care. It provides information that describes and quantifies EMP services that can be used for business case development and service improvements. Further standardisation of activity and intervention categories will enhance data collection, benchmarking possibilities and multicentre research.

A Survey of Staff Perceptions of an Emergency Medicine Pharmacist Program in a Community Hospital: A Brief Report

For an emergency medicine pharmacist to become a well-integrated multidisciplinary team member, his or her services need to be accepted by the emergency department (ED) staff. There have been 2 published studies attesting the value of the emergency medicine pharmacist by ED staff: at an academic medical and trauma center in 2007 and a large academic medical center in 2011. The aim of this study is to determine whether the emergency medicine pharmacist's value, as perceived by ED staff, would be similarly accepted at a smaller community hospital with limited clinical pharmacist services. This prospective, descriptive survey examined the perceptions of ED providers and nurses in regard to the emergency medicine pharmacist at a 26-bed Level II trauma center with 65,135 annual visits. Of the 90 participants polled, 50% (45) responded. Overall, the ED staff's perceptions of an emergency medicine pharmacist were positive. Eighty-six percent of all participants surveyed had consulted the emergency medicine pharmacist at least once in their last 5 shifts. Thirty-one percent answered that being available for consultation was the most important aspect of the emergency medicine pharmacist's role, whereas attending codes (22%) and patient education (20%) were the next most important activities. Providers consulted with the emergency medicine pharmacist most for antibiotic stewardship (including guided empiric therapy and culture callbacks) drug-drug and drug-disease state interactions, and dosing of pediatric medications. Nurses referred to the emergency medicine pharmacist most for compatibility consultations, medication retrieval, and high-risk medication verification. As was previously found in academic settings, an emergency medicine pharmacist is an invaluable addition to the health care team and can be incorporated into an existing pharmacy staffing model at a small, community hospital.

12 Telepharmacy Services and Emergency Medicine Pharmacist Interventions in Freestanding Emergency Departments

12 Telepharmacy Services and Emergency Medicine Pharmacist Interventions in Freestanding Emergency Departments