Pharmacists in the ER could cut medication errors

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SARASOTA, Fla. -- Is there a need for an Emergency Pharmacist Program?

EPH programs have been around since the 1970s, but until recently, they have been rare. Their development in the emergency rooms is a result of the unique clinical environment that exists in the E/R, which is considered high risk for adverse drug events from a systems perspective.

The primary aims of the EPH program are to diminish the risks of adverse events and to reduce costs. The innovative EPH program works with the varied staff in the E/R to improve medication safety and provide pharmacologic information to staff.

The emergency room is a high-risk area where medications are given instantaneously at a very fast pace.

“Having a pharmacist review those medications before the patient gets it is additional safety net.” Pharmacist Michelle Malatlian developed the E/R Pharmacist Program at Sarasota Memorial Hospital in 2007. “Med safety became a very important thing in the world of health care. We wanted to improve the safety of our patients.”

There's a big benefit to having a pharmacist on duty in the E/R, says Dr. Brian Garvy. “A pharmacist acts as our second eyes and ears, to help us sort out what medications people may be on, or what they've neglected to take, maybe new medicines that you're taking that they didn’t tell us about.”

Pharmacists, he says, help identify drug interactions, select the appropriate drug for the right reasons, make adjustments if the patient can’t tolerate medication by mouth, and may adjust dosage for conditions like kidney failure. “Last week I had a gentleman that was toxic on digoxen or Digitalis.”

The pharmacist was instrumental in helping dose that patient correctly and get him the medicine. “Digitalis had put him into complete heart block, so it was a true emergency.”

In an environment where decisions are made in moments, making the right one can make the difference between life and death. “Every nursing station here at SMH has this chart which shows you a comparison of similar sounding medications, so there can be no mix up. The letters actually vary on medications that are similar in print so that they can tell the difference.”

Published reports have ascertained E/R-based pharmacists have the potential to reduce iatrogenic harm to patients. Although a pharmacist-based safe-practice intervention appears to have face value, no study has yet attempted to demonstrate that such an intervention actually reduces preventable adverse drug events in the E/R.

How the emergency pharmacist role could be optimized, defined as one that would be most likely to improve the quality of care and reduce adverse medication events in the E/R.