Hospi lab m3

• Pharmacists in the Emergency Services Unit

  • Emergency medicine is an ever changing and rapidly evolving practice

  • The role of the pharmacist is really important in the emergency department (ED) as pharmacists provides many vital services to the ED
• Pharmacists in the Emergency Services Unit

  • Central role of Pharmacist → improve patient outcomes by:

  – improving patient safety

  – preventing medication errors

  • Pharmacists also provide optimized pharmacotherapy regimens and therapeutic outcomes through participation in direct patient care activities and adapting quality-improvement initiatives in the ED.
• Pharmacists in the Emergency Services Unit

  • Pharmacists can provide education to members of the pharmacy department and other health care providers, as well as patients and their caregivers
• Essential Roles of Pharmacists in the Emergency Services Unit

  1. Direct Patient Care
  2. Medication Order Review
  3. Medication Therapy Monitoring
  4. Patient Care Involving High alert Medications (HAM) and Procedures
  5. Resuscitation
  6. Medication Procurement and Preparation
  7. Medication Information
  8. Documentation
• Direct Patient Care

  • The majority of medication errors occur in the PRESCRIBING and ADMINISTRATION phases of the medication-use process;

  – Therefore, it is critical for Emergency Medicine Pharmacists (EMPs) to be involved in direct patient care activities (medication selection and prescribing process)
• Direct Patient Care

  • EMPs are most effective in doing this when physically present in the ED

  • EMPs, in collaboration with other health care providers, should be accountable for ensuring optimized medication therapy regimens and therapeutic outcomes.
• Medication Order Review

  • All medication orders should undergo prospective order review by a pharmacist prior to administration of the medication to the patient
• Medication Therapy Monitoring

  • EMPs should provide recommendations: for monitoring parameters for drugs administered in the ED:

  – Effectiveness

  – Safety

  • Given the number of patients in the ED and competing interests for an EMP’s time, focusing on high-risk medications should be prioritized.
• Medication Therapy Monitoring

  • EMPs should work closely with nursing staff and re-assess patients to ensure proper response, safety, and monitoring is completed.
• Patient Care Involving High alert Medications (HAM) and Procedures

  • EMPs should be present at the bedside to facilitate the delivery of patient care involving HAM or procedures. Participation should include:

  – Assisting in the appropriate selection of medications and corresponding doses

  – Preparation of medications

  – Patient monitoring
• Patient Care Involving High alert Medications (HAM) and Procedures

  • In addition, EMPs should provide education and training related to high-alert medications to ED healthcare providers
• Resuscitation

  • EMPs should be present during all critical and acute resuscitative efforts in the ED.
• Resuscitation

  • The role of EMPs in resuscitation may

  include a variety of responsibilities including, but not limited to:

  – Assisting clinicians with differential diagnosis, particularly when related to a potential medication-related cause

  – Ensuring appropriate medication selection and dose

  – Answering medication information questions
• Resuscitation

  • The role of EMPs in resuscitation may include a variety of responsibilities including, but not limited to:

  – Making recommendations for alternative routes of administration when appropriate

  – Preparing medications for immediate administration

  -Obtaining medications that are not readily-available in the ED

  – Completing resuscitation documentation
• Medication Procurement and Preparation

  • EMPs should be an integral part of the medication procurement and preparation process for medications used in the ED, as dispensing medications is one of the five stages of the medication-use process that EMPs can influence to prevent medication errors.
• Medication Procurement and Preparation

  • EMPs should be involved in the decisionmaking process regarding which medications will be made available immediately within the ED.

  • EMPs may assist in the evaluation and management of these medications, including monitoring for appropriate usage, inventory levels, override list optimization, and medication storage.
• Medication Procurement and Preparation

  • Inventory and storage replacement should be maintained by pharmacy technician support and should not be the direct responsibility of EMPs
• Medication Information

  • The most common cause of medication errors is a lack of information related to medication therapy

  • Provision of medication information is therefore a vital role in the practice of all pharmacists, including EMPs.
• Medication Information

  • In addition, other members of the health care team are more likely to utilize the resources of a pharmacist when that pharmacist is located in the ED rather than the central pharmacy department
• Documentation

  • Pharmacist interventions in the inpatient setting improve patient outcomes through optimized pharmacotherapy regimens, monitoring of medication therapy, and avoidance of adverse medication events.
• Documentation

  • EMPs improve the medication-use process and patient care by providing recommendations about medication therapy, serving as a medication information resource and improving patient safety.
• Documentation

  • Documentation can include both internal pharmacy documentation for cost justification purposes or patient care notes in the electronic medical record for handoff to other medical professionals.

  • Allergy documentation, therapy plans, and patient education are some examples of activities that can be documented in the medical record.
• Documentation

  • Cost-avoidance documentation may provide the justification needed for further expansion of EMP services.
• • Emergency cart (E-Cart)

  – Wheeled cabinet or chest of drawers which contains all of the equipment necessary for emergency resuscitation.

  – Conveniently positioned throughout the hospital for quick access in emergency cases.

  – Contains medications as well as equipment for defibrillation, intubation, IV supplies and tubing.
• Purpose of E-Cart

  • To ensure availability of all drugs, equipment and supplies necessary to initiate advanced life-support measures.

  • To have the emergency cart and defibrillator constantly ready for use in case of life threatening condition such as CP arrest.
• Contents of E-Cart

  • Defibrillator

  – an apparatus used to control heart fibrillation by application of an electric current to the chest wall or heart
• Contents of E-Cart

  • Ambu bag or “self-inflating bag”

  – a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.
• Contents of E-Cart

  • Emergency drugs

  – essential drugs given for emergency cases usually via infusion
• Contents of E-Cart

  • IV supplies and tubing

  – they are used to provide electrolytes, nutrients or medications via intravenous route