Establishment of pharmaceutical services within the emergency department

Abstract

The essential role of the pharmacist in Emergency Department has been documented to support the delivery of safe and effective medication use processes within this fast pace clinical setting governed by high decision density taken promptly for the critical patient. The aim of this study was to establish a holistic pharmaceutical service tailored to the need of the Adult ED at Mater Dei Hospital. Initially, observation of ED dynamics and completion of gap analysis exercise on the medication use process were conducted. Two validated questionnaires were completed in order to capture the perception of ED physicians and nurses on a proposed pharmaceutical service. Gold standard international guidelines were incorporated with findings from the gap analysis and questionnaires to delineate a blueprint for the service categorised into operational, clinical and other services. The pharmaceutical service started on March 2017 by one pharmacist operating within the department weekdays from 07.30 to 15.00. Operational services were primarily set up through management of ED centralised medication floor-stock. Non-automated medication cabinets were reorganised according to formulation and high alert drugs (60% of total drugs) were identified with generic labelling using Tall-man-lettering, aiming to increase safety by optimising the speed versus accuracy trade off. The need to update the Government Formulary List in order to add certain drugs for use within the ED and to remove others so as to decrease inadvertent risks of errors was recognised. Clinical services provided ranged from medicine information to participation in resuscitation cases. Cases were attended to according to their priority with over 300 inputs documented over a 3 month period. Other services involved compilation of departmental policies and pathways, review of MDH official antidotes list, delivery of pharmacology updates to nursing staff and participation in major national events. Through the active participation of a pharmacist, essential pharmaceutical services of the Emergency Department have been established over a one year period. As part of the multidisciplinary team, the pharmacist can improve the safety and quality in the overall medication use process within a fast paced scenario such as the ED resulting in optimised patient care.