Emergency Room Pharmacist

[clarkbar]

What are the main responsibilities of an ED Pharmacist? I assume med rec, code blues, intubation or sedation drugs, alteplase.

What additional medications and roles do the pharmacist do? What are the daily responsibilities and work flow? What are the expectations?

Given that most patients pass through the ED or are D/C, what ABX or monitoring or rounding opportunities present themselves, if any? Thank you and have a nice day.

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[sunnyandseventytwo]

Clarkbar, are you writing a book or something?

There I am dating myself: Are you a tictok influencer and you've somehow monetized getting people to apply to pharmacy school?

 

[Rockinacoustic]

https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/emergency-medicine-pharmacist-services.pdf

 

[storyhill]

I would say I spend 40% of my time speaking with patients and doing med recs. 20% of my time reviewing orders from the ED. The rest of the time is split between helping doctors and nurses during higher acuity patients that are quite various: trauma, stroke, overdose, psych, pre and post intubation, cardiac arrest, seizures. Helping nurses with various questions, helping doctors order things or interpret antibiotic sensitivies, what antibiotics to give in light of their 10 allergies, how to order a therapy plan for follow rabies vaccinations, dose warfarin for patients who have been in the ED for a long time. basically you're attending to all the medication related things that happen in the ED. Some of the same things a decentralized pharmacist does in any other unit but I am full time on the unit sitting with the docs and nurse the whole shift. In our hospital the other decentralized pharmacists aren't with the docs all of the time because the docs usually sit in a different area and visit multiple units. The doctors in the ED are with us all of the time so I think there is a lot more utilization of us compared to others. They just walk over to my desk to talk with me. That's been my experience. Oh and currently I spend 5% of my time trying to find an illegal stream of the NBA finals on my second computer screen.

 

[sunnyandseventytwo]

I would say I spend 40% of my time speaking with patients and doing med recs. 20% of my time reviewing orders from the ED. The rest of the time is split between helping doctors and nurses during higher acuity patients that are quite various: trauma, stroke, overdose, psych, pre and post intubation, cardiac arrest, seizures. Helping nurses with various questions, helping doctors order things or interpret antibiotic sensitivies, what antibiotics to give in light of their 10 allergies, how to order a therapy plan for follow rabies vaccinations, dose warfarin for patients who have been in the ED for a long time. basically you're attending to all the medication related things that happen in the ED. Some of the same things a decentralized pharmacist does in any other unit but I am full time on the unit sitting with the docs and nurse the whole shift. In our hospital the other decentralized pharmacists aren't with the docs all of the time because the docs usually sit in a different area and visit multiple units. The doctors in the ED are with us all of the time so I think there is a lot more utilization of us compared to others. They just walk over to my desk to talk with me. That's been my experience. Oh and currently I spend 5% of my time trying to find an illegal stream of the NBA finals on my second computer screen.

I was curious if anyone else uses dual screens but have been too lazy to start a thread. Ours are a carry over from some old pharmacy system that had a non-integrated lab system. As that's no longer the case I keep thinking the second screens will be removed due to budget cuts. My web surfing will take a definite hit if this ever happens.

 

[Dred Pirate]

I was curious if anyone else uses dual screens but have been too lazy to start a thread. Ours are a carry over from some old pharmacy system that had a non-integrated lab system. As that's no longer the case I keep thinking the second screens will be removed due to budget cuts. My web surfing will take a definite hit if this ever happens.

I love my dual screesn for two reasons
1. Easier to work on ivents or pull up a reference while looking at the chart
2. Have the game pulled up

 

[gwarm01]

Clarkbar, are you writing a book or something?

There I am dating myself: Are you a tictok influencer and you've somehow monetized getting people to apply to pharmacy school?

I was gonna say, why do you keep making threads asking what a job means then never responding?

 

[CetiAlphaFive]

I was curious if anyone else uses dual screens but have been too lazy to start a thread. Ours are a carry over from some old pharmacy system that had a non-integrated lab system. As that's no longer the case I keep thinking the second screens will be removed due to budget cuts. My web surfing will take a definite hit if this ever happens.

Dual screen here. It's how I ignore resident presentations and meetings while still working. Lol

 

[clarkbar]

I would say I spend 40% of my time speaking with patients and doing med recs. 20% of my time reviewing orders from the ED. The rest of the time is split between helping doctors and nurses during higher acuity patients that are quite various: trauma, stroke, overdose, psych, pre and post intubation, cardiac arrest, seizures. Helping nurses with various questions, helping doctors order things or interpret antibiotic sensitivies, what antibiotics to give in light of their 10 allergies, how to order a therapy plan for follow rabies vaccinations, dose warfarin for patients who have been in the ED for a long time. basically you're attending to all the medication related things that happen in the ED. Some of the same things a decentralized pharmacist does in any other unit but I am full time on the unit sitting with the docs and nurse the whole shift. In our hospital the other decentralized pharmacists aren't with the docs all of the time because the docs usually sit in a different area and visit multiple units. The doctors in the ED are with us all of the time so I think there is a lot more utilization of us compared to others. They just walk over to my desk to talk with me. That's been my experience. Oh and currently I spend 5% of my time trying to find an illegal stream of the NBA finals on my second computer screen.

So it sounds like med recs for the most part? The 20 percent are general staffing in the ED?
Can you elaborate on the other various dx states and your role? (I am especially looking for good intubation resources, as I have heard ED rphs dose those.)
What is the point of rounding and sensitivities, given the short stay of ED patients? They are always d/c or admitted unless no beds are available. I am still having trouble seeing how this is a full-time job, at least by ICU or staff rph standards. Please fill me in, as I do have genuine interest in this role.

In ICU, there is a cornupcopia of potential, but perhaps annoying to the MDs, things to discuss, for instance--deescalation is the bread and butter, but glucose control, sleep, pain, pressors, acidosis, HTN, following labs are things to be aware of--the point being the patient is there 3 days to 3 weeks.

 

[sunnyandseventytwo]

In ICU, there is a cornupcopia of potential, but perhaps annoying to the MDs things to discuss

Maybe the way you do it.

 

[Rockinacoustic]

So it sounds like med recs for the most part? The 20 percent are general staffing in the ED?
Can you elaborate on the other various dx states and your role? (I am especially looking for good intubation resources, as I have heard ED rphs dose those.)
What is the point of rounding and sensitivities, given the short stay of ED patients? They are always d/c or admitted unless no beds are available. I am still having trouble seeing how this is a full-time job, at least by ICU or staff rph standards. Please fill me in, as I do have genuine interest in this role.

In ICU, there is a cornupcopia of potential, but perhaps annoying to the MDs, things to discuss, for instance--deescalation is the bread and butter, but glucose control, sleep, pain, pressors, acidosis, HTN, following labs are things to be aware of--the point being the patient is there 3 days to 3 weeks.

Literal answers to all of the above in post #3...

 

[Dred Pirate]

So it sounds like med recs for the most part? The 20 percent are general staffing in the ED?
Can you elaborate on the other various dx states and your role? (I am especially looking for good intubation resources, as I have heard ED rphs dose those.)
What is the point of rounding and sensitivities, given the short stay of ED patients? They are always d/c or admitted unless no beds are available. I am still having trouble seeing how this is a full-time job, at least by ICU or staff rph standards. Please fill me in, as I do have genuine interest in this role.

In ICU, there is a cornupcopia of potential, but perhaps annoying to the MDs, things to discuss, for instance--deescalation is the bread and butter, but glucose control, sleep, pain, pressors, acidosis, HTN, following labs are things to be aware of--the point being the patient is there 3 days to 3 weeks.

we have 24/7 ED Rph coverage - and have had for almost 16 years - we definitely keep busy.

 

[KidPharmD]

So it sounds like med recs for the most part? The 20 percent are general staffing in the ED?
Can you elaborate on the other various dx states and your role? (I am especially looking for good intubation resources, as I have heard ED rphs dose those.)
What is the point of rounding and sensitivities, given the short stay of ED patients? They are always d/c or admitted unless no beds are available. I am still having trouble seeing how this is a full-time job, at least by ICU or staff rph standards. Please fill me in, as I do have genuine interest in this role.

In ICU, there is a cornupcopia of potential, but perhaps annoying to the MDs, things to discuss, for instance--deescalation is the bread and butter, but glucose control, sleep, pain, pressors, acidosis, HTN, following labs are things to be aware of--the point being the patient is there 3 days to 3 weeks.

Have you ever been in an ED as a staff member? There is a lot going on. We may only have 40-50 beds in our small by adult standards ED, but those beds turn over every 3-6 hours if things are going well. We can easily care for 200 different patients in a 10hr shift. That's a lot of patients to assess for home meds, appropriate ED therapy, discharge prescriptions/admission orders even if nothing goes haywire. Then, smack in the middle of everything, someone comes in actively trying to die and I am at the bedside for 2 hrs of a single patient making recommendations, preparing drips, helping titrate pressors or sedation, etc. After that is over, I've got 2 hours of other patients to catch up with.

Trust me, there is more than enough work.

Edit: Of course, then there are my counterparts in the Adult, academic, Level 1, ED who move from dying patient to dying patient 24 hrs a day without much time in between to worry about anything else.