Clinical Pharmacist in the ER - yes? no?

[halipharmd]

The company I work for doesn't have pharmacist present in the ER at all, much less codes, etc. I just was wondering if other medical personnel find value? Really until pharmacists have a true defined place on the healthcare team recognized by medicare and other billing agencies, it's a grey area. Personally, I would I love to find a job in ER I was scouring the internet for pros and cons and found a few:

http://www.pharmacytimes.com/contri...rmacists-in-the-er-equals-better-patient-care

http://www.npr.org/blogs/health/201...harmacists-in-the-er-to-cut-medication-errors

There's tons more. I know at my current job I see a lot of errors that could be addressed from this very position.

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[WalkingCorpse]

As a first year resident, I find it very valuable to have a pharmacist in the ED to ask questions and to have someone who makes sure we are ordering drips and such the right way through the EMR. It expedites things and avoids calls to and from pharmacy. We only have one pharmacist in the ED, who is there during "business" hours, so from around 9 am to 7 pm or so Monday to Friday.

 

[njac]

At ACEP (American College of Emergency Physicians) this past fall, a resolution was passed outlining the role and importance of high-level clinical pharmacists in the Emergency Department. One of the physicians I work with said the passage of this document was basically a giant pharmacy love-fest and there was little to no discussion needed.

It's buried in this document, but this was the only non-pharmacy media I found it in with a quick google on my phone: https://www.acep.org/uploadedFiles/ACEP/About_Us/Leadership/Council/2014 Resolutions Compendium.pdf

If you want to find an ED job where you aren't delegated to med Rec and transitions of care, I recommend doing a PGY-1 pharmacy practice residency, followed by a PGY-2 in emergency medicine.

 

[TooMuchResearch]

As a first year resident, I find it very valuable to have a pharmacist in the ED to ask questions and to have someone who makes sure we are ordering drips and such the right way through the EMR. It expedites things and avoids calls to and from pharmacy. We only have one pharmacist in the ED, who is there during "business" hours, so from around 9 am to 7 pm or so Monday to Friday.

I also find it very useful when they pull meds for us with critical patients when the nurses are doing other things.

OP, clinical pharmacists are incredibly useful. I specifically asked programs if they had them in the ED when I interviewed for residency.

 

[Daiphon]

Yes, yes, 100x yes. I find them invaluable, and from a tox perspective (recognizing & preventing) they're super useful... especially if you don't have tox people in your ED.

Right, njac? d=)

-d

 

[barnacle]

If I could have 24/7 social worker, psych nurse & ED pharmacist I would be a happy person. ED pharmacists are amazing, often the most up-to-date people in the ED. Like njac said do a fellowship in EM.

 

[The White Coat Investor]

ED pharmacists are great, I'm sure. But the truth is that ANYONE EXTRA would be great. I've never been in an ED that I felt was adequately staffed. So the question is what are you going to give up to get an ED pharmacist? For the price of a 24/7 pharmacist I could probably add a nurse, a clerk, and two techs. Sorry, I'd rather have those 4 people than a dedicated pharmacist. I'm already doing too much "non-doctor" stuff and I know the corporation that owns my hospital sure as heck isn't going to add a pharmacist without taking something else away.

Would I find a way to use a pharmacist? Sure. But the most useful thing they could do for me now is answer the phone, meet patients in the waiting room and triage them, answer the alarms, get some blankets and cokes, get urine out of the patients, and hassle the lab and radiologist. And if I magically had enough staff to get all that done....my next hire would be a scribe, and then a full-time crisis/social worker/case manager. And after that? Another doc or PA. The pharmacist is way down the list. This isn't an ICU. 95% of the drugs I'm using are pain meds, antiemetics, and antibiotics and my nurses and I know those pretty darn well. The PCC is excellent and only seconds away by phone. And mix and pull drugs in a code? 95% of the ones I'm going to give are already pre-mixed in the crash cart and ready to be pushed.

It just seems like pharmacists looking for something to do rather than actually fulfilling a need that I have. Sorry if that rant comes off as grouchy. I'm post-night shift.

 

[DeadCactus]

I think they add a lot to the large academic ED's. There is enough pathology to benefit from their knowledge, they counter the increase in medication errors coming from a learning environment, and they provide a great educational resource. Probably not as cost-effective in the community...

 

[The White Coat Investor]

I'm sure it's great to have a pharmacist around, especially if you have ten docs on and >100K visits a year. But don't get used to having one....There is one pharmacist in my entire hospital at night and I'm not even convinced they are awake half the time.

And don't forget that "luxuries" like pharmacists standing around to answer questions aren't free. It's not like the hospital can bill the patient an extra charge because a pharmacist did med recon or answered some questions.

 

[Arcan57]

I'm sure it's great to have a pharmacist around, especially if you have ten docs on and >100K visits a year. But don't get used to having one....There is one pharmacist in my entire hospital at night and I'm not even convinced they are awake half the time.

And don't forget that "luxuries" like pharmacists standing around to answer questions aren't free. It's not like the hospital can bill the patient an extra charge because a pharmacist did med recon or answered some questions.

Clinical pharmacists doing med recs offloads the nurses which allows more productivity from the nurses. While on a 1 to 1 basis pharmDs are more expensive then RNs, if you have one pharmD doing all the med recs in the ED you're probably approaching the realm of breaking even. Also, while it sounds like you have a capable ED staff, my main shop has a lot of nurses so new the umbilical stump hasn't even dried out. Could you argue they should pay the RNs more so that we could retain veteran RNs who can successfully dilute most antibiotics or set a pump for the common vasoactive meds? Sure, but pharmDs and ED nurses come out of different cost centers so I don't see that happening anytime soon.

 

[The White Coat Investor]

The cost center argument is an excellent one to get another person into the department. I'd love to get some staffing of any kind paid out of the pharmacy budget. But the whole concept is basically a huge/academic ED concept anyway. At any given time in my ED there may be 5-18 patients only one of whom might be on a drip of any kind, and it's probably protonix. It's not the ICU, and if they need to be in the ICU, we try to get them there ASAP. I would have a very hard time justifying a pharmacist if I was in charge of the business decisions. Now, if you're at USC or something, sure, what's a pharmacist when you have a dozen docs on and 100+ beds in the ED. But how many positions are there out there for pharmacists? Not that many. In my million person urban area there are only two EDs that would even consider it-the academic center and the 100 bed mega trauma center. So if the pharmacists work 15 twelves a month, that's 8 positions in my entire state.

 

[TooMuchResearch]

The cost center argument is an excellent one to get another person into the department. I'd love to get some staffing of any kind paid out of the pharmacy budget. But the whole concept is basically a huge/academic ED concept anyway. At any given time in my ED there may be 5-18 patients only one of whom might be on a drip of any kind, and it's probably protonix. It's not the ICU, and if they need to be in the ICU, we try to get them there ASAP. I would have a very hard time justifying a pharmacist if I was in charge of the business decisions. Now, if you're at USC or something, sure, what's a pharmacist when you have a dozen docs on and 100+ beds in the ED. But how many positions are there out there for pharmacists? Not that many. In my million person urban area there are only two EDs that would even consider it-the academic center and the 100 bed mega trauma center. So if the pharmacists work 15 twelves a month, that's 8 positions in my entire state.

We actually have some 15 bed EDs around here that have them on at least during second shift for med recs and to help out if needed.

 

[Apollyon]

I'm sure it's great to have a pharmacist around, especially if you have ten docs on and >100K visits a year. But don't get used to having one....There is one pharmacist in my entire hospital at night and I'm not even convinced they are awake half the time.

And don't forget that "luxuries" like pharmacists standing around to answer questions aren't free. It's not like the hospital can bill the patient an extra charge because a pharmacist did med recon or answered some questions.

At the University Hospital at my first job out of residency, there were 8 docs on for 100K volume, and we didn't have an ED pharmacist. Would it have been nice? Sure. But necessary, no.

 

[DeadCactus]

No one is arguing it's necessary. It's luxury that can be justified in the proper setting and provides a useful service...

 

[Birdstrike]

No one is arguing it's necessary. It's luxury that can be justified in the proper setting and provides a useful service...

Agree. At academic and trauma centers. Otherwise simply not likely to be affordable budget wise, as a dedicated clinical pharmacist for an ED.

 

[deleted480308]

I don't even think the question is about being useful/helpful...if my pot of money pays the pharmacist, I'd want proof that they speed me up enough to break even. If I'm the hospital I'm thinking the same thing

 

[halipharmd]

So maybe the pharmacist provider bill, if ever passed, would assign dollar payment for services we already provide for free. If we could bill.........

 

[EMIM2011]

I enjoy working with a pharmacist in the ED, but unfortunately I share the concerns mentioned above regarding productivity, cost and so on. Also, with regard to med recs, this seems like a rather questionable use of a highly-trained professional such as a pharmacist to me. In our ED, we have specially-trained techs who do med recs only. They call pharmacies, decipher handwritten med lists, call the PCP´s office. Not sure that this would a valuable use of a pharmacist´s time.

 

[Caesar]

I love the ED pharmacists. Both places I'm at have them mostly around the clock, they're good for mixing meds for us (ketofol) making drips up, handling our tPA, K-centra, etc and they stop me from doing stupid things. Some of them are really cost aware because they came from retail and let me know if I'm writing for something that is going to be very expensive for a patient and provide an alternative (case in point, one of our medicaid groups doesn't cover zofran suspension but does the tablets so one of them let us know and will give the pt instructions on dissolving the tablets for little kiddos).

 

[halipharmd]

Quite honestly though, if provider status would happen for pharmacists, billing for the services they provide would help justify in $$$ worth to a hospital. At least, in my perfect pharmacist world.