Emergency Pharmacist (EPh)

[tigerlily5822]

Advertisement - Members don't see this ad

I was wanting to get opinions about having an emergency pharmacist in the ER.

Would you be open to having one in the ER?
If your department already does this, what has been your experience?

I am currently a pharmacy student very interested in working ER/Critical Care and the Rx school I am at has some faculty that are very involved in this area. I can only speak from what I have seen at this teaching hospital, but pretty much everything that deals with drugs goes through this pharmacist. She handles all mixing, administering (hooks up IVs, etc... for nurses when things going crazy), always consulting (I don't think there was a moment where she wasn't being paged or an MD/RN wasn't asking a question), trauma comes in she's in there already calculating and administering meds (sedatives, anesthetics, etc...)

Bit of a diatribe, but I am interested in hearing input from those whose hospitals already do this and those that do not.

For information:
http://www.emergencypharmacist.org/
http://www.psqh.com/sepoct07/ahrq.html
http://www.healthcare411.org/trans/DrFairbanks_FullInterview_trans_20070905.htm

 

[EM_Rebuilder]

There is one in our ED and she has been a god send anytime I needed anything!

She works her tail off and I swear that when I was there as a day or night person, it seems like she was always around!!

She did it all from suggesting medication for particular conditions, going over med lists with patients and trying to streamline them, going over meds and working on lower costs, etc...

Aside from actualy physician contact, I know that she sort of dictates the med supplies in the ED, fills in as a nurse giving medications and such if needed, is usually around on traumas helping out, and helps package and transport people up the ICUs if needed....I am certain she does even more than this, but these are the hats I have seen her in thus far!

 

[docB]

Sounds great. We'd love one. I just can't imagine the hospital paying for such a thing. We don't have ultrasound or even a tonopen.

 

[AmoryBlaine]

Sounds great. We'd love one. I just can't imagine the hospital paying for such a thing. We don't have ultrasound or even a tonopen.

If you were really good you would just palpate the globes. I keeed, I keeed.

I did a rotation at a place with a full time ED pharmacist, it was effing awesome. She was so willing to help out with stuff but also not overbearing about having to be involved in every case.

Actually during one of my medicine months we had pharm students on the team. I can't even tell you how much they brought to the table, when you have someone on 12 different meds it is pretty great to have someone else keeping an eye on them. Plus the PharmD who was their boss knew everything, he'd almost always have something to add on rounds which changed the plan.

DocB raises a good point though, I'm not really sure how the market would be when you went looking for a job...

 

[BADMD]

Both places I've worked have had 24 hour pharmacy coverage dedicated to the ED. It is a god send. I like having have someone who is knowledge that I can bouce my medication ideas off of. I also like that I can get my drugs mixed up in a few minutes and I'm quite happy working with some whose 1st priority is mixing my drugs. And finally, inpatient PharmDs aren't used to some of the toxicologic conditions and I'm quite happy workoing with someone who is familiar with some unusual/off label drug dosages/uses. Tuere are more, but these are the top few that come to mind.

There are a few ED pharmacy residency programs in the US. It might be worth it for you to look into what they do.

 

[southerndoc]

We have a full-time pharmacist assigned to the ED, but her role is administrative right now. She's not prospectively verifying medication orders. Her role right now is to ensure compliance with the medicine reconciliation form, which the Joint Commission thinks is a great idea. Which brings me to another point... at some point we're going to have so many things to do with regards to patient care, we will either see one patient every two hours, or we'll hire somebody to actually see patients because the physicians will be too busy doing reconciliation forms, consult requests, sexual abuse screening, domestic abuse screening, drug abuse screening, and all their interventions.

 

[Jeff698]

We have a full-time pharmacist assigned to the ED, but her role is administrative right now. She's not prospectively verifying medication orders. Her role right now is to ensure compliance with the medicine reconciliation form, which the Joint Commission thinks is a great idea.

Good lord. What an incredible waste of a pharmacists time and education. Way to go 'Joint' Commission. Now I don't wonder about the name, anymore.

I was moonlighting yesterday in a small ED. I'd see a patient walk into registration and wonder why it took 20 minutes or so before I'd see the chart pop up in the rack. After looking at the chart, I found there were about 20 pieces of JC approved/required papers in there, including that stupid med reconciliation form. No wonder it takes so long.

I'm about sick of all these safety meausures that look great on paper but just kill the throughput of an ED.

Take care,
Jeff

 

[FISKUS]

Our ED nursing is always understaffed, we cant get a full time phlebotomist ( $10/hr) so nurses do all specimen collecting, labeling, submitting, re collecting because the the first one wasnt labeled right. Admin cant come up with funds for even basic nursing CME but they are giving us 18 hr/day pharm coverage. ( $$$) Besides checking on admitted pts - I havent noticed any impact on regular ED operations

Makes as much sense as providing cosmetic dentistry for hospice pts

 

[RockfordWF]

I was wanting to get opinions about having an emergency pharmacist in the ER.

Would you be open to having one in the ER?
If your department already does this, what has been your experience?

I am currently a pharmacy student very interested in working ER/Critical Care and the Rx school I am at has some faculty that are very involved in this area. I can only speak from what I have seen at this teaching hospital, but pretty much everything that deals with drugs goes through this pharmacist. She handles all mixing, administering (hooks up IVs, etc... for nurses when things going crazy), always consulting (I don't think there was a moment where she wasn't being paged or an MD/RN wasn't asking a question), trauma comes in she's in there already calculating and administering meds (sedatives, anesthetics, etc...)

Bit of a diatribe, but I am interested in hearing input from those whose hospitals already do this and those that do not.

For information:
http://www.emergencypharmacist.org/
http://www.psqh.com/sepoct07/ahrq.html
http://www.healthcare411.org/trans/DrFairbanks_FullInterview_trans_20070905.htm

There is one in our ER, and he is there in the room for our critical patients---both suggesting medicines and doses and also fetching them for us. He is also a great resource for decisions on meds to prescribe (price, insurance coverage, side effects, et. al.).

They are very useful in my experience.

 

[drewpydog]

In the ED at Wake Forest, there are 24-hour-a-day pharmacists (residing in a fully-stocked pharmacy). They are invaluable. As others have mentioned, they are always there for any trauma or medical code, pulling out meds and doses quicker than you can say, "Can I have..." They are also available anytime for non-emergent dosing question. I found them particularly useful for renal dosing questions.

Like DocB said, though, outside of the Ivory Tower, when you can't afford an ultrasound....

 

[Seaglass]

In the ED at Wake Forest, there are 24-hour-a-day pharmacists (residing in a fully-stocked pharmacy). They are invaluable. As others have mentioned, they are always there for any trauma or medical code, pulling out meds and doses quicker than you can say, "Can I have..." They are also available anytime for non-emergent dosing question. I found them particularly useful for renal dosing questions.

Like DocB said, though, outside of the Ivory Tower, when you can't afford an ultrasound....

Second that. Loved it, wish I had it here (at this nationally recognized program . . . )

 

[sarahinromania]

We have 24 hour pharmacy coverage at our ED and they are awesome to have around. They answer your bizarre questions about the heparin cardiology protocol in an atypical patient with weird bleeding/clotting risk at 3 am when you're not quite thinking straight, are super handy at codes (ours usually have all the meds ready *and* jump into the fray to attach EKG leads, etc.), and unofficially host the "I just need three minutes without being asked for something while I inhale my food" sanctuary of the ED. Several staff who went to residency here but worked elsewhere for a couple of years before returning as faculty have told stories about calling our ED pharmacy at 3:30 in the morning from two time zones away trying to figure something out with no pharmacist of their own to consult. I plan on keeping the number handy when I move on.