Emergency Room Pharmacist

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clarkbar

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Hello, physicians,

I am a clinical pharmacist, thinking of transitioning from the ICU room to the emergency room. As I am always trying to compliment the physicians, have any of you worked with an emergency room pharmacist?

A. What responsibilities did they have?

B. Did they act under protocol?

C. What main recommendations did they make?

D. What is the best way to be the most helpful?

Thank you for your time!

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Hello, physicians,

I am a clinical pharmacist, thinking of transitioning from the ICU room to the emergency room. As I am always trying to compliment the physicians, have any of you worked with an emergency room pharmacist?

A. What responsibilities did they have?

B. Did they act under protocol?

C. What main recommendations did they make?

D. What is the best way to be the most helpful?

Thank you for your time!

I generally felt they were helpful, but I didn't use them all that much. It was nice when the came to the critical patients who needed immediate orders like propofol, precedex, RSI meds, opiates, etc. However most of these can be just be overridden (and rightly so) by the RN.
 
I generally felt they were helpful, but I didn't use them all that much. It was nice when the came to the critical patients who needed immediate orders like propofol, precedex, RSI meds, opiates, etc. However most of these can be just be overridden (and rightly so) by the RN.
Thank you for your input. I am also concerned about the role and its utility. In the ICU there are numerous ABX, labs, pain, BG, acidosis, sleep, HTN, adverse interactions, to follow the patient for a long-period of time, as opposed to ED, where most of the things I mentioned do not apply.

If I take the job, do you have any advice on trying to make it useful, get along with the docs, nurses, to take control of any patient care points, other than med rec?
 
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I'm just a consultant, but they are great! ED physicians (and RNs) can be...very ignorant of things like long acting injectable antipsychotics. Pharmacists can help bridge this knowledge gap greatly and honestly just prevent horrible mistakes like double dosing.
 
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I'd say the utility of an ED pharmacist is low during the average churn of community medicine, but could be more valuable in tertiary and academic centers. I suspect the nurses may potentially have a different perspective, as they're frequently the ones trying to determine which drugs are compatible, etc. "Being helpful" is not usually enough to justify the existence of such a position, so I'd imagine there are corresponding additional responsibilities – following up cultures etc. – that are part of the ED job, as well. It may or may not be similar to ICU responsibilities.
 
We have ED pharmacists at all of the sites I work at. They are extremely helpful and considered a part of the team. They are very valuable during codes and providing medications. They are also helpful with antibiotic choice and dosing. They are also able to approve orders in real-time versus having to be cleared by the inpatient pharmacy. Orders are filled much quicker during the daytime hours when they are present in the emergency department.
 
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We sit right next to ours. I was skeptical at first but it's an amazing resource.
Totally agree. We have 2-3 in our ED (140,000 patients/year) and have an ED pharmacy residency (2 per year). Valuable resource. They respond to all our stroke, trauma, medical, and STEMI alerts. Can easily pull/draw up meds to allow the nurses to focus on starting IVs and such. Validating meds in real-time can catch errors. One was very helpful the other day in identifying the cause of someone's thrombocytopenia: apixaban. Never knew it could cause it.
 
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One sits right next to me and makes sure the nurses aren't killing patients, that triage room isn't killing patients, that undertriaged patients aren't in the lobby and dying slowly, and most importantly I am not killing patients

Probably more valuable than me
 
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That's good to hear! What ABX and codes and medications would be a good start for me to review for the ED?
How do they respond to all the stroke, trauma, medical and STEMI alerts? How much does the med rec take up their time or feed into the value added portion?
How do they prevent med errors with nures? What comes up?
 
I have been an ED Rph for almost 20 years - we have had 24/7 coverage for 15 years,
What I do
day to day responsibilities
-all code response (an extra set of hands specifically for medications obviously speeds that up)
-culture reviews
-order verification (often by far the most monotonousness part of the job as 95% of the order are simple one time orders) - but the ones you do intervene on are worthwhile
-changing one potentially unnecessary kalbitor or andexxa order can pay your salary for a few weeks
-we sit right next to the docs so numerous "what abx do you recommend for XYZ?"
-we can can adjust dose on any abx order
-we do admission orders (see above)
-have pharm techs do med recs, but help facilitate that and review them before the physician processes admission orders
- a million and one questions from nursing -how do I give this? -compatibility -where is this med? -the pyxis is broken

non-day to day stuff
- policy and procedure review
-RN in services
-ED committee meetings
-Lots of teaching -9 months of residents and probably that many months of students


If you are asking about resources about what ABX and codes to review- I am concerned you might be in over your head . Do you currently have an ED rph and you are going to be added to the staffing team? if so, your work place should have training resources. If you are starting an ED pharmacist program, going in completely green will not go over well the first time you are relied upon in a truly critical situation.

Although the more I think about that - if you are green and new you likely won't be relied upon as much. After 20 years of working with many of the same physicians, we have a camaraderie built up where just today we were crazy busy and I get a "patient in 5 is septic and crashing, can you order the abx and whatever pressors they need?"
 
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One was very helpful the other day in identifying the cause of someone's thrombocytopenia: apixaban. Never knew it could cause it.
Neither did I and I'm still skeptical other than the standard "any drug can cause Thrombocytopenia if you think about it hard enough"
 
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Having the ed Pharmacist during codes and traumas is wonderful.
One thing one of my hospitals did that I loved was we had a pharmacy tech do a med recc on all the patients. Was wonderful to see a full med list. Inpatient teams loved it.
 
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Disagree with anyone saying they aren’t helpful. ED pharmacists are great. They pretty much have all meds needed for codes, strokes, trauma etc right away and RNs can focus on their roles. Great resource for MDRO/VRE/ESBL pts. They can also save me a bunch of time from sifting through everyone’s fake allergies and see when they got previous atbx etc. but the most important thing not mentioned is they independently verify all ED med orders instead of waiting on central pharm. Saves a huge amount of time. Especially for the clipboard sepsis warriors.
 
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I am a huge fan of ED pharmacists. Honestly I just did a "study" about things that make or break an ED job and a pharmacist was one of my main points. It does definitely depend on the setting and the pharmacist but in high acuity places a killer pharmD is a game changer. I walk into the room for a sedation and all my meds are already drawn up and they already know what I'm gonna use, critical peds patients already have weight based doses ready, etc... They also have kept me from messing up many times. Definite plus for me. DM me if you would like to talk to one of our ED pharmacists. She's a good friend of mine.
 
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