ER Pharmacist

[dudek1984]

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Is there any ER pharmacists here? If so, I wanted to find out what goes on on a typical day. What kind of interventions do you make and where do you see the biggest impact in terms of safety and cost savings. Specific examples would be awesome.

I work in a small community hospital where the ER sees ~60-100 patients per day (~28,000 per year) Its mostly a geriatric population, a lot of nursing home residents etc. but they do see some young blood also. I was wondering what kind of impact we could have on the ER if we started an ER pharmacist position. A dedicated pharmacist working 5 days a week during the peek hours of the ER.

I believe we have the backing of our administration for this.

I also found some data that an error prevented in the ER saves the hospital ~ $260. Any input on this?

Thanks

 

[Its Z]

I also found some data that an error prevented in the ER saves the hospital ~ $260. Any input on this?

Thanks

Could your administrator write a check with the money saved?

 

[KARM12]

Talk to njac!

 

[Its Z]

Talk to njac!

she don't know nothin.

 

[nnguyenc]

i did my rotation at an ER

you don't really touch anyone

when the docs yell..."WHERE'S THE EPI?"

you hand them the epi...then go retrieve medication
records from pharmacy...blah blah blah...not
really that dramatic


i think ICU was more involved for pharmacist...make
more of an impact IMO

 

[KARM12]

she don't know nothin.

Where have you been?

 

[Its Z]

Where have you been?

Everywhere... but your town.

 

[KARM12]

Everywhere... but your town.

We've had some bipolar weather the last month... probably for the better.

 

[njac]

It depends on where you work and the model they're using in the ED. Some places use theirs for order entry/verification and then assistance for codes/traumas, others are big on med rec, others are purely clinical.

I think there are advantages to all of the schools of ED pharmacy. I can give an example of one of the biggest potentially life-saving interventions I've made, and it may seem totally mundane.

100kg 15y/o in the ED for abdominal pain. I was making it a point that day to see every peds patient that came through. When I went to talk to him, his mom busted out all of his asthma meds. Including his Epi Pen, Jr.

After the initial "omg wtf" moment I got the ED doc to write a regular Epi Pen rx with his discharge stuff. Not as sexy as the code/trauma/tox stuff I prefer to do - but a perfect example of how just taking the time to look at a patient in the flesh could be potentially life saving.

so where in the country are you? 😉

 

[dudek1984]

It depends on where you work and the model they're using in the ED. Some places use theirs for order entry/verification and then assistance for codes/traumas, others are big on med rec, others are purely clinical.

I think there are advantages to all of the schools of ED pharmacy. I can give an example of one of the biggest potentially life-saving interventions I've made, and it may seem totally mundane.

100kg 15y/o in the ED for abdominal pain. I was making it a point that day to see every peds patient that came through. When I went to talk to him, his mom busted out all of his asthma meds. Including his Epi Pen, Jr.

After the initial "omg wtf" moment I got the ED doc to write a regular Epi Pen rx with his discharge stuff. Not as sexy as the code/trauma/tox stuff I prefer to do - but a perfect example of how just taking the time to look at a patient in the flesh could be potentially life saving.

so where in the country are you? 😉

We're located in downtown Chicago. The only question that I have is which one of the three models that you mentioned do you think is the most effective? I think that it's really hospital specific and the only way to find out is to try it initially and then reevaluate. It's hard to say how many medication errors happen in the ER due to the fact that they rarely report them. Just the other day I was in the ICU reviewing medications administered in the ER and found the 3 medications that they gave all had the wrong dose for that patient.

But I also think that we have a lot of med rec errors.
Do you think that a combination of order entry/verification, codes, med rec and clinical would be feasible?

Thanks for the info

 

[njac]

check your PMs.

 

[VCU07]

We're located in downtown Chicago. The only question that I have is which one of the three models that you mentioned do you think is the most effective? I think that it's really hospital specific and the only way to find out is to try it initially and then reevaluate. It's hard to say how many medication errors happen in the ER due to the fact that they rarely report them. Just the other day I was in the ICU reviewing medications administered in the ER and found the 3 medications that they gave all had the wrong dose for that patient.

But I also think that we have a lot of med rec errors.
Do you think that a combination of order entry/verification, codes, med rec and clinical would be feasible?

Thanks for the info

I'm an EM pharmacist in a large city. We do a ton of med recs, but we also take part in just about everything from distribution to code participation (incl. order entry). I find myself doing a lot of drug info research as well. Our EM docs tend to be very good with their meds and if we get a question it more than likely ends up being something complicated. What I enjoy about the ED is that the docs have 100% confidence in us. I don't think there has been a time that they haven't taken one of my recommendations. Further, I think the ED is a good mix of just about everything...retail to more clinical.

Also, none of you may care, but I got this position w/o a residency. I graduated and worked my way into the position from a hospital that was willing to provide me the education and training necessary to do the job. Unfortunately, this type of scenario may not be possible today.

Oh, and to give you an example of what types of interventions we can make in the ED: I had this one a few months back. We f/u on daily cx. reports. Had a pregnancy lady with VRE in the urine. Of course when you call the number on file it comes up incorrect. So, I spent about an hr tracking her down. I eventually found out that she got her meds filled at CVS. Thank God they had a correct number on file. I called, but she didn't speak english. Long story short, got a hold of an interpreter and found out she was febrile and overall very ill. Got her to come back in at which time she was admitted. She spent a good three weeks in the hospital. She ended up doing fine at d/c.

 

[p-rog]

In ER Pharmasist should be present because patient may need medicines as emergency case.

lol, very insightful!🙄

 

[xiphoid2010]

lol, very insightful!🙄

Was an ED intern for more than 2 years at large trauma center (ED had 100 beds). The pharmacist sat in the satellite pharmacy next to the ED, and the job is to process ER orders, dispense ED meds, answering drug info questions, and do the traumas/codes. ER pharmacist days goes from bored enough to do facebook to multiple 50 meter dashes from trauma rooms to ORs. Me and the other ED intern loved our jobs. On slow days, we had time to study and do our homework. Busy days means we were in the midst of neat stuff. Being next door to ED, instead of being IN it, means we are usually safe from all the drug seekers or nurses who are too lazy to look something up.

Then I did a ED rotation for my P4 year at another large medical center's ED, thinking I'll love it as much. Nope. Some good traumas, but the pharmacist sat in the middle of the ED, with no satellite full of drugs, no tech/intern support, and way too easy for nurses and patients to walk over and bug with every little thing. It kinda of explained why the preceptor was always in a bad mood. 😛

 

[v1nce]

What do pharmacists do in the OR?

 

[xiphoid2010]

What do pharmacists do in the OR?

nothing, it's her job as a part of the trauma team to get the patient to the OR. This can be quite exciting with patient's chest cracked open, a resident's finger plugging the hole in patient's aorta, and nurses pushing carts, and the pharmacist running along and handing out epi and levophed like water. Another good one is when a cancer pt in the CT room crashed from a GI bleed, a nurse was on the cart doing chest compressions, blood was spewing out of the pt's mouth like a little fountain with each compression as we were pushing for the OR. I found it strangely funny when when the badge for the OR door wouldn't scan, and the senior almost lost it and was screaming "ah, this ISN'T right!!!" Ah, good memories. 😀