ED Pharmacist PSHP CE Final - Rob Notes V.5

Establishing Emergency Department Pharmacy Services

and Pharmacist Impact

Glenn R. Oettinger, PharmD, BCPSand

Robert S. Pugliese, PharmD, BCPS

1

The Pennsylvania Society of Health System PharmacistsOctober 29th, 2015

2

Objectives

1)Explain justification for an Emergency Medicine Pharmacist (EMP)

2)Describe the core roles of the EMP3)Describe strategies for implementing an EMP

position4)Identify how to encourage growth in the

specialty of Emergency Medicine (EM) Pharmacy 5)Describe some ways in which EMPs can

systematically improve the care of patients in ED

6)Discuss other key administrative roles of EMPs

The Emergency Medicine PharmacistA Safety Measure for Hospitals

Glenn Oettinger, PharmD, [email protected]

@GlennOettinger3

Part 1

4

The Emergency Medicine Pharmacist: A Safety Measure for Hospitals1

• Justification• Role• Implementation

5

JUSTIFICATIONOvercoming skepticism

6

The Ideal ED

7

The Ideal ED

• No patient is overlooked• Adequate support for all clinical staff• Appropriate supervision of all residents

and students• All patients rest assured medications

ordered are reviewed by a pharmacist

8

Reality

9

Reality• ED is Vulnerable

• High volume and overcrowding• Wide spectrum of diseases• Frequent interruptions and distractions• Fast paced • Verbal orders

10

ED is Inherently a Patient Safety Risk2,3,4

• Established safety mechanisms missing from most EDs• Pharmacy review of medications• Pharmacy preparation of medications• Pharmacist involvement in clinical decision making

• Medication-related adverse events in the ED• 3.6% of ED patients receive inappropriate medication• 5.6% of ED patients receive inappropriate discharge Rx

Gaps in the Average ED Medication Use System5

11

Dispensing(pharmacist)

Data Entry and Screening

Preparing, mixing, compounding

Pharmacist double check

Dispensing to Unit

Transcribing(Pharmacist, nurse,

unit clerk)

Receive order or retrieve from MAR

Check if correct

Prescribing(physician, nurse

practitioner, pharmacist)

Clinical decision making

Drug Choice

Drug regimen determination

Medical Record Documentation

Order (written, verbal, electronic)

Monitoring(Nurse, physician,

pharmacist)

Assess for therapeutic effect and adverse affect

Review laboratory results if necessary

Treat adverse drug event if occurring

Medical record documentation

Administering (nurse)

Drug preparation for administering

Nurse verifies orders

Drug administered

Documentation in MAR

12

Most ED Medication Events are Preventable!• ED has highest rate of preventable

adverse events in the US6 • 110 million ED visits annually in US • 5% experience potential events = 550,000

potential events per year• 70% are PREVENTABLE = 38,500 preventable

events

13

ED Systems are Stretched7,8

ED overcrowding = Reduced capacity to deliver safe care• Over last decade

• ED visits 26%• 9% of EDs closing nationwide • 198,000 hospital beds closed

• Reduced capacity to deliver safe care• Boarding inpatients

• Contributes to overcrowding and elevated risk

14

Safety Benefits of an ED Pharmacist ProgramProviding an extra layer of protection

• Available for immediate high risk med review

• Respond to all traumas, resuscitations, and critical patients

• Pharmacotherapy consults with physicians for medication selection

• Staff education

15

Joint Commission Compliance9,10

ED Pharmacist improves JC compliance• Increased oversight of high yield medications• Increased monitoring of drug effect• Enhanced degree of communication with nurses

and physicians• Development of processes for managing high

risk medications (i.e. TPA, sepsis antibiotics, pediatric meds)

16

Adding Value

It has been shown that staff value the ED Pharmacist

• 26 item survey to random ED staff with 82% response11 • 99% felt ED pharmacist improves quality of care• 96% felt ED pharmacist was an integral part of ED

team• 95% indicated they had consulted with ED

pharmacist at least a few times during last 5 shifts

The ED Pharmacist – A Safety Measure in Emergency Medicine• ED pharmacist improves process measures such

as:• Time to cath lab, abx in pna, pain management,

etc12

• Adds critical layer of safety to vulnerable patients13

• Adds cost-saving benefit to the ED14

17

Cost-savings in the Emergency Room: A Four Month Study of ED Pharmacist Interventions14

Type of Intervention

No.Interventions

Average CostAvoidance

perIntervention

($)

Cost Avoidance ($)

Drug-drug or drug

disease interactions

or drugincompatibilitie

sidentified

334 1,647 297,053

Therapeuticrecommendatio

n

523 1,188 273,383

Adverse drug event

prevented

48 1,098 23,190

Medication error

prevented

488 1,375 436,150

Total 1393 5,308 $1,029,776

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Role of the ED Pharmacist

19

20

Role of the ED Pharmacist• Clinical Consultation Duties

• Responds to pharmacotherapy consultations• Provides drug selection and dose

recommendations• Therapeutic substitutions• Recognizes disease state specific

pharmacotherapy• Implements patient-specific pharmacokinetics

21

Other Clinical Duties• Order screening

• Focus on allergies, drug interactions, and appropriate dosing

• Selection and preparation of medications• High Risk Medications, RSI, codes

• Resuscitations and trauma response• ED pharmacist at bedside actively overseeing

medication use process

22

Pediatric ADE’s in the ED15

• For every 1000 pediatric patients • 100 prescribing errors• 39 administration errors

• 22% of acetaminophen doses incorrect

23

Pediatric patients at risk

• Most ED’s generally not well-prepared to manage pediatrics16

• 6% “well” prepared nationwide• Pediatrics account for 27% of ED visits• All children need weight-based dosing,

increasing the likelihood for errors

24

ED Pharmacist – An Educator

• New medications• Drug warnings• Drug-drug interactions• Provides current, evidenced-based information

on pharmacological therapy• Simulation exercises• Becomes an established authority through

education

25

Benefits of Having an ED Pharmacist17,18,19

• Research and educational advancements

• Vulnerable populations • i.e. Severe sepsis, severe trauma,

patients requiring sedation, pediatrics• Patient safety

• Reduced rate of adverse events• Medication selection, order screening,

stat bedside preparation

26

IMPLEMENTATION

27

National Implementation20

• 3-5% of EDs in U.S. have a dedicated clinical pharmacist

• 18.3% have attempted to gain funding for a pharmacist position • Primarily through pharmacy budget

• 30.1% plan to request funding• demand

28

Bottom Line

• ED’s across America are in need of dedicated pharmacy specialists

• Arrive with a plan and they will embrace you

29

Step I: Assess Individual ED Environment

• Size of hospital• Academic center vs. non-academic• Urban vs. rural• Patient demographics• Annual patient volume• Trauma centerHave potential ED pharmacist candidate shadow medical staff • Determine needs

30

Step 2: Recruitment

Finding a full time dedicated ED Pharmacist• Education

• PharmD• Residency – PGY1 preferred• PGY2 accredited emergency pharmacist

programs emerging• ACLS, PALS certification

31

Step 2: Recruitment

Experience• Critical/acute Care • Emergency Medicine • Pediatrics

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What to Look for

Characteristics• Proactive – continually offers assistance• Build relationships with all medical staff• Actively seeks out patients that can benefit

from ED pharmacist intervention• Ability to appear helpful and not

confrontational• Ability to work well under pressure and time

constraints

33

Step 3: Overcoming Challenges

Funding• Grants• EM department co-funding• Couple implementation with a residency project

Staff Resistance• Temporary response to change

34

Financial ChallengesImportant to demonstrate return on investment

• ED pharmacist save money• Recommend lower cost meds with equal or

better efficacy• Reduce adverse drug events• Waste reduction

35

ROI

4 month study – 2150 interventions21

• 1393 directly related to ADE’s• Cost avoidance of estimated $1,029,776

36

Availability, Accessibility, and Visibility

• Dedicated to the ED• Physically located in ED (not isolated to a

satellite)• Easily accessible and visible to all staff with

frequent “walk-through”

37

ResourcesProvide ED Pharmacist with necessary equipment (laptop, cell phone, pager, computer space centrally located in ED)

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Go Team ED!

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References – Part One1. Emergency Pharmacist Research Team, University of Rochester Department of Emergency Medicine. Rollin J.

(Terry) Fairbanks, Principal Investigator; Karen E. Kolstee, Project Coordinator; Daniel P. Hays, Lead Pharmacist. www.EmergencyPharmacist.org Supported by The Agency for Healthcare Research and Quality, Partnerships in Patient Safety, Grant no. 1 U18 HS015818

2. Hafner JW, et al. Annals of Emergency Medicine, 2002; 39(3).3. Leape LL, et al. JAMA, 1995; 27(1).4. Sanders MS, et al. Human Factors Engineering and Design. 7 th ed. McGraw Hill, Inc.,1993.5. Aspden P et al, Preventing Medication errors: Quality Chasm Series. Nat’l Academy Press: 1 st ed, 20076. USP Patient Safety CAPS7. Institute of Medicine, The Future of Emergency Care. Nat’l Academies Press; 20078. Derlet RW. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg

Med. 2002;39(4):430-2.9. Fairbanks, Patel, and Shannon. EPh Time-Motion Study (2007). Results presented at AHSP Mid-Year Clinical

Meeting, December 5, 2007. (available at www.emergencypharmacist.org/toolkit.html) 10. Conners GP, Hays D. Emergency Department Drug Orders: Does Drug Storage Location Make a Difference?

Annals of Emergency Medicine. 2007;50:414-41811. Fairbanks RJ, Hildebrand JM, Kolstee KE, Schneider SM, Shah MN. Medical and nursing staff value and utilize

clinical pharmacists in the Emergency Department. Emergency Medicine Journal Oct 2007; 24:716-719.12. Fairbanks RJ, Results of the AHRQ Emergency Pharmacist Outcomes Study. American Society of Health-System

Pharmacists 42nd Mid-Year Clinical Meeting, Las Vegas: 12/5/07. (available at www.EmergencyPharmacist.org).13. Fairbanks RJ et al, The Optimized Emergency Pharmacist Role, Presented at AHRQ Patient Safety & Health IT

Conference, June 2006 (available at www.EmergencyPharmacist.org).14. Lada P, Delgardo G. Documentation of Pharmacists' Interventions in an Emergency Department and Associated

Cost Avoidance. Am J Health-Syst Pharm-Vol 64 Jan 1, 200715. Aspden P et al, Preventing Medication errors: Quality Chasm Series. Nat’l Academy Press: 1st ed, 200716. Institute of Medicine, The Future of Emergency Care. Nat’l Academies Press; 200717. Bond CA, et al, Pharmacotherapy, 1999; 19(6). 18. Leape LL, et al JAMA, Mar 2000; 283(10).19. Gattis WH, et al, Arch Internal Med, 1999; 159(16).20. Thomasset and Faris, Am J Health-Syst Pharm, Aug 2003; 6021. Lada, P. et al, Am J Health-Syst Pharm, Jan 2007; 61(4)

http://www.EmergencyPharmacist.org/

http://www.emergencypharmacist.org/toolkit.html



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The Emergency Medicine PharmacistSystematically improving patient care hospital wide

Robert S. Pugliese, PharmD, [email protected]

@theEDpharmacist

Part 2

41

Emergency Medicine Pharmacists recognized by American College of Emergency Physicians (ACEP)

“RESOLVED, That ACEP create a policy statement that supports clinical pharmacy services in emergency departments and collaboration among emergency medicine providers to promote safe, effective, and evidence-based medication practices, to conduct emergency-medicine-related clinical research, and to foster an environment supporting pharmacy residency training in emergency medicine”2

Resolution 44

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Emergency Medicine Pharmacists recognized by American College of Emergency Physicians (ACEP)

“Any of us who’s ever had access to clinical pharmacy services in the [emergency room] know it’s really important”–Louise A Prince, President, ACEP New York1

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Surprise!?• Many Emergency Departments:

• Overcrowded (primary care)• Understaffed (5-to-1 nursing ratio!)• Provide ICU level care (and fix tummy aches)• Mixed population (inpatient/outpatient)• Lack common medication safety protections

• Prospective medication order review not mandated by Joint Commission

= HIGH RISK

44

Do you ED Pharmacist?

45

First mention of EM Pharmacy service was in 1977 published in American Journal of Hospital Pharmacy3

Yes14%No

86%

ER Pharmacist Survey 2000 (n=119)4

Yes30%No

70%

ER Pharmacist Survey 2007 (n=99)5

Pharmacy residency programs surveyed

Emergency Medicine residency programs

surveyedYes62%

No38%

?

46

Yes14%No

86%

ER Pharmacist Survey 2000 (n=119) 4

Yes30%No

70%

ER Pharmacist Survey 2007 (n=99) 5

Yes62%

No38%

Critical Care Pharmacist Survey 2006 (n=382) 6

Hospitals with ICUs surveyed

47

We need more Emergency Medicine Pharmacists

Critical Care Emergency Medicine0

20406080

100120140

116

27

ASHP Accredited PGY2 Residency Programs*

*Source: ASHP Online Residency Directory. Available at: http://accred.ashp.org/aps/pages/directory/residencyProgramSearch.aspx. Accessed 1-8-2015

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Emergency Medicine Pharmacy

A long road ahead

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Emergency Medicine Pharmacistsare Great Collaborators!• ED pharmacists find themselves at the crossroads of the

hospital• ED pharmacists often must act as intermediaries and

facilitators in interdepartmental collaborations• ED pharmacists are a trusted team member and are

looked to when problems arise • ED Pharmacists in unique position to identify systematic

problems and develop solutions• Many initiatives begin in the ED and we are there at the

ground floor

50

Shouldn’t we go help

them?

Nah, it’s the ER. We don’t go there

51

ASHP Guidelines on Emergency Medicine Pharmacist ServicesEssential/Desirable Administrative Roles of EM Pharmacists7

1. Medication and Patient Safety2. Quality Improvement Initiatives3. Leadership and Professional Service 4. Emergency Preparedness5. Education6. Research and Scholarly Activity

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1. Medication and Patient Safety• Intervention documentation• ADE/ADR Reporting• ED Performance Improvement (PI)

Leadership

56

Emergency Medicine Pharmacist ImpactConclusions• A majority of interventions occurred through prospective

consults where EMPs assisted in determining patient treatment.

• An average of 16 interventions occurred each day, roughly equating to one intervention per hour between 0800 and 2330.

• All EMP interventions were accepted except for 1 of 478 (0.002%)

• Due to the fast paced nature of the ED, almost 100% documentation capture was only possible with the support of students documenting all EMP interventions

57

2. Quality Improvement Initiatives• Jeff FAST Program – Facilitating Anticoagulation for

Safer Transitions• Pediatric ED Workgroup – Develops and promotes

evidence based protocols for pediatric ED population• Sepsis Initiative – ED Pilot now house wide evidence

based care bundle leading to mortality benefits• Sickle Cell Workgroup – collaboration between

outpatient Sickle Cell Center and ED • Stroke Committee – decreased time-to-TPA to <60

min; TPA made centrally (not at the bedside) with average 11 min turnaround

58

Quality Improvement Initiatives

59


60


62


63


Antibiotic Compatibilities in Sepsis Treatment

Amik Anid Azith Aztre Cefe Ceft Ceftri Dopa Epi Line Mero Met Mica Moxi Norepi P/T Tig Tobra Vanco

Amikacin (Amik) - C - C C C - C

C

C - C - - - C C - C

Anidulafungin (Anid) C - - - C C C C C C C C - - C C - C CAzithromycin (Azith) - - - - C - - - - - - - - - - - C - -Aztreonam (Aztre) C C - - C C C C C C - - - - - C C C CCefepime (Cefe) C C C C - - - C - C - C - - - - C C CCeftazidime (Ceft) C C - C - - - C C C - C - - C - C C -Ceftriaxone (Ceftri) - C - C - - - - - C - - - - - - C - CDopamine (Dopa) - C - C C C - - C C - C C - C C C - CEpinephrine (Epi) - C - C - C - C - - - - - - C - C - C

Linezolid (Line) C C - C C C C C - - C C - - - C C C C

Meropenem (Mero) - C - - - - - - - C - - - - C - - - C

Metronidazole (Met) C C - - C C - C - C - - - - - C - - -

Micafungin (Mica) - - - - - - - C - - - - - - C - - - -

Moxifloxacin (Moxi) - - - - - - - - - - - - - - - - - - -Norepinephrine (Norepi) - C - - - C - C C - C - C - - - C - -Piperacillin/Tazobactam (P/T) C C - C - - - C - C - C - - - - C - C Tigecycline (Tig) C - C C C C C C C C - - - - C C - C C

Tobramycin (Tobra) - C - C C C - - - C - - - - - - C - CVancomycin (Vanco) C C - C C - C C C C C - - - - C C C -

65

Quality Improvement InitiativesSevere Sepsis Initiative

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Quality Improvement Initiatives –

Pediatric/ED Workgroup

Triage• Vital Signs• Peak Flow• Pulse Ox

Physician Order SetPediatric Asthma• First series Bronchodilators (if not previously

ordered):• Albuterol q 20 min x3 +Ipratropium x 2

with 2nd and 3rd nebs• CXR if:

• Fever (Temp ≥ 100.4• Foreign Born• First-time Wheeze• Focal Lung Findings

• Assess Severity

Treatment• Oral

Steroids

Nursing ED FLOPediatric Wheezing• Peak Flow pre-Rx• First series Bronchodilators:

• Albuterol q 20 min x3• +Ipratropium x2 with 2nd and 3rd nebs

• Peak Flow post-Rx• O2 NC if < 93%

Mild• O2 Sat > 93%• RR WNL for age• If > 7 yrs PF >

70%

Meets ALL Discharge Criteria?• O2 Sat > 93%• RR WNL for age

Treatment• Oral Steroids• Second series bronchodilators:

• High dose albuterol q2h• Ipratropium q4h

• Peds consult 877-656-5559• Peds RT consult pager 2141• Admit

Moderate• O2 Sat > 93%• RR elevated for age• If > 7 yrs PF 40-70%

Home• Asthma action plan (can consult peds RT

to assist with plan and/or teaching)• F/U PMD within 1 week• Equipment at home (Spacer/nebulizer)• Prescriptions for Albuterol +/- ICS

Treatment• Steroids• Continuous albuterol• Magnesium• Peds consult• Peds RT consult• Admit

Severe• O2 Sat ≤ 93%• If > 7 yrs PF <

40%

YesNo

Dangerous Pediatric Respiratory rates

0-60 days over 60 60 days- 1year over 401-5 years over 305-18 years over 20

Expected 70% 40%Height (cm) Peak Flow Expected Expected

43 (108) 147 103 5944 (112) 160 112 6445 (114) 173 121 6946 (117) 187 131 7547 (119) 200 140 8048 (122) 214 150 8649 (124) 227 159 9150 (127) 240 168 9651 (130) 254 178 10252 (132) 267 187 10753 (135) 280 196 11254 (137) 293 205 11755 (140) 307 215 12356 (142) 320 224 12857 (145) 334 234 13458 (147) 347 243 13959 (150) 360 252 14460 (152) 373 261 14961 (155) 387 271 15562 (157) 400 280 16063 (160) 413 289 16564 (163) 427 299 17165 (165) 440 308 17666 (168) 454 318 18267 (170) 487 341 195

Pediatric Wheezing/Asthma ED Pathway

Pts <20kg Albuterol 2.5mg q20min x3 +Ipratropium 0.5mg q20min x2

Pts >20kg Albuterol 5mg q20min x3 +Ipratropium 0.5mg q20min x2

Pts <20kg Albuterol 5mg q2hPts >20kg Albuterol 10mg q2h

Pts <20kg 5mg/hrPts >20kg 10mg/hr

Prednisone 2mg/kg MAX 60mg POPrednisolone Sol 2mg/kg MAX 60mg POMethylprednisolone 2mg/kg MAX 60mg IV

Magnesium Sulfate 50mg/kg MAX 2gm IVadminister over 20 minutes

First Series Bronchodilators

Second Series Bronchodilators

First Dose Steroids

Adjunct Medication

High Dose Albuterol

Continuous Albuterol

Issue Date January 2013

67

Quality Improvement Initiatives –


Pathway – Neonate/Infant 0-90d Fever ED Management Algorithm Definitions

o Neonate: 0 – 28 days of life o Infant: 29 – 90 days of life o Fever: Rectal temperature ≥ 38ºC (100.4 ºF)

Obtain IV access Initiate Medications (C) Admit to pediatrics

Rectal temperature ≥ 38ºC (100.4 ºF)

Neonates 0 – 28 days old

Initiate Neonate/Infant Fever Pathway (Assure FLO orders are placed if not done) Call pediatric consult (CC) Obtain IV access Initiate Medications (B) UA and urine culture (use Cath Kit) Blood culture x1 LP with HSV PCR Stool culture if diarrhea CXR, Flu antigen, RSV PCR if respiratory symptoms Admission to pediatrics

ESI 2 Notify Physician FLO/Nurse initiated orders -Heelstick for CBC + diff -Accucheck for glucose -Lido 4% cream x1 prn IV place (A) -Sucrose Sol oral (Sweet-Ease) prn for painful procedures

Infants 29 – 60 days old

Initiate Neonate/Infant Fever Pathway (Assure FLO orders are place if not done) Call pediatric consult (CC) UA and urine culture (use Cath Kit) Blood culture x1 LP with Enterovirus PCR Stool culture if diarrhea CXR, Flu antigen, RSV PCR if respiratory symptoms

Infants 61 – 90 days old

Initiate Neonate/Infant Fever Pathway (Assure FLO orders are place if not done) Call pediatric consult (CC) UA and urine culture (use Cath Kit) Blood culture x1 LP (if NOT Low Risk) with Enterovirus PCR Stool culture if diarrhea CXR, Flu antigen, RSV PCR if respiratory symptoms

Is the patient LOW risk?

Clinical criteria: Previously healthy Term infant with uncomplicated nursery stay Nontoxic clinical appearance No focal bacterial infection on examination (EXCEPT otitis

media)

Laboratory criteria: WBC count 5 – 15,000/mm3 Bands <20% Negative gram stain of unspun urine (preferred) OR

negative leukocyte esterase and nitrite, OR <5 WBCs/hpf in stool (if diarrhea)

If LP done o CSF <8 WBCs/mm3 AND negative gram stain o Corrected: <1 WBC/500 RBC

Social criteria: Reliable care taker Assured follow up within 24 hours

A) Lidocaine 4% Cream (Anecream/LMX-4) Dosing: 1 gram = 5 cm ribbon = 40 mg lidocaine

Wt(kg) Recommended Dose (Amount of Cream Applied) Per Site

Max Dose (Amount of Cream Per Application)

TOTAL AMT USED ON ALL SITES*

Max Application Time (hr)

< 5 0.5 g (2.5 cm) 1 g (5 cm) 1

5-10 0.5-1 g (2.5-5 cm) 2 g (10 cm) 2

11-20 1-2 g (5-10 cm) 10 g (50 cm) 2

> 20 1-2 g (5-10 cm) 20 g (100 cm) 2

*Maximum amount of cream per application may be repeated in 2 hours; not to be applied more than 3 times in a 24 hour period / NO MORE THAN 2 SITE APPLICATIONS B) Medications 0 – 28 days old (x1 doses only in ED)

-Ampicillin 0-7 days: 100 mg/kg/dose IV q8h (max: 2 grams/dose) 8-28 days: 75 mg/kg/dose IV q6h (max: 2 grams/dose)

-Cefotaxime 0-7 days: 50 mg/kg/dose IV q12h (max: 2 grams/dose) 8-28 days: 50 mg/kg/dose IV q8h (max: 2 grams/dose)

-Acyclovir 20 mg/kg/dose IV q8h

-Sodium Chloride 0.9% Bolus (20 ml/kg) prn dehydration -Acetaminophen 15mg/kg/dose PO or PR q6h prn fever ≥100.4°F

C) Medications 29 – 90 days old (x1 dose in ED) -Vancomycin 15 mg/kg/dose IV q6h (max: 500 mg/dose) -Cefotaxime 75 mg/kg/dose IV q6h (max: 2 grams/dose)

-Sodium Chloride 0.9% Bolus (20 ml/kg) prn dehydration -Acetaminophen 15mg/kg/dose PO or PR q6h prn fever ≥100.4°F

D) Medication for Low Risk patients (post-LP)

-Ceftriaxone 50 mg/kg/dose IM once (max: 1000 mg/dose)

Was LP done?

NO YES

Medication (D) Discharge Reevaluation in 24 hours Reevaluation in 24 hours

HIGH RISK

LOW RISK

No Medication

Discharge Reevaluation in 24 hours Reevaluation in 24 hours

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WINNER!


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3. Leadership and Professional Service

• ED Medication Reconciliation Project (Coming Soon!) • Goal is to establish a model

for technician/intern based medication reconciliation for 100% of patients coming through the ED

• LEAN Leaders – Interdepartmental LEAN ED Medication Distribution Project• Pharmacy Techs are content experts

Med Rec

70

Interprofessional Med Rec Design Project

Leadership and Professional Service

71

Patient's Pharmacy (and cross street):___________________________

Please write down the medications you take. If you do not remember your medication names, you can call your pharmacy, ask a caregiver/family member, or ask a staff member for help.

Medication History

Drug and Food allergies (describe what happens when you have a reaction):

Pharmacy Phone Number:________________________

Patient Name:________________________________ Date of Birth: ___/___/_____ Recently hospitalized at Jefferson? ○ Yes ○ No Do you see a physician at Jefferson? ○ Yes ○ No

ED Staff Only: Med Rec Start Time and Date: Med Rec Completion Time: Notes:

○ Once daily ○ Twice daily○ Other ________________

○ By mouth○ Other: ________________

○ By mouth○ Other: ________________

○ By mouth○ Other: ________________

List any Over the Counter (OTC) medications you take and when you last took them (for example: Aspirin or Benadryl):

Prescription Medication Name and Dose

List any herbal supplements or vitamins you take and when you last took them (for example: St. Johns Wort or Fish Oil products):

○ By mouth○ Other: ________________

○ By mouth○ Other: ________________





Last dose?

○ By mouth○ Other: ________________

○ By mouth○ Other: ________________



How do you take the medication? How Often?○ Once daily ○ Twice daily○ Other ________________

○ By mouth○ Other: ________________

○ By mouth○ Other: ________________


72

4. Emergency Preparedness

• Disaster Management Workgroup – ED Pharmacists act as department liaisons for disaster management support

• Antidote Inventory Management – Developed formulary antidote database to identify critical antidotes, identify storage locations, set supply par levels, and monitor stock

73

5. Education• Pharmacy Resident Rotation

• ED rotation provides unique environment for resident to work on a wide range of skills

• Always opportunities for research in the ED• Many residency grads are finding opportunities as

ED pharmacists• Pharmacy Student Rotations (IPPE/APPE)• #1 most requested rotation site at TJU• Students get the opportunity to apply concepts in

a wide range of disease states• Formal Lectures

74

6. Research and Scholarly Activity• Nitrous oxide toxicity case report – AJHP8 • The Jeff FAST Program – Presentation to National

Anticoagulation Forum• The Jeff FAST Program – Journal of Hospital Practice9

• ED Interventions Student Poster - ASHP Midyear• The Sepsis Initiative – Critical Care Medicine (Abstract)• The Sepsis Initiative - Presentation to University Health

System Consortium and IHI National Meetings • The Sepsis Initiative - ASHP Foundation for Medication

Use Excellence Finalist

75

6. Research and Scholarly ActivityPharmacy Resident Research Manuscripts

• Post Intubation Sedation ED Protocol• Establishing the Jeff FAST Program• ED Pharmacist Effect on Sepsis Protocol

Adherence• Pharmacy Led Med Rec in ED • Improving the Pharmacologic

Management of Severe Sepsis

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6. Research and Scholarly Activity

77

6. Research and Scholarly Activity• Social Media and FOAMed? Free Open Access Meducation• Blogs/Podcasts – ALiEM, EMPharmD, LITFL• Twitter - @PharmERToxGuy, @ASHP_EMPharm,

@theEDpharmacist• Instagram• YouTube• Facebook• WikiEM

78

ASHP Emergency Care Section Advisory Group

79

Questions?

80

References – Part Deux1. American College of Emergency Physicians. 2014 Council Resolutions, Chicago.

Resolution 44: Support for Clinical Pharmacists as Part of the Emergency Medicine Team. Available at: https://www.acep.org/uploadedFiles/ACEP/About_Us/Leadership/Council/2014%20Resolutions%20Compendium.pdf. Accessed January 8, 2015.

2. Cheryl A. Thompson. Pharmacy News: Emergency Physicians Group Supports ED Clinical Pharmacy Services. AJHP News. December 15, 2014. Available at: http://www.ashp.org/menu/News/PharmacyNews/NewsArticle.aspx?id=4140. Accessed January 8, 2015.

3. Elenbaas RM, Waeckerle JF, Mcnabney WK. The clinical pharmacist in emergency medicine. Am J Hosp Pharm. 1977;34(8):843-6.

4. Thomasset KB, Faris R. Survey of pharmacy services provision in the emergency department. Am J Health Syst Pharm. 2003;60(15):1561-4.

5. Szczesiul JM, Fairbanks RJ, Hildebrand JM, Hays DP, Shah MN. Survey of physicians regarding clinical pharmacy services in academic emergency departments. Am J Health Syst Pharm. 2009;66(6):576-9.

6. Maclaren R, Devlin JW, Martin SJ, Dasta JF, Rudis MI, Bond CA. Critical care pharmacy services in United States hospitals. Ann Pharmacother. 2006;40(4):612-8.

7. Eppert HD, Reznek AJ. ASHP guidelines on emergency medicine pharmacist services. Am J Health Syst Pharm. 2011;68(23):e81-95.

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ED Pharmacist PSHP CE Final - Rob Notes V.5

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