Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation

Abstract

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

Longitudinal qualitative evaluation of pharmacist integration into the urgent care setting

“…It was subsequently recommended that pharmacists in the UK should manage patients with minor ailments in A&E. 12 An analysis of 18,613 A&E attendances across 49 sites in 2015 found that, with additional training, 27.9% of cases were believed to be manageable by a pharmacist prescriber. 13 In 2014, the Royal Pharmaceutical Society (RPS), based on a pilot conducted in one region within England, 14 proposed the incorporation of pharmacists into A&E in an enhanced role alongside other roles such as advanced practice nurses and physician associates. 15…”

The advanced clinical practice pharmacy role and its implementation to practice in England

“…The contribution and impact of the ACP role which was only partially answered by the literature. A study showed the potential contribution of ACPs being able to manage around one third of cases presenting in the Emergency Department (Hughes et al, 2017). Benefits of the role were consistent with the reasons for developing the role, which were the provision of flexible models of care where needed, across multi-professions and sectors of care.…”

“…Benefits of the role were consistent with the reasons for developing the role, which were the provision of flexible models of care where needed, across multi-professions and sectors of care. Several authors suggested ACPs were best suited within primary care roles or roles traditionally provided by primary care providers in secondary care, such as urgent care centres or a minor illness area (Barnes, Ashraf & Din, 2017;Hughes et al, 2017;Wright et al, 2018).…”

4CPS-275 A systematic review of pharmacist input in the screening, management and prevention of metabolic syndrome

“…A patient is considered to have MetS if three out of five factors are present. 1 Purpose To critically appraise, synthesise and present the available evidence on: the types and impact of pharmacist input in MetS, to characterise the populations who would benefit most and to describe facilitators and barriers. Material and methods A search was conducted in MEDLINE, IPA, CINAHL and Cochrane using the keywords of Pharm* AND 'Metabolic syndrome*'.…”