Implications of the presence of an emergency medicine pharmacist during critical care trauma patient resuscitation

Abstract

Purpose The available literature has shown that the presence of an Emergency Medicine Pharmacist (EMP) is associated with decreased time to medication procurement, a reduction in medication errors, and overall cost avoidance. However, there is limited literature that systematically evaluates the impact of EMPs in the treatment of critically ill trauma patients presenting to the emergency department (ED). Methods This study was a retrospective chart review evaluating 1082 adult patients presenting to the critical care area (CCA) of the ED at the University of Louisville Hospital in Louisville, Kentucky for trauma evaluation from July 2014 to December 2014. The study group consisted of patients presenting to the CCA when an EMP was present. Primary outcomes included time to administration of antibiotics, analgesia medication, sedation medication, rapid sequence intubation (RSI), and anticoagulation reversal. Secondary outcomes included time to administration of appropriate antibiotics at an appropriate dose and vaccination administration. Results The presence of an EMP was associated with a statistically significant decreased median time from triage to the administration of an analgesic medication (11 minutes [interquartile range (IQR) 8‐27] vs 13 minutes [IQR 8.5‐20], P = 0.04). There was no statistically significant difference in triage time to antibiotic administration, RSI, sedation medication administration, or anticoagulation reversal. Patients in the EMP group were more likely to receive appropriate empiric antibiotics compared with the control group (80.7% vs 52.2%, P = 0.01). Conclusion The presence of an EMP was associated with decreased time to analgesia medication administration as well as an increased likelihood of the administration of appropriate empiric antibiotics in critically ill trauma patients.

Medication use optimization in critical care through a pharmacy morbidity, mortality, and improvement program

“…The PI enhancements in this report build upon prior quality improvement descriptions of critical care pharmacists 22–28 . The pharmacist‐led MMI program is a unique approach that teaches residents and preceptors the medication use process and how to lead positive, systems‐based PI 10,14–16 .…”

“…The PI enhancements in this report build upon prior quality improvement descriptions of critical care pharmacists. [22][23][24][25][26][27][28] The pharmacist-led MMI program is a unique approach that teaches residents and preceptors the medication use process and how to lead positive, systems-based PI. 30,39 This theory supports why the most common level of reliability was 1 across all critical care MMI events, but improved to IHI level 2 reliability for EMR enhancements, that is, standardized, directed actions that mitigate human-based factors.…”

“…Guiding organizations, including the American College of Clinical Pharmacy (ACCP), American Society of Health‐Systems Pharmacists (ASHP), and Society of Critical Care Medicine (SCCM), have highlighted the role of hospital pharmacists as medical safety leaders through direct and indirect patient care including rounds, protocol and clinical pathway development, formulary review, quality improvement, and leveraging technology 14–17,21 . Numerous studies have documented the role of critical care pharmacists as patient safety leaders 22–28 . The SCCM, ACCP Critical Care Practice and Research Network, and ASHP joint position paper describe several foundational activities critical care pharmacists should perform around medication safety quality improvement, but MMI programs are not included 16 .…”

“…[14][15][16][17]21 Numerous studies have documented the role of critical care pharmacists as patient safety leaders. [22][23][24][25][26][27][28] The SCCM, ACCP Critical Care Practice and Research Network, and ASHP joint position paper describe several foundational activities critical care pharmacists should perform around medication safety quality improvement, but MMI programs are not included. 16 Studies documenting the impact of specific pharmacist-led MMI programs on improved medication safety practices are needed.…”