Standard of practice in emergency medicine for pharmacy services

Welch, Susan; Currey, Elizabeth; Doran, Elizabeth; Harding, Andrew M; Roman, Cristina; Taylor, Simone E; Thomas, Alicia; Munro, Courtney

doi:10.1002/jppr.1627

Cited by 12 publications

(17 citation statements)

References 34 publications

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“…1,[10][11][12][13] Emergency medicine (EM) clinical pharmacists are increasingly involved in the early management of critically unwell patient presentations. [14][15][16][17][18][19] The benefits of early involvement of the EM pharmacist in these scenarios are likely multifactorial with emerging evidence demonstrating improvements in time to medication prescribing and administration, and a reduction in medication errors. 12,15,20 The implementation of sepsis performance improvement programmes which includes education, screening, measurement of sepsis bundle performance, patient outcomes and actions for identified opportunities is associated with better sepsis bundle performance and a reduction in mortality.…”

Section: Introductionmentioning

confidence: 99%

Introduction of an emergency medicine pharmacist‐led sepsis alert response system in the emergency department: A cohort study

Roman

Dooley

Nevill

et al. 2023

Emerg Medicine Australasia

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Objective: To determine effects of implementing a sepsis alert response system in the ED that included early intervention by emergency medicine (EM) pharmacists. Methods: A prospective cohort (8 February 2016 to 28 February 2018) of patients after implementation of a sepsis alert response system in an Australian ED was compared to a retrospective cohort (3 January 2015 to 7 February 2016) of patients with sepsis who presented during EM pharmacist working hours and were admitted to the ICU. Results: There were 184 patients, including 80 patients pre-and 104 patients post-implementation. The post-intervention cohort was triaged at a higher acuity, had higher quick Sepsisrelated Organ Failure Assessment (qSOFA) scores and higher initial lactate measurements. After the intervention, antimicrobial agents were administered to patients within 60 min of presentation more often (21 [26.3%] to 85 [81.7%], P < 0.001). After adjusting for presenting triage category, admission lactate and presenting qSOFA scores, this association remained significant (adjusted odds ratio 9.99; 95% confidence interval 4.7-21.3). Significant improvements were observed for proportion of patients who had intravenous fluids initiated within 60 min (47.5% vs 72.1%); proportion of patients who had serum lactate measured within 60 min (50.0% vs 77.9%) and proportion of patients who had blood cultures performed within 60 min (52.5% vs 85.6%). Conclusion: Implementation of a sepsis alert response that included early involvement of the EM pharmacist was associated with improvement in time to antimicrobials and other components of the sepsis bundle. An upfront, multidisciplinary approach to patients presenting to the ED with suspected sepsis should be considered more broadly.

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Section: Introductionmentioning

confidence: 99%

Introduction of an emergency medicine pharmacist‐led sepsis alert response system in the emergency department: A cohort study

Roman

Dooley

Nevill

et al. 2023

Emerg Medicine Australasia

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“…This highlights that any of our initiatives to implement new roles must focus not only on the therapeutics but also on establishing relationships, acknowledging that this does take time and any evaluations of new services or roles must take this into account. This research has particular relevance to those considering the implementation of new services that are detailed in the recently published standards of practice for ED pharmacy services …”

Section: Conflicts Of Interest Statementmentioning

confidence: 99%

“…This research has particular relevance to those considering the implementation of new services that are detailed in the recently published standards of practice for ED pharmacy services. 5 There are more relevant examples. Locally and internationally, there is a current focus on harm from opioids, with the Society of Hospital Pharmacists of Australia continuing to advocate for systematic approaches to reduce harm associated with these medicines.…”

mentioning

confidence: 99%

Findings from afar and translation closer to home

Dooley¹

2020

Pharmacy Practice and Res

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“…Pharmacists serve many important roles within the emergency department (ED) and their presence is recommended by numerous organisations 1–5 . Emergency medicine (EM) pharmacists serve as part of a multidisciplinary EM team to assist in caring for patients by participating in patient care decisions and ensuring safe, effective pharmacotherapy, among numerous other roles.…”

Section: Introductionmentioning

confidence: 99%

Effect of pharmacist education and intervention on ketorolac prescribing in an emergency department

O’Brien

Fuh

White

et al. 2021

Pharmacy Practice and Res

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Background Pharmacists serve many important roles within the emergency department (ED) and frequently provide education on medications to clinicians and patients. Following a study that demonstrated a potential “analgesic ceiling” effect with ketorolac and suggested that doses lower than 30 mg IV may be effective, we implemented a reduced‐dose ketorolac pathway in our institution’s ED. Aim To assess the impact pharmacist education and on‐shift, active interventions had on ED clinicians' IV ketorolac prescribing habits. Method This was a retrospective, quasi‐experimental study conducted to evaluate the effect of a brief pharmacist‐led educational email intervention on ketorolac prescribing habits within an ED at a large, academic medical center. All orders of IV ketorolac for adult patients in the ED 180 days prior to and following the educational email were included in the analysis. Results Prior to the educational effort, 30 mg IV doses of ketorolac were most frequently ordered (n = 1772). However, following the educational effort, significantly fewer orders were for the 30 mg dose (n = 718) and the majority of orders were for 15 mg IV (n = 2081; p < 0.00001), consistent with the teaching from the intervention. Conclusion In this study, a significant prescribing practice change was facilitated by pharmacist‐led email education supported by on‐shift active guidance for clinicians by pharmacists.

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Standard of practice in emergency medicine for pharmacy services

Cited by 12 publications

References 34 publications

Introduction of an emergency medicine pharmacist‐led sepsis alert response system in the emergency department: A cohort study

Introduction of an emergency medicine pharmacist‐led sepsis alert response system in the emergency department: A cohort study

Findings from afar and translation closer to home

Effect of pharmacist education and intervention on ketorolac prescribing in an emergency department

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