The description and definition of Emergency Department Pharmacist Practitioners in the United Kingdom (the ENDPAPER study)

Abstract

Background Due to a shortage of emergency department doctors and nurses, hospitals have started to employ pharmacists who have additional clinical skills, known as Emergency Department Pharmacist Practitioners, to help deliver services. Objective To describe, compare and define the Emergency Department Pharmacist Practitioner role. Setting UK emergency departments. Method Using a purpose developed questionnaire hosted on a tablet computer, Emergency Department Pharmacist Practitioners were asked to report their contribution to patient care and the wider emergency department over 10 work days. Main outcome measure Emergency Department Pharmacist Practitioners’ work. Results Twenty Emergency Department Pharmacist Practitioners from 15 UK hospitals were recruited. Of 682 patients cared for, 4.8% (n=33) were of blue triage category (least urgent) and 4.1% (n=28) red (immediate need). Specific activities to inform patient diagnosis included clinical examinations (264/682 patients, 38.7%) and the review of investigation/test/procedure results (270, 39.6%). For treatment, EDPPs prescribed a total of 603 medicines (for administration in the ED) to 266 patients (39.0%) and performed procedures for 63 (9.2%). Eleven of the practitioners also took on the role of designated care provider (i.e. the healthcare professional with overall clinical responsibility) for at least some of their patients. From application of the care typology, all 20 practitioners carried out both ‘traditional’ and ‘practitioner’ activity and 9/20 of them sometimes provided more ‘practitioner’ than ‘traditional’ care to individual patients. Seven key role attributes were identified including how these pharmacists support patients with medical complaints and injuries of any severity and at any stage of their visit. Conclusion Emergency Department Pharmacist Practitioners combine traditional clinical pharmacy activities with more hands-on medical practise including being designated care provider. The role is versatile in that care and support provided to patients and the wider emergency department professional team is varied and therefore somewhat adaptable to situations which present.

Protocol for systematic review and meta-analysis of randomized controlled trials, cost-benefit analysis and interrupted timeseries interventions on pharmacist’s prescribing

“…6 In the United Kingdom hospital emergency departments, pharmacists practice prescribing medications like paracetamol, salbutamol, and sodium chloride; among the least prescribed include etanercept and digoxin. 7 Patients with a history of asthma who visit a remote area and require albuterol can be attended to by a pharmacist. 22 Pharmacists have shown they can enhance care by lowering morbidity and mortality rates, minimizing adverse medication events, and lowering health-care expenditures.…”

Educational supervision to support pharmacy professionals’ learning and practice of advanced roles

“…Simultaneously, there has been a move to increase pharmacy professionals’ (pharmacists and pharmacy technicians) contributions to patient care to address increasing patient demand alongside workforce shortages. Benefits of advanced clinical roles for pharmacy professionals are: improving patients' access to healthcare [ 1 , 2 ], reducing healthcare and prescribing costs [ 3 , 4 ] and clinical interventions [ 5 , 6 ]. In 2015, NHS England (NHSE) announced a pilot to support the development of clinical pharmacists in general practice (family medicine) to work “in a patient-facing role to clinically assess and treat patients using their expert knowledge of medicines for specific disease areas” [ 7 , 8 ].…”

Development of the Manchester framework for the evaluation of emergency department pharmacy services

“…Pharmacists provide services to emergency departments (EDs) in many countries such as the United States [ 1 ], Saudi Arabia [ 2 ], Colombia [ 3 ] and the United Kingdom (UK) [ 4 ]. In the UK, in part due to a shortage of ED doctors and nurses, pharmacists have completed additional clinical training so to take on a greater role in patient care [ 5 ]. Termed ‘ED pharmacist practitioners’, they provide traditional pharmacy care e.g.…”

“…medicines reconciliation [ 6 ], but also ‘practitioner’ care e.g. perform physical examinations and manage patients [ 5 ]. There has been some evaluation of ED pharmacy services, particularly in the United States [ 7 , 8 ], but this is mostly limited to the more traditional activities of pharmacists in those settings.…”

“…There has been some evaluation of ED pharmacy services, particularly in the United States [ 7 , 8 ], but this is mostly limited to the more traditional activities of pharmacists in those settings. Overall, while at least 20 pharmacists now work as practitioners and provide care to patients in UK EDs [ 5 ], there has been no evaluation of the quality of those services. Evaluation of the quality of care provided by health services is important to identify areas requiring improvement, as well as ensure the appropriate use of resources [ 9 , 10 ].…”