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INTEGRATION OF A PHARMACIST INTO THE EMERGENCY DEPARTMENT

European Statement

Patient Safety and Quality Assurance

Author(s)

PALOMA CRESPO-ROBLEDO, MARIA SEGURA BEDMAR, IRENE ESCRIBANO VALENCIANO, NURIA BLAZQUEZ-RAMOS, BEATRIZ MARTIN CRUZ, CARMEN MORIEL SANCHEZ

Why was it done?

Patient safety is an essential component of quality care. It’s known that EDs are an element of risk for the onset of adverse events due to conditions related to patients’ comorbidity, communication problems, medication errors and working conditions like limited information about the patient, workload, interruptions, shifts, etc. It was detected that reconciliation of medication was not performed; neither validation of the medication prescribed and medications were stocked with no order and control.

What was done?

A project was developed to increase patient safety in the Emergency Department (ED) based on the presence of a hospital pharmacist in the team.

How was it done?

First thing was to review and validate the medication prescribed in patients who were under observation, at the same time performing a reconciliation given their acute situation. This way a relationship between nurses, physicians, patients and pharmacist was established.
Then, electronic prescription software was integrated within the automated dispensing cabinet (ADC), eliminating potential errors choosing the right drug. Only when a pharmacist has checked the medication, the list appears in the display and can be taken out all at once. The main problem has been to agree the stocks and how nurses can return easily and operatively the medication in order to not accumulate it out of the ADC.

What has been achieved?

Pharmacists’ clinical figure is being disclosed in a country where Hospital Pharmacy is a central and close department. In 43 days, 428 patients got their prescription checked in the ED, 346 pharmaceutical interventions were made in 198 patients, a median (IQR) average of 1 (1,2) interventions per patient. The main reason for an intervention was the adequacy to pharmaceutical forms included in the Hospital(n=130), followed by reconciliation interventions(n=77). Category of errors detected were mostly B (NCC MERP), showing pharmacists can detect an error occurred but that did not reach the patient

What next?

Hospital pharmacists should show their clinical and logistic potential, fighting with other health professionals to increase safety and care in patients. ED is the entrance of patients into the health system and where more errors can be committed, the work of a pharmacist should start at ED to prevent errors and give support and be part of the team.

A TARGETED STRATEGY AND TRAINING PROGRAM TO IMPROVE THE MEDICATION RECONCILIATION PROCESS

European Statement

Clinical Pharmacy Services

Why was it done?

Medication reconciliation at admission was implemented in our hospital in 2011 and since then we could hardly meet the expectations of clinicians (completion of a Best Possible Medication History (BPMH) for 70% of patients in less than 24 hours). We also observed that the high patient volume decreased the quality of our BPMH completion process.

What was done?

We developed a strategy and an organisational thinking to remove human and technology barriers in performing medication reconciliation (MR). We designed a program to improve the overall quality of MR and increase the added value of MR for clinicians, nurses and pharmacists.

How was it done?

Our approach included four steps:
(1) “customer approach”; by conducting semi-structured interviews with students, clinicians and nurses to get their feedback, needs, expectations about medication reconciliation,
(2) literature review with Pubmed® and Embase®and benchmarking of other similar practices in France and Canada
(3) set a task force including pharmacists and students to define a strategy and metrics
(4) design solutions and assess them.

What has been achieved?

First, we defined and chose to target “High risk” admission inpatients only. Second, a training program based on two e-learning modules was implemented to develop skills of pharmacy students and residents. This program explores the “why” of conducting MR based on real life examples. It also defines the “what” (what is MR) and the “how” (i.e the different steps to run a MR and how to appropriately interact with the patient).

What next?

At each student rotation, the efficacy of the training program will be evaluated by comparing the concordance of BPMHs performed separately by a student and a pharmacist. A survey will be conducted to evaluate the level of learners’ satisfaction.

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