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Medical and nursing staff value and utilize clinical pharmacists in the emergency department

Despite the potential impact that emergency pharmacist (EPh) programs could have on medication safety and quality of care in the ED, very few programs exist. This descriptive survey study aimed to assess staff perceptions of an EPh program. A random sample of medical and nursing staff in an academic medical center Emergency Department (ED) with a dedicated EPh program received a 26-item survey (82% return rate). 99% of respondents felt the EPh improves quality of care, 96% feel they are an integral part of the team, and 93% had consulted the EPh at least a few times during their last five shifts. Staff felt that the EPh should be available for consults, attend resuscitations, and check orders. This study reinforced the value of many specific duties of the EPh program found that doctors and nurses overwhelmingly favor the presence of an EPh in the ED, frequently seek their advice, and feel they improve quality of care. Staff acceptance is clearly not a barrier to implementation of this program. ©2007 University of Rochester Department of Emergency Medicine Staff Survey Manuscript: in press, Emergency Medicine Journal (p. 3) INTRODUCTION Studies have shown that clinical pharmacists have a significant impact on patient safety in intensive care units and inpatient wards. Reports of clinical pharmacists practicing in the emergency department (ED) have existed for decades, but very few (1-3%) EDs in the United States utilize dedicated clinical pharmacists. Recently, experts and influential organizations have called for the increased use of emergency pharmacists (EPh). A potential roadblock to implementation of an EPh program is the perception that physician and nursing staff might be unlikely to seek or accept the services of an emergency pharmacist. Although several authors have reported on the role of the EPh, 5 8 9 no recent reports have examined the perceived value of this role from the perspective of emergency physician and nursing staff. This study is part of a larger research effort (supported by the U.S. Agency for Healthcare Research and Quality) to evaluate the use of emergency pharmacists in the emergency department. Work is under way to study outcomes such as the impact on quality measures and adverse events in the ED. This study reported here is intended to address one perceived barrier by investigating whether the EPh role is accepted by ED staff. Specifically, this study aims to assess ED nursing and provider staff acceptance of the EPh as a member of the emergency care team, and their perceptions of the value of specific EPh functions. ©2007 University of Rochester Department of Emergency Medicine Staff Survey Manuscript: in press, Emergency Medicine Journal (p. 4) METHODS This is a descriptive survey study of staff members in a U.S. academic medical center/trauma center ED with 93,000 annual visits. The EPh is a doctor of pharmacyprepared, residency trained clinical pharmacist based in the ED who provides consultations to providers and nurses, reviews medication orders, attends resuscitations, and assists with rapid preparation of urgent medications. A 26-item survey instrument was developed from previously obtained qualitative data and published literature. Five point Likert scales were used where appropriate (1 = “strongly agree” and 5 = “strongly disagree”). Fifty percent of all ED nurses and providers, including attendings, fellows residents, and midlevel providers (nurse practitioners and physician assistants), were randomly selected to receive an email request to participate. A web-based survey was used and the resulting data were electronically imported to a database. Statistical Methods. Response rates and demographic data were analyzed using descriptive statistics. “Agree” and “strongly agree” responses were combined into a single “agree” category, descriptive statistics and confidence intervals around the proportions were calculated using Stata 7.0 (College Station, TX). RESULTS Ninety one of 182 eligible staff members were randomly selected to receive survey instruments; 82% were returned (42 nurses, 33 providers). Respondents had a mean 7 years experience in the study ED, 54% of providers and 74% of nurses were female, and 41% work at least part of their clinical time in the pediatric area. Results are ©2007 University of Rochester Department of Emergency Medicine Staff Survey Manuscript: in press, Emergency Medicine Journal (p. 5) ©2007 University of Rochester Department of Emergency Medicine presented in Tables 1-3. Respondents felt the EPh improves quality of care and are an integral part of the team, and most had consulted the EPh at least a few times during their last five shifts. Table 1: General perceptions Overall n=75 No (%; 95% C.I.) Providers n=33 No (%; 95% C.I.) Nurses n=42 No (%; 95% C.I.) “How many times in your last 5 shifts in the ED during which an emergency pharmacist was on duty, have you consulted the emergency pharmacist? (select one)” Multiple times per shift 18 (24%;15-35% ) 6 (18%; 7-35%) 12 (29%; 16-45%) At least once per shift 30 (40%; 29-52%) 14 (42%; 25-61%) 16 (38%; 24-54%) A few times 22 (29%;19-41%) 12 (36%; 20-55%) 10 (24%; 12-39%) Not at all 5 (7%; 2-15%) 1 (3%; 0-16%) 4 (10%3-23%) “Which of the following do you think is most important in maximizing the emergency pharmacist’s contribution to medication safety? (select one)” Attend medical and trauma resuscitations 27 (36%; 25-48%) 11 (33%; 18-52%) 16 (38%24-54%) Order review 7 (9%; 4-18%) 2 (6%; 1-20%) 5 (12%; 4-26%) Being available for consult 35 (47%; 35-59%) 18 (55%; 36-72%) 17 (40%; 26-57%) Staff education 6 (8%; 3-17%) 2 (6%; 1-20%) 4 (10%; 3-23%) Patient education 0 (0%; 0-5%) 0 (0%; 0-11%) 0 (0%; 0-8%) “Which of the following types of orders should the emergency pharmacist check before they are administered? (select all that apply)”* All orders 9 (12%; 6-22%) 3 (9%; 2-24%) 6 (14%; 5-29%) Urgent orders 30 (40%; 29-52%) 14 (42%; 25-61%) 16 (38%; 24-54%) Non-urgent orders 2 (3%; 0-9%) 1 (3%; 0-16%) 1 (2%; 0-13%) High risk medications 64 (85%; 75-92%) 29 (88%; 72-97%) 35 (83%; 69-93%) Rarely used medications 56 (75%; 63-84%) 25 (76%; 58-89%) 31 (74%; 58-86%) *note: Multiple answers given by several respondents