Patient Safety, 2008

American Society of Health-System Pharmacists

June 2008

AHRQ-sponsored research on how clinical pharmacy services can reduce medication-related errors in hospital emergency departments has been put to use in hospitals in a pharmacists' mentoring program. The American Society of Health-System Pharmacists (ASHP) launched the mentoring program, called "Patient Care Impact Program," in 2007.

The goal of this ongoing mentoring experience is to encourage the creation of permanent programs featuring clinical pharmacists' involvement with medication use in the emergency department. The research that led to this mentoring program was funded under AHRQ's "Partnerships in Implementing Patient Safety" grants, and headed by Rollin J. Fairbanks, MD, MS, of the University of Rochester in New York.

Through his AHRQ-funded grant, Fairbanks interviewed emergency department staff to learn which pharmacist services they found helpful, and to gather ideas about how an emergency pharmacist program might be structured. One finding was that pharmacists in the emergency department often devoted an inordinate amount of time to lower-level tasks that could be done by a technician. Fairbanks says, "It is important to find ways to free the emergency pharmacist to concentrate on high-risk and high-yield situations. For more routine situations, the emergency pharmacist should establish an active presence in the emergency department, and cultivate supportive relationships with emergency department physicians, nurses, and other staff."

Fairbanks' years of experience as an emergency physician, followed by his studies in human factors engineering, had convinced him of the value of the emergency pharmacist's role. He found it paradoxical that emergency departments, where patients present with such complex medical challenges, rarely benefited from the medication review systems that were routine in the rest of the hospital. He also found that little research had been done on the topic.

Fairbanks and his colleague, Daniel B. Hays, PharmD, BCPS, an emergency pharmacist at the University of Rochester, are co-mentors of ASHP's program. Between June and December 2007, pharmacists in 19 hospitals (including one in Ireland) met periodically in person and by telephone with teams of expert mentors to design programs for their own hospitals. They developed job descriptions for an emergency pharmacist and justifications for their own programs. A toolkit to guide implementation was developed. Participants also made plans to gain the support of hospital leaders and staff, to get their programs up and running, and to establish systems for quality assurance.

The group came together at ASHP's clinical meeting in December 2007. Participants presented the results of their efforts in a series of sessions available to approximately 20,000 ASHP members attending the meeting.

ASHP's involvement in the mentoring project reflects its members' increasing interest in emergency pharmacy practice, according to Daniel Cobaugh, PharmD, ASHP Foundation Director of Research and Program Development. The program has attracted pharmacists already working in emergency departments, as well as pharmacists whose institutions are interested in establishing an emergency pharmacist program.

A new group of 10 hospital pharmacists began participation in 2008. Notes Cobaugh, "Each hospital will structure its emergency pharmacy program a bit differently. A small hospital, for example, may not be able to afford a dedicated emergency pharmacist." He adds that there are many ways the hospital pharmacy service can work to improve emergency department care. For example, they can develop quality measures for medication use or help staff understand and use computerized physician order entry systems.

Cobaugh is delighted by the potential broad reach of the program. "The first cohort included the Veterans Affairs San Diego Healthcare System, which created a pilot emergency pharmacist program with the potential for replication throughout the VA system." Other participants belong to multi-hospital systems, where they can promote their program to other hospitals within the same system.

With some 30,000 members, ASHP is a national professional association representing pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other areas. ASHP aims to prevent medication errors, help people make the best use of medicines, and assist pharmacists in fulfilling these goals.

Impact Case Study Identifier: CQuIPS 08-02
AHRQ-Sponsored Activity: Research
Topic(s): Patient Safety, Medication Errors
Scope: National

Fairbanks RJ, Hildebrand BA, Kolstee KE, et al. Medical and nursing staff highly value clinical pharmacists in the emergency department. Emergency Medicine Journal 2007; 24:716-719. (HS15818)

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