Emergency medicine (EM) pharmacy practice has existed for over 30 years. In recent years, however, the specialty has grown significantly. A large number of health care systems have either a dedicated EM pharmacist or other clinical pharmacist presence in the Emergency department (ED). Over the past decade, the role of the EM pharmacist as a critical member of the health care team has expanded significantly and many innovative practices have evolved throughout the country. There is also some heterogeneity between different EM pharmacy practice sites. This article reviews the history and general concepts of EM pharmacy practice as well as illustrate some of the established benefits of an EM pharmacist.
DaileyRH. Approach to the patient in the emergency department. In: RosenPBRDanzlDFHockbergerRS, eds. Emergency Medicine: Concepts and Clinical Practice. Vol 1. 4th ed. Saint Louis, MO: Mosby-Year Book; 1998.
3.
ElenbaasRMWaeckerleJFMcNabneyWK. The clinical pharmacist in emergency medicine. Am J Hosp Pharm. 1977;34(8):843–846.
4.
SpigielRWAndersonRJ. Comprehensive pharmaceutical services in the emergency room. Am J Hosp Pharm. 1979;36(1):52–56.
TroutmanWG. The pharmacist in emergency medicine: poison information. Can J Hosp Pharm. 1981;34(1):9–11.
7.
LadaPDelgadoGJr. Documentation of pharmacists' interventions in an emergency department and associated cost avoidance. Am J Health Syst Pharm. 2007;64(1):63–68.
8.
RothschildJMChurchillWEricksonA. Medication errors recovered by emergency department pharmacists. Ann Emerg Med. 2009;55(6):513–521.
9.
Change in requirement for ED pharmacy review.Hosp Peer Rev. 2007;32(7):104.
10.
Committee on the Future of Emergency Care in the United States Health System. Board on Health Care Services and Institute of Medicine. Hospital–Based Emergency Care: At the Breaking Point. The National Academies Press: Washington, DC; 2006.
11.
SzczesiulJMFairbanksRJHildebrandJM. Survey of physicians regarding clinical pharmacy services in academic emergency departments. Am J Health Syst Pharm. 2009;66(6):576–579.
12.
ThomassetKBFarisR. Survey of pharmacy services provision in the emergency department. Am J Health Syst Pharm. 2003;60(15):1561–1564.
13.
AttwoodRJSmithVDRussiCS. An automated electronic notification system as a screening tool for severe sepsis and septic shock. Ann Emerg Med. 2. 010;56(3):S64–S65.
14.
KitchBTCooperJBZapolWM. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563–570.
15.
Pharmacist in ED yields good results.ED Manag. 2010;22(7):82–83.
16.
JellinekSPCohenVFancherLB. Pharmacist improves timely administration of medications to boarded patients in the emergency department. J Emerg Nurs. 2009;36(2):105–110.
17.
ZedPJAbu-LabanRBBalenRM. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. Can Med Assoc J. 2008;178(12):1563–1569.
18.
HeplerCDStrandLM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–543.
19.
ClassenDCPestotnikSLEvansRSLloydJFBurkeJP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. J Am Med Assoc. 1997;277(4):301–306.
20.
BatesDWSpellNCullenDJ. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. J Am Med Assoc. 1997;277(4):307–311.
21.
JohnsonJABootmanJL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155(18):1949–1956.
22.
PatelPZedPJ. Drug-related visits to the emergency department: how big is the problem?. Pharmacotheraphy. 2002;22(7):915–923.
23.
HohlCMZedPJBrubacherJR. Do emergency physicians attribute drug-related emergency department visits to medication-related problems?. Ann Emerg Med. 2010;55(6):493–502 e494.
24.
HayesBDDonovanJLSmithBS. Pharmacist-conducted medication reconciliation in an emergency department. Am J Health Syst Pharm. 2007;64(16):1720–1723.
25.
CarterMKAllinDMScottLA. Pharmacist-acquired medication histories in a university hospital emergency department. Am J Health Syst Pharm. 2006;63(24):2500–2503.
26.
De WinterSSprietIIndevuystC. Pharmacist- versus physician-acquired medication history: a prospective study at the emergency department. Qual Saf Health Care. 2010;19(5):371–375.
27.
RudisMICrepsiMEscalanteP. Drug Related Problems (DRPs) in the Emergency Department (ED): clinical pharmacists improve detection of medication non-adherence. Acad Emerg Med. 2007;14(5):S200.
28.
BridgemanPJRynnKO. Medication reconciliation in the emergency department. Am J Health Syst Pharm. 2008;65(24):2325–2326.
29.
KnightHEdgertonLFosterR. Pharmacy technicians obtaining medication histories within the emergency department. Am J Health Syst Pharm. 2010;67(7):512–514.
30.
RandolphTC. Expansion of pharmacists' responsibilities in an emergency department. Am J Health Syst Pharm. 2009;66(16):1484–1487.
31.
WeantKASterlingEWinsteadPS. Establishing a pharmacy presence in the ED. Am J Emerg Med. 2006;24(4):514–515.
32.
PatelNBergerTStrawderA. Can a brief educational session by a clinical pharmacist reduce emergency department (ED) re-visit rates?. Acad Emerg Med. 2010;17(5 suppl 1):S116 (Abstract 337).
33.
HohlCMAbu-LabanRBZedPJ. Patient-reported adverse drug-related events from emergency department discharge prescriptions. Can J Emerg Med. 2009;12(4):331–338.
34.
HohlCMAbu-LabanRBBrubacherJR. Adherence to emergency department discharge prescriptions. Can J Emerg Med. 2009;11(2):131–138.
35.
NiskaRBhuiyaFXuJ. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Nation Health Statistics Rep. 2008;26:1–31.
36.
FairbanksRJHildebrandJMKolsteeKE. Medical and nursing staff highly value clinical pharmacists in the emergency department. Emerg Med J. 2007;24(10):716–718.
37.
CohenVJellinekSPHatchA. Effect of clinical pharmacists on care in the emergency department: a systematic review. Am J Health Syst Pharm. 2009;66(15):1353–1361.
38.
RappRPPiecoroJJSwintoskyJV. The value of emergency care situations in the clinical pharmacy education of a pharmacist. 1974. Ann Pharmacother. 2006;40(4):742–746.
39.
EdwardsGASamuelsTM. The role of the hospital pharmacist in emergency situations. Am J Hosp Pharm. 1968;25(3):128–133.
40.
DraperHMEppertJA. Association of pharmacist presence on compliance with advanced cardiac life support guidelines during in-hospital cardiac arrest. Ann Pharmacother. 2008;42(4):469–474.
41.
KumarARobertsDWoodKE. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–1596.
42.
KumarAEllisPArabiY. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136(5):1237–1248.
43.
HouckPMBratzlerDWNsaW. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164(6):637–644.
44.
MacdonaldNDavisSLLulekM. Improving choice and timing of antibiotics for sepsis in the emergency department. Presented at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy September 17-20, 2007. Chicago, IL USA. (Abstract 505) URL:http://www.abstractsonline.com/viewer/?mkey=%7BD52CF5B5%2DE7A0%2D40B1%2DB430%2DCE0AC26BBA9E%7D. Last Accessed December1 30, 2010.
45.
AttwoodRJRudisMIRussiCS. Impact of ED Pharmacist Initiative to Improve Antibiotic Administration in Sepsis. Presented at the Midwest Pharmacy Residency Conference May 5-7 2010, Omaha Nebraska.
46.
RynnKMiddletonJ. Evaluation of a pharmacist managed culture follow-up program in the emergency department. Pharmacotherapy. 1999;19:516.
ZedPJFiliatraultL. Clinical outcomes and patient satisfaction of a pharmacist-managed, emergency department-based outpatient treatment program for venous thromboembolic disease. Can J Emerg Med. 2008;10(1):10–17.
49.
SlobodkinDKitlasJZielskeP. Opportunities not missed–systematic influenza and pneumococcal immunization in a public inner-city emergency department. Vaccine. 1998;16(19):1795–1802.
50.
StackSJMartinDRPlouffeJF. An emergency department-based pneumococcal vaccination program could save money and lives. Ann Emerg Med. 1999;33(3):299–303.
51.
SlobodkinDZielskePGKitlasJL. Demonstration of the feasibility of emergency department immunization against influenza and pneumococcus. Ann Emerg Med. 1998;32(5):537–543.
52.
SlobodkinDKitlasJLZielskePG. A test of the feasibility of pneumococcal vaccination in the emergency department. Acad Emerg Med. 1999;6(7):724–727.
53.
ShapiroEDBergATAustrianR. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. New Engl J Med. 1991;325(21):1453–1460.
54.
HaysDKelley-PiscottiSO'BrienT. The role of the dedicated trauma team pharmacist: a pilot study to assess patient safety benefits. Presented at the American Association for the Surgery of Trauma 2006 Annual Meeting. New Orleans, LA, September 28-30, 2006. URL: http://www.emergencypharmacist.org/doc/AAST_abstract.pdf. Last accessed December 30, 2010.
55.
SchulerPHowardTBrownM. The impact of pharmacist-initiated interventions for acute ischemic stroke in the emergency department. Pharmacotheraphy. 2007;27(9):208 (Abstract 66).
56.
SweisRTJensenJKhudeiraZ. Pharmacists in the emergency department prove to be an integral part of the healthcare system. Presented at the American Society of Health System Pharmacists Annual Midyear Clinical Meeting December 7-11, 2008. Orlando, Fl. URL: http://www.ashpadvantage.com/bestpractices/2008_papers/sweis.htm. Last accessed December 30, 2010.
57.
AcquistoNMHaysDPFairbanksRJ. Pharmacists enhancing the time to cardiac catheterization laboratory and patient safety during acute myocardial infarction presentation to the emergency department. Presented at the American Society of Health System Pharmacists Annual Midyear Clinical Meeting December 7-11, 2008. Orlando, Fl. URL: http://www.ashpadvantage.com/bestpractices/2008_papers/acquisto.htm. Last accessed December 30, 2010.
58.
LarisonD. Development, delivery, and outcomes of a clinical pharmacy service expansion for sexual assault patients in the emergency department. Pharmacotheraphy. 2008;28(9):189e (Abstract 250).
59.
CobaughDJSchneiderSM. Medication use in the emergency department: why are we placing patients at risk?. Am J Health Syst Pharm. 2005;62(17):1832–1833.
60.
HafnerJW,Jr.BelknapSMSquillanteMD. Adverse drug events in emergency department patients. Ann Emerg Med. 2002;39(3):258–267.
61.
BrownJNBarnesCLBeasleyB. Effect of pharmacists on medication errors in an emergency department. Am J Health Syst Pharm. 2008;65(4):330–333.
62.
RatzYShafirIBerkovitchS. The importance of the pharmacist in reporting adverse drug reactions in the emergency department. J Clin Pharmacol. 2010;50(10):1217–1221.
63.
FaganSCTouchetteDSmithJA. The state of science and research in clinical pharmacy. Pharmacotheraphy. 2006;26(7):1027–1040.
64.
JainALRobertsonGJRudisMI. Surgical complications of toxicology. Emerg Med Clin N Amer. 2003;21(4):1–28.
65.
ZedPJTisdaleJEBorzakS. Low-molecular-weight heparins in the management of acute coronary syndromes. Arch Intern Med. 1999;159(16):1849–1857.
66.
CarrRZedPJ. Octreotide for sulfonylurea-induced hypoglycemia following overdose. Ann Pharmacother. 2002;36(11):1727–1732.
67.
YeungJKZedPJ. A review of etomidate for rapid sequence intubation in the emergency department. Can J Emerg Med. 2002;4(3):194–198.
68.
SwadronSPRudisMIAzimianK. A comparison of phenytoin-loading techniques in the emergency department. Acad Emerg Med. 2004;11(3):244–252.
69.
American Society of Health-System P. ASHP statement on the role of health-system pharmacists in counterterrorism. Am J Health Syst Pharm. 2002;59(3):282–283.
70.
ASHP statement on the role of health-system pharmacists in emergency preparedness.Am J Health Syst Pharm. 2003;60(19):1993–1995.
71.
Hospital Incident Command System: Center for HICS Education and Training: URL: http://www.hicscenter.org. Accessed November 25, 2010.
72.
Joint Commission on Accreditation of Healthcare Organizations. In: Comprehensive Accreditation Manual for Hospitals: The Official Handbook.2006;Oakbrook Terrace, IL: Joint Commission Resources, EC–4.20.
73.
WitsilJCAazamiRMurtazaUI. Strategies for implementing emergency department pharmacy services: results from the 2007 ASHP Patient Care Impact Program. Am J Health Syst Pharm. 2010;67(5):375–379.
74.
LingJMMikeLARubinJ. Documentation of pharmacist interventions in the emergency department. Am J Health Syst Pharm. 2005;62(17):1793–1797.
75.
WymoreESCasanovaTJBroekemeierRL. Clinical pharmacist's daily role in the emergency department of a community hospital. Am J Health Syst Pharm. 2008;65(5):395–396, 398, 399.
