Establishing New Services in the Emergency Dept and Elsewhere

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A previous Tip from a few weeks ago examined the establishment of an ambulatory care practice site. This week’s Tip takes a look at establishing a clinical pharmacy site in the emergency department (ED) of a hospital. In doing so, attention is called to various components of management addressed in the textbook, including basic functions of management, business planning, and implementing value-added pharmacy services.

Morgan et al take the reader through various facets before (planning) and just after implementation of services in an ED department.1 They describe the need for ED pharmacists, including ED use of time-sensitive and high-risk medications to vulnerable patients. ED pharmacists have been shown to help reduce readmission rates and medical errors, so the prospective ED pharmacist should come prepared with this evidence in their business plan that will include how much money can be saved. That plan would also include support for ED pharmacists documented by groups outside of pharmacy, such as the American College of Emergency Physicians (ACEP). The authors review the services potentially provided by ED pharmacists, such as ED resuscitation team participation, pharmacotherapy consultation, ADE reporting, toxicology recommendations, ED personnel in-service education, clinical research, assistance with grant application preparation, scholarly publications, formulary management, and others. The authors then review a few studies documenting the benefit of having an ED pharmacist, including increases in vaccinations, reduction in return ED visits among patients, improved antimicrobial stewardship, increase of patients receiving guideline-adherent treatment in various diseases, reduction in catheterization lab time, and others. The evidence presented by the authors also includes financial analyses of ED pharmacist implementation. They describe barriers, such as the challenge in acquiring necessary buy-in, high start-up costs, inadequate definition of the roles of the ED pharmacist, and inadequate planning for adjusting the workflow of the ED as well as perhaps the pharmacy department.

Incorporating a new clinical pharmacist position requires considerable planning, evidence, and other management skills addressed in the management text and in other Tips, including but not limited to time management, financial forecasting, acquiring the proper evidence, demonstrating value, and melding clinical applications/knowledge with solid leadership.

Additional information about Management Functions and Business Planning for Pharmacy Programs and Implementing Value-Added Pharmacy Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Morgan SR, Acquisto NA, Coralic Z, et al. Clinical pharmacy services in the emergency department. Am J Emerg Med. 2018;36:1727-1732.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California


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8 months ago

Have you been a part of the beginning stages of a new service? What did you learn from it?