Services can be developed organization-wide or in particular areas within the organization. This week’s Management Tip of the Week 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 referenced below, 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.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, and formulary management. 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, and reduction in catheterization lab time. The evidence presented also includes financial analyses of ED pharmacist implementation. They describe barriers, such as the challenge of 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 entire pharmacy department.

Incorporating a new clinical pharmacist position requires considerable planning, evidence, and other management skills, including but not limited to time management, financial forecasting, acquiring the proper evidence, demonstrating value, and melding clinical applications/knowledge with solid leadership. The example described and reference cited here go into significant detail about service in and ED; however, the main premises hold true for any other niche setting, even while the specific detail may change. Establishment of a service requires detailed business planning, consultation of the literature, support/evidence from professional organizations, legal and ethical requirements, and consideration of challenges, costs, and benefits to determine return-on-investment. This kind of preparation will likely breed success.

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.

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

Authored by:

Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social/Behavioral Pharmacy at Touro University California