4/26/2017. Emergency Department Pharmacist Interventions in a Small, Rural Hospital. Disclosure Statement. Learning Objectives

Transcription

1 Emergency Department Pharmacist Interventions in a Small, Rural Hospital Chaundra Sewell, PharmD PGY1 Pharmacy Practice Resident Community Medical Center Missoula, MT Disclosure Statement This presenter has no disclosures to make to the audience Learning Objectives Identify interventions that an emergency medicine pharmacist in a small, rural hospital can make Identify opportunities for emergency medicine pharmacists to further their involvement in the care of patients in the emergency department 1

2 Study of Medication Errors in the Emergency Department (ED) 1 10-month study 40-bed ED in academic, tertiary-care facility 70,000 patients per year No CPOE Clinical pharmacist observed nurses on 28 shifts Made note of any med errors Only intervened when there was risk of harm to patient Study of Medication Errors in the ED 1 : Results 59.4% of patients had 1 or more errors 1 error that reached the patient for every 8 med orders and 5 doses administered Observer intervened on 52 occasions 1 error may have contributed to or resulted in temporary harm to the patient Likely underestimates true incidence Why so few emergency medicine pharmacists? Pedersen et al. 2

3 Background Community Medical Center (CMC) has a medication reconciliation (med rec) pharmacist who works out of the ED Monday- Friday Primary job is to complete med recs on admitted patients Why not expand this position to an EMP? Study Objectives Determine what our med rec pharmacist does and how we can expand the services Identify the types of interventions that are being made by our med rec Estimate cost savings and time spent on these interventions Compare data from the first 4 weeks to a 4 week timeframe later in the residency year Methods Med rec pharmacist in the ED Monday through Friday All interventions logged into Quantifi system Data was be quantified into amount, time spent, and cost-savings Cost-savings were calculated based off prior research and data that determined each pharmacy intervention saves approximately $109 3

4 Calculating Cost Avoidance Healthcare Inflation Rate Factor = 4.5% per year Cost of preventable adverse drug event (ADE) = $3,447 $5,167 when for annual inflation rate Rate of preventable ADEs = 2.6% Calculating Cost Avoidance Costs avoided per pharmacy intervention: $5,167 x 2.6% = $ To make the estimate even more conservative we use: $4,200 x 2.6% = $ Phase 1 Results 4

5 Phase 1 Results Intervention Number of interventions Time spent (min) Cost savings ($) Med Rec Drug Information Dose Recommendation Clarification of Orders Abx Recommendation Patients Own Med Eval Allergy Clarified Patient Counseling Creatinine Clearance Evaluation Drug Interactions Total Discussion 62 hours worth of work done Assuming a 40 hour work week, equates to 1.5 weeks If we extrapolate, $257,894/year Pharmacy should continue to expand services in the ER to increase hours Limitations Staffs comfort with pharmacist Staffs understanding of pharmacy services Physician working that day All medication orders from ED are override status Do not need verification to pull meds from Pyxis 5

6 Limitations Slower than usual Timing of the shift Method of logging interventions Method of quantifying cost-savings Question #1 Which of the following interventions did the EM pharmacist in this study spend most of their time on? A. Drug information B. Medication reconciliation C. Dose recommendations D. Clarification of orders Question #1 Which of the following interventions did the EM pharmacist in this study spend most of their time on? A. Drug information B. Medication reconciliation C. Dose recommendations D. Clarification of orders 6

7 Question #2 Which of the following interventions were the EM pharmacists in this study NOT involved with but could be an opportunity for them to expand into in the future? A. Drug information B. Medication reconciliation C. Dose recommendations D. Culture follow-up Question #2 Which of the following interventions were the EM pharmacists in this study NOT involved with but could be an opportunity for them to expand into in the future? A. Drug information B. Medication reconciliation C. Dose recommendations D. Culture follow-up Phase 2 Pharmacist-led culture follow-up process approved Plan to the pilot this program during phase 2 Data gathering April

8 Phase 2: Change of Plans No longer a med rec pharmacist as of April 14 Shifts the focus of the project Effects on data due to resident availability in the ED Results to be determined References 1. Patanwala AE, Warholak TL, Sanders AB, Erstad BL. A prospective observational study of medication errors in a tertiary dare emergency department. Ann Emerg Med Jun;55(6) Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education Am J Health Syst Pharm Sep;73(17)