History: First emergency was started in US in
1950. Since then the rate of mortality
is highly decreased. The role of pharmacist in emergency department was first
time defined in 1970. Initially the role of pharmacist was confined to the drugs
distribution in this department. Later on the role was expended to other
activities. The primary role of pharmacist in emergency department is divided
into two main roles:
a) Essential Role: essential role of pharmacist include
direct involvement in pharmacotherapy management. Essential role include things
like Direct patient care rounds, drug prescription review etc. Parts of
essential role include things like :
1) Direct patient care Rounds:
IN this case pharmacist is involved
in optimization of therapy via controlling errors in drug selections and
prescribing. A whole team of health care is involved in this scenario including
nurses and physicians. A complete review or selected review of drugs use is
done in emergency depending upon the number of pharmacist available. For
example when limited number of pharmacist are available then triage system may
be followed instead of focusing on all critically ill, high risk patients or
selected drug with high chance of interaction are selected to be checked. This triage system just like first priority”
critically ill patient only” then “high risk patient” and/or “selected drug
with high chance of drug interactions” is preferred when the number of
pharmacists are not according to the need.
Medication order review:
A prospective review
of medication order must be done by the pharmacist before the drug is
administered to the patient. In some case the review if not done is not
compulsory. Just like
1) In- Case of emergency
- when the patient is critical and
review time may fall his life in danger so it is good not to have a review.
Although selection is done along with the physician.
2) If the Delay of the review harms the patient.
3) If medical practitioner is itself present there.
When serving in emergency the services provided by the
pharmacist depends on the number of patient and number of pharmacist available.
When low number of pharmacist are hired in Emergency department the pharmacist
work is overloaded. So in this case the medication orders coming for review, the
pharmacist will review the orders according to the need.
Majority of emergency orders are one time orders so it is
necessary that pharmacist review the order before administration. Similarly to direct patient care rounds a
triage system is also followed here. When running short of time other
department pharmacist may be involved through computerized provider order entry
(CPOE) system where all of the pharmacist are linked through computerized
system with emergency department. Alarm system may be developed where Emergency
pharmacist require the help of other pharmacist and is done quickly.
Medication Therapy Management:
Medication therapy
management is necessary in Medication use process, whether the therapy selected
was safe and effective, sub-optimal, or failed and whether changes to the
therapy regimen is needed. Medication
therapy management prevent the insecure use of medicines in future and promote
regular use of medicines.
Patient care involving high risk medications and procedures:
High risk medications include medicines with narrow
therapeutic Index (NTIs). Such drugs must
be used under the strict supervision of pharmacist. similarly alternate
procedure used in life saving process must be observed by pharmacist form the
bed side of the patient. Emergency
pharmacist should evaluate current procedure associated with the use of high
risk medications. Participation of
pharmacist in such process include proper selection, proper doses, preparation
of medications and monitoring of therapy.
Several recommendations for reducing errors associated with high risk
medications and procedure must be followed i.e smart infusion technology and
double medication check system for high risk medications.
Resuscitation:
The role of pharmacist in stabilizing
(resuscitation) the patient is crucial. As previously said pharmacist prevent
medication error thus prevent any harm to the patient. Other things pharmacist must do is immediate medication preparation, providing
as instant source of knowledge, making recommendations for alternate route of
administration, answering questions regarding drug in emergency room, assessing
physicians with differential diagnose related to medication cause and resuscitation documentation.
Toxicological
emergencies
The role of pharmacist can,t be neglected here. As the
pharmacist provides as a primary source of drug information. No toxicological emergency can be done in a
better manner without the involvement of pharmacist. In toxicological
management Emergency pharmacist should have a proper and through knowledge of
antidotes and their administration, supportive therapies, antidote preparation,
monitoring antidote effectiveness and safety.
In order to become a successful and complete member of toxicological
team pharmacist must have knowledge and skill or must have gone through some
post-graduation courses and exams in this vary field.
Medication procurement and Preparation:
Medication procurement in emergency
department presents challenges as compare to the central pharmacy department.
Because of the urgent treatment drugs must be readily available. Medication procurement process in emergency
department depends on the number of pharmacist , average number of patient
entertained and number of patients available. In case of low profile pharmacy
services provided by hospital emergency, drugs may be kept in pavilion,
emergency kits which keep all required drug for emergency and similarly
automated emergency cabinets. A
satellite pharmacy with compounding ability is best source of medications
availability to emergency department. As a separate sterile room may not be
possible in emergency departments so a laminar flow hood may be a least choice
for IV preparations. If satellite pharmacy is not available the central
pharmacy with rapid preparations processes must set up to provide the needs.
And Emergency pharmacist itself should be competent in performing such
processes.
Medication Information:
Cause of nearly all the medication
interactions and errors is lack of information. As an expert of pharmacology
and toxicology pharmacist must assure to deliver the regarding information to
the health care personals involved in emergency department. Information
provided by the pharmacist include information about the rationale use of drug,
proper dosing, route of administration, way of administration etc. Pharmacist should be able to concern primary,
secondary and tertiary sources literature when provision of information is need
to be delivered to health care personals.
Documentation:
Documentation provide future record about the
patient condition and therapy used in emergency. It may be a legal process
required in some states. Documentation may be done in various manners and
through various ways depending on the institution. It may include electronic
devices, internet in a hospital linking various departments or done manually.
Manual documentation is done on a paper and is a tedious process and loss of
record is a prominent chance. Electronic documentation provided a batter way of
documentation and retrieval of record can
be done easily.
b) Desirable Roles: - Desirable role of pharmacist include those role which are optional which
depends upon the skills of pharmacist, time and workload. if desirable roles
can be delivered it adds prestige to the standing of pharmacist.
Desirable roles of pharmacist include
Education:
The role of EMPs in education can be
variable and broad, and it has been mentioned in conjunction with other
responsibilities throughout these guidelines. It is desirable for EMPs to
participate in the education of other health care providers, including pharmacists
and pharmacy staff, pharmacy students, pharmacy residents, physicians, medical
residents, mid-level practitioners, nurses, and emergency medical support
personnel. The types and levels of education will vary with patient care and
administrative workload.
Research and Scholarly Activities:
Three type of researches are
conducted by emergency pharmacist. These include “trauma and injury control
research” pre-hospital Emergency research and research attributed to other
fields but affect emergency.
