Role of Pharmacist In Emergency/Emergency Pharmacist Role

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.