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A Pharmacist at the Bedside

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Placing specialized pharmacists in the emergency department is a relatively uncommon practice, but it’s something that Dan Hays, PharmD, sees as a crucial component of patient safety. As a clinical pharmacy specialist for the University of Rochester (NY) Medical Center, Hays works four consecutive 12-hour shifts each week in the 120-staffed-bed ED.

URMC is one of two facilities in the country to offer an accredited residency program for pharmacists interested in specializing in emergency medicine—the other is 320-licensed-bed Detroit Receiving Hospital. Rather than playing the traditional role of medication dispenser, the ED pharmacist instead participates in implementing the best possible care immediately upon patient arrival. “The decrease in medication errors is what leads to improvement in patient safety,” says Hays. “We feel that dispensing takes the pharmacist out of the ED loop. We’re here solely on a consultation basis.”

Rochester is looking to fill the remaining shifts for the position to secure a daily 12-hour pharmacist presence to help ED clinicians sort through patients’ often complex drug histories, Hays says.

Specialized pharmacists remain a rare sight in emergency rooms nationwide, however; only 1 percent to 3.5 percent of hospitals have such positions, Hays says. The Medical Center in Bowling Green, KY, is testing a pilot program with pharmacy students, but the facility has yet to actualize an official emergency pharmacist position, according to Melinda Joyce, corporate director of pharmacy. “One of the biggest limitations is that most hospitals don’t have 24-hour pharmacist coverage,” says Joyce. Also, the ED isn’t for everyone, so hospitals are often left with only one or two people willing to carry out the role.

But like Hays, Joyce touts the importance of having specialized pharmacists bedside with physicians. “Not only can they talk to patients about medications, but they can also make accurate determinations about what meds should be used and how to dose it all,” she says, adding that this is especially critical for reducing doctors’ chances of administering meds that could potentially trigger allergic reactions in patients. “Families sometimes just gather up everything and bring it all to the hospital. The pharmacist can sift through the materials and get a good idea of the patient’s medical history, how it has been working and what kinds of problems have occurred,” Joyce says.

—Matt Rogers