Implementation of an Advanced Pharmacy Practice Model in the Emergency Department

Purpose Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists’ interventions in acute care settings. Methods An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. Results The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. Conclusion Cost-avoidance studies of pharmacists’ interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.

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Implementation and safety evaluation of autoverification for select low-risk, high-volume medications in the emergency department

Bienvenida

Kroll

Ruhland

et al. 2022

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Use of autoverification has decreased in many emergency departments (EDs) with the expansion of emergency medicine (EM) pharmacists. Few studies have evaluated ways to prioritize verification of medications. Here we describe a process to design, implement, and measure the safety of autoverification of low-risk, high-volume medications. Summary A 3-month retrospective review of medications ordered and administered in the ED generated a list of medications to be considered for autoverification. Concurrently, a novel risk stratification tool was created to identify low-risk medications. Taking these together, medications that were high volume and low risk were considered potentially autoverified medications (PAMs). To evaluate the safety of PAMs, a retrospective review of the ED medication orders placed before implementation of autoverification was performed. A total of 7,433 medication orders were reviewed. Of these, 3,057 orders (41%) were identified as PAMs. EM pharmacists verified 2,982 (97.5%) of the orders without changes. Of the remaining 93 orders that were modified or discontinued and met autoverification criteria, only 2 (0.07%) were identified as potentially inappropriate for autoverification. Conclusion Low-risk, high-volume medications can be safely autoverified in the ED by using a systematic approach to order selection. Using these methods can provide large decreases in verification volume, close to 41%, without compromising patient safety.

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Implementation of an Advanced Pharmacy Practice Model in the Emergency Department

Cited by 6 publications

References 42 publications

Impact of Postgraduate Second-Year Pharmacy Training (PGY2) on Clinical, Financial, and Educational Outcomes: A Scoping Review

Impact of Postgraduate Second-Year Pharmacy Training (PGY2) on Clinical, Financial, and Educational Outcomes: A Scoping Review

Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review

Implementation and safety evaluation of autoverification for select low-risk, high-volume medications in the emergency department

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