Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department

Abstract

The study sought to determine whether the inclusion of a pharmacist on the emergency department (ED) resuscitation team was associated with improved compliance with the Advanced Cardiac Life Support (ACLS) guidelines and patient survival. The study also evaluated cost avoidance associated with a pharmacist providing clinical services to the ED. Cardiac arrest event records were evaluated for compliance with ACLS guidelines as well as for whether or not a pharmacist was involved as a member of the resuscitation team. Pharmacists documented all interventions performed while physically present in the ED which were utilized to associate cost avoidance. When a pharmacist assisted as a member of the resuscitation team, a significant increase in the percentage of medications administered in compliance with the ACLS guidelines was noted (78% vs 67%, = .0255). An increase in survival to hospital admission (25% vs 17.8%, = .0155) was also noted though no significant increase in survival to hospital discharge (15% vs 4.4%, = .6392) was observed. Over a 5-month period, pharmacists in the ED performed 1200 interventions, which created US$98 362 in cost avoidance. This extrapolates to approximately US$320 000 per year in cost avoidance. Inclusion of a pharmacist as a member of the resuscitation team improved compliance with medications administered according to the ACLS guidelines and increased survival to hospital admission, though survival to hospital discharge was unaffected. The presence of a pharmacist in the ED was associated with approximately US$320 000 in cost avoidance per year, if not more.

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

“…Compliance with ACLS recommendations was 27.4% higher with a pharmacist present at the code, corresponding to $1283 in CA due to prevention of a major ADE . Another study using pharmacy residents as extenders confirmed this benefit, demonstrating an 11% increase in compliance to ACLS guidelines with pharmacist presence in the ED . A key gap in this area is that the proportion and types of ADEs prevented by this intervention are not well documented and should be explored further.…”

“…58 Another study using pharmacy residents as extenders confirmed this benefit, demonstrating an 11% increase in compliance to ACLS guidelines with pharmacist presence in the ED. 59 A key gap in this area is that the proportion and types of ADEs prevented by this intervention are not well documented and should be explored further. Additionally, improved accuracy and efficiency of medication preparation performed by a pharmacist in the delivery of ACLS have not been described.…”

A Comparison of Tertiary Drug Resources’ Consistency Regarding Drug-Drug Interactions of Adjunctive Analgesics

“…7 Pharmacists are uniquely qualified to provide drug information and therapy recommendations to other health care providers in high-acuity settings, and their comprehensive training in pharmacotherapy has demonstrated better patient outcomes and lower health care costs in a variety of clinical areas. [8][9][10] Despite these facts, not all health care systems employ emergency department pharmacists, and the intimate drug knowledge required to make an appropriate recommendation in the emergency setting is not possessed by all pharmacists. 11 Regardless of training, level of expertise, or years in the profession, pharmacists and other health care providers alike rely on tertiary drug resources as a tool to provide up-to-date information in a rapid fashion.…”

Pharmacy Student Performance in a Capstone Course Utilizing the Pharmacists’ Patient Care Process

“…Pharmacists consistently improve patient care outcomes and are considered vital members of the patient care team in numerous practice settings and specialties. [1][2][3][4][5][6] As such, high value has been placed on the independent ability of a pharmacist to identify drugrelated problems in patients with a range of medical comorbidities and disease severity. 1,2 The Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes and the Accreditation Council for Pharmacy Education (ACPE) Standards for the Doctor of Pharmacy degree have been updated to place empha-sis on students graduating as "practice-ready" pharmacists in leading medication therapy management as a member of the healthcare team.…”