A career as . an a&e department pharmacist

For personal use only. Not to be reproduced without permission of the editor
(permissions@pharmj.org.uk)
By Gail Foreshew, MSc, MRPharmS
Pharmacists can help A&E departments achieve thefour-hour target for dealing with patients department is one of the busiest in Britain, Drug history taking
with 131,581 patients attending in 2004. Arecent £6m development has enabled a new Taking a drug history has been found to be Roles for hospital pharmacists
have expanded in recent years,with pharmacists working inmore specialties and regularly a key role for pharmacists working on med- attending ward rounds, as well as working and the redesign has allowed for a full-time specialist emergency department pharmacist dent and emergency (A&E) departments.
pharmacists are more accurate than doctors The A&E department is traditionally an area that has had little pharmacist input jointly accountable to both the clinical phar- departments. However, it is the department patients are admitted to medical admissions with the highest turnover of patients in a director for the emergency department.
wards, may have several benefits. For exam- hospital and is where substantial quantities of ple, it enables better judgements to be made medicines are administered. A&E depart- cialist pharmacist’s post at QMC is: “To by doctors about adjusting patients’ treat- ments are chaotic places at times and, for histories are already known. It also means resuscitation room may increase the risks include helping to bridge the gap between that any drug-related issues on admission, or associated with the use of medicines. Thus, there are many challenges for pharmacists ting wards in the hospital, and improving highlighted early on in a patient’s stay as rec- in providing a service to these departments.
made by a pharmacist working in the emer- drug histories for patients on the medical Key areas of work
admissions ward, this service also helps to reduce junior doctors’ workload and speeds hospitals are using pharmacists in their A&E emergency care. Current targets for treat- amount of time patients spend waiting for ment in the A&E departments, introduced in December 2004, specify that 100 per cent of patients attending the A&E must be admit- pharmacist takes a drug history for those ted, transferred or discharged within four hours.1 These targets have led to a hospital- Background
wide redesign of processes and to changes in skill mix, with nurses and other health patients about the medicines they are tak- ing or, as appropriate, from referring to the patient’s GP, nursing or residential home cist’s roles in the emergency department is Gail Foreshew is an emergency department
to look at initiatives to help achieve the pharmacist then reviews the patient’s med- pharmacist, Queen’s Medical Centre, Nottingham icines in light of the reason for admission.
H O S P I TA L P H A R M A C I S T Any drug-related issues that may be impor-tant to the patient’s treatment are brought tothe attention of medical staff. The pharma-cist may suggest a simplification of amedicine regimen if necessary. A full drughistory and any relevant comments are doc-umented in the patient’s medical notes andthe pharmacist informs ward-based pharma-cists of any patients that may need to befollowed-up.The pharmacist is also involvedin completing drug charts, which are thenreviewed and signed by a doctor.
Ward rounds
every morning for patients that have beenadmitted to hospital under the care of the emergency department.This is a small ward Gail Foreshew (right) advises registrar Dr Sue West-Jones round with up to 14 patients and is attendedby the emergency department pharmacist.
ing incidents and drug errors. The multi- mation on administration of these drugs, any On the ward round, the pharmacist’s role copy self-carbonated drug charts used in the dosage calculations that are required and is to clarify drug histories, add any new hard to read and this resulted in patients on chart, provide advice to medical and nursing the wards either not receiving their medi- Teaching other staff
staff and write discharge medication forms.
As well as ensuring the appropriateness of medicines for patients, having a pharmacist department’s risk management group, the A&E department pharmacist’s role. This complete discharge medication forms speeds up the discharge process. For patients who drug charts to rectify the problem. These are discharged during the ward round, med- icines are dispensed by the pharmacist, or piloted and implemented in the department.
education team. Informal educational input discharge technician, immediately after the is part of the pharmacist’s daily work and Intravenous drug therapy A second issue
formal teaching sessions are also undertaken charge prescriptions can be dispensed on the ward using pre-packs. This enables patients errors with intravenous medicines. This led to be discharged promptly and helps to clear organising training for all adult and paedi- induction to ensure that they are aware of trust and national guidelines.Topics covered help meet the four-hour target for the emer- standardised intravenous infusion guidelines.
guidelines and guidelines specific to the Guidelines
Risk management
receive training on various subjects includ- guidelines in place in the emergency depart- QMC is part of the department’s risk man- was created. Since this time, new guidelines and reviews all incidents. Any trends are have been developed for treating illnesses studied and practices altered if appropriate.
and infections only applicable to the emer- The pharmacist liaises with members of the hospital’s drug incident group regarding any department pharmacist has taken a lead role drug incidents that may have a hospital-wide in their development.These guidelines have increasingly flexible use of workforce skills.
management issues have included the intro- antibiotic guidelines for the treatment of duction of colour-coded syringe labels in line with national guidance and reviewing the treatment of patients who have received there will still be times when PGDs will be ampoules in view of similar packaging.
addition, for paediatric patients, guidelines have been introduced for the dose-rounding pharmacist is involved in writing new PGDs of analgesia, as well as a treatment algorithm and reviewing and updating the old ones.
for patients presenting with anaphylaxis.
The pharmacist is also involved in reviewing Intravenous infusions can involve compli- trust-wide PGDs to ensure these are applic- Documentation Incidents on medical
cated calculations. A set of standardised wards highlighted problems in identifying infusion guidelines for the administration of exactly which medicines had been adminis- Source of advice
tered while patients were in the emergency department. Incidents were analysed using available for use by both medical and nursing the hospital’s Datix programme for report- staff. The guidelines contain essential infor- information to all medical and nursing staff.
H O S P I TA L P H A R M A C I S T related issues they have and to organise their started in 2004.The group aims to provide a medicines if they are admitted to residential link for all emergency care pharmacists and or nursing homes. For these patients, the includes A&E department pharmacists. It ran pharmacist also clarifies drug histories and its first series of workshops at the UKCPA reviews medicines, advising on specific areas such as analgesia and fracture prevention.
study day is expected to be held this year.
Research
example, the study day “Introduction to crit- At QMC, the pharmacist is involved in the ical care” run by the UKCPA Critical Care hospital’s emergency department research group. In addition to undertaking audits, the pharmacist assists in research projects, help- Future developments
Counselling at discharge
issues. At other hospitals, a number of pilot studies looking at ways in which the phar- pharmacist is likely to continue to expand as selectively counsels patients on discharge, department have already taken place.
realise the benefits of having pharmacists as concentrating on seeing patients taking mul- part of their teams. It is also possible that pharmacists in the A&E department in see- there may be new roles for pharmacy tech- nursing staff. Examples of patients that have attempts are made to streamline a patient’s including those with coughs and colds, aller- ● A patient admitted with hypoglycaemia gic reactions, bites and stings, and reactions References
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Department of Health. Reforming emergency carried out at Guy’s and St Thomas’ NHS care. London: Department of Health; 2002.
2.
Hospital pharmacists group. Providing pharmacy comes of patients presenting with requests services to medical admissions units. Hospital for repeat medicines being seen by a phar- macist were studied.9 The study showed that 3.
Covington T, Pfeiffer F.The pharmacist-aquired Assessment and care team
the pharmacist was able to supply a faster ser- medication history.American Journal of Hospital vice compared to the previous service where patients waited to be seen by a doctor.
4.
(FACT) team at QMC is a multidisciplinary Pulver L, Meyer E, et al. Review of pharmacist- team based in the emergency department.
benefits for patients, some hospitals are dis- conducted medication histories in three teaching The team consists of nurses, physiotherapists couraging the types of patients examined in hospitals.Australian Journal of Hospital Pharmacy the studies from attending A&E depart- patients aged 65 years and over to establish 5.
Tulip S, Campbell D. Evaluating pharmaceutical whether these patients will be able to man- minor illnesses are being seen by the primary care nurse who redirects patients to the most intermediate care if this is unlikely. Interme- appropriate health care service, which may 6.
Audit Commission.A spoonful of sugar: medicines diate care includes admission to residential include an emergency GP appointment.
Clinical decision units
7.
Crown J. Review of prescribing, supply and administration of medicines. London: Department QMC plays an integral part in this process Clinical decision units are attached to the and patients requiring intermediate care are A&E departments in some UK hospitals.
8.
Anon. Developing roles for pharmacists in referred to the pharmacist for any medicines They are designed for short-stay patients UK Clinical Pharmacy Association
hours, which may include patients who have 9.
Collignon U, Oborne C, Parfitt A, Ellis C.
Emergency Care Group
taken overdoses who need monitoring for a Pharmacist sees patients in the emergency few hours or patients admitted with cellulitis department: new model of care (abstract).
This group is planning to run a study day in before continuing treatment under a home- care service. Because of the high patient Association autumn symposium; 2004 November care — where are we now?”The day will turnover, a rapid and efficient pharmacy ser- be centred around pharmaceutical care and Paper on accident and emergency
patient’s journey through emergency care, Training for the role
department pharmacists
the developing role of the emergency care pharmacist, the impact of the four hour A paper determining the incidence of drug mandatory qualification for A&E department related problems and comparing the extent pharmacists. Most training is “on the job”, to which complete medication histories are information will be available from the UK with training needs varying depending on the recorded by doctors and clinical pharmacists in an A&E department is set to be published (www.ukcpa.org.uk)
in next month’s issue of Hospital Pharmacist.
H O S P I TA L P H A R M A C I S T

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