Enhanced pharmacy practice in ER, what does it mean for patient care?

Emergency Department (ED) performance as measured by the four-hour target reached a record low in 2018. There are many reasons for continuous poor performance, not least a shortage of healthcare professionals – particularly doctors – to staff these departments.

In an effort to supplement these shortages, training courses tailored to an emergency care setting have been developed to provide advanced clinical skills to pharmacists.

The findings of a Health Education England (HEE) study concluded with the hypothesis that pharmacists with additional clinical skills training could manage 36 percent of ED patients as part of a multidisciplinary team. This created further interest and likely increased role implementation, but also led to further questions: what were these pharmacists actually doing, and how can we evaluate whether they add value to existing emergency care provision?

This is the first ever study to define and describe the role of a pharmacist who has overall clinical responsibility for patients in an emergency care setting.

A research team at the University of Manchester, led by Daniel Greenwood, sought to answer these questions through multiple research methods, including real time data collection from ED pharmacists, literature reviews and expert multidisciplinary panels.

The data collected enabled the research team to identify key role attributes of EDPPs. They reported that ED pharmacy practitioners:

  • Have completed additional hands-on clinical skills training
  • Provide medical and/or pharmaceutical care, and sometimes arrange social care
  • Work in any area of the ED
  • Support patients with medical complaints and injuries of any severity and at any stage of their visit
  • Are sometimes the designated care provider of patients
  • Care for patients as part of a multidisciplinary team and learn from and educate this team; and
  • Undertake indirect patient care activities, such as develop guidelines.

To our knowledge, this is the first ever study to define and describe the role of a pharmacist who has overall clinical responsibility for patients in an emergency care setting.

Methods to support evaluation of the impact of these pharmacists were also developed. This includes a quality evaluation framework and a service specification which can be compared with existing service structures and processes, in addition to setting out expectations for hospitals wishing to launch the service.

So, where to from here? [Our] plans are to develop and conduct a study that will conclude the quality impact of ED pharmacy practitioners. This will focus on prescribing errors [and] other priority outcomes such as length of ED stay.

The research team also plan to improve their understanding of multidisciplinary working in emergency care as the ED workforce continues to diversify. In addition, as more pharmacists acquire additional clinical skills and move into new practice settings such as general practice and other urgent care settings this research provides a basis for evaluation of these new roles.

It is vital that we understand how and how well pharmacists in emerging roles care for patients to ensure quality and value for the NHS.


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