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From the ASHP Guidelines on Emergency Medicine Pharmacy Services (my emphasis in bold):
Research on pharmacist interventions in the inpatient setting has demonstrated improvement in patient outcomes through optimized pharmacotherapy regimens, improved monitoring of medication therapy, and avoidance of adverse medication events. In addition, pharmacist participation in patient care has been shown to significantly reduce the costs associated with medication therapy. Research has detailed EMP interventions in the ED, describing improvements to the medication-use process and patient care by EMPs recommending improvements in medication therapy, serving as a medication information resource, and improving patient safety. Several of these publications have shown dramatic cost avoidance. More detailed studies on the role of EMPs in managing specific disease states and a definitive evaluation of improvement in patient outcomes are needed.
An article in this month’s issue of AJEM also hits on an essential point regarding some of the ideas related to the tracking and documentation of interventions and association with cost savings mentioned in this episode:
It is important to note that a true pharmacoeconomic model that predicts cost avoidance associated with implementation of a clinical pharmacist in the ED does not currently exist.
A study conducted by Abu-Raimaileh and colleagues may just be the beginning of small steps being taken to define and demonstrate quality interventions by pharmacists in the emergency department. However, this certainly is not the end all or be all of where we should be at this point.
We do have our work cut out for us in several ways, three of which are highlighted below:
- Changing the way that pharmacists have routinely conducted research in the ED when it comes to justification of pharmacy services. In doing so, more meaningful practice-based research for our roles in the emergency department can emerge and begin to evolve (some ideas on how to do this are described in the episode).
- Reaching out vital stakeholders among our nursing and physician colleagues (including our EM residents) within our own EDs and begin to collaborate with them in conducting real honest-to-goodness quality improvement initiatives in measuring the true impact of the pharmacists’ role in the emergency department through the demonstration of a [potentially likely] decrease in interventions by EMPs over time.
- [Revolutionary] shifting of the mindset of institutional administrators who have traditionally held hard and long to the idea of utilizing cost avoidance associated with interventions in justifying the presence of the emergency medicine pharmacists.