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Emergency Medicine Pharmacy and its History

Jimmy September 4, 2021

What is Emergency Medicine Pharmacy?

American College of Clinical Pharmacy (ACCP) and the American Society of Health-System Pharmacists (ASHP) defined emergency medicine pharmacists (EMPs) as one who: 

“specializes in the delivery of direct patient care at the bedside and care for patients across diverse populations and acuity levels. These specialists are critical members of the inter-professional emergency medicine team, can anticipate pharmacotherapy needs in the fast‐paced environment of the emergency department (ED), and have expertise in the management of time‐dependent emergencies, pre‐hospital medicine, emergency preparedness, public health, and toxicology. Emergency medicine pharmacy practice focuses on rapid assessment of available patient data to optimize pharmacotherapy, improve patient safety, increase efficiency and cost‐effectiveness of care, facilitate medication stewardship, educate patients and health care clinicians, and contribute to research and scholarly efforts.”

Early Years of Emergency Pharmacy

Dr. Robert Elenbaas is the pioneer of emergency pharmacy, he practiced at Truman Medical Center in Kansas City, Missouri

He became the first director of the American College of Clinical Pharmacy, which he also founded. In the United States, clinical pharmacy services in the emergency department started in 1970.

“Joe Barone went and started EM program at Rutgers right after finishing at UICC in 1981. Probably the longest continuous of us all. Not sure of starting years but Mary Ann Howland in NYC, Jay Schauben had ED/Tox programs back then.”

“My own first PGY2 EM/Tox Resident was Sue Gorman but she left after a year to take a dream faculty position in EM. The first to complete 2yr was Kevin Rynn and Don Tillman 92-94 (it was a 2yr contract for PGY1 and PGY2) ultimate early commitment.”

– Frank Paloucek (Twitter: @Itsalltox)

  • The first accredited postgraduate year 2 (PGY2) residency training program in EM pharmacy was established at Detroit Receiving Hospital
    • The second accredited program was launched shortly thereafter by the University of Rochester Medical Center.

The  service provided by the pharmacy department in the emergency department is uncommon and only a few of large urban emergency department has it. 

The emergency (EM) pharmacists became the “walking pharmacology book” as they respond to various questions regarding drug information. 

Later on, EM pharmacists took several shifts even night shifts to be present when the number of patients increases.

Medication Errors in the ED

A medication error is any error in the medication process, regardless of whether a patient experiences an adverse consequence.

Thousands of Americans die each year as a result of medication errors, and approximately half of these errors occur during hospitalization.

An estimated $29 billion is spent each year in the United States as a result of medication errors.

Statistics of Medication Error:

  • A recent study showed that 59.4% of patients had one or more medication error.
  • ED has highest rate of preventable errors 
  • 110 MILLION ED patients yearly in US* 
  • 5% experience potential events 
  • 70% of these are PREVENTABLE**
  • 77% of all ED medication errors between ordering phase and administration phase 
  • 23% of errors were discovered before patient received medication 
  • 39% in other area of hospital
*National Center for Health Statistics. **Harvard Medical Practice Study

Clinical Pharmacy Program by Fairbanks

In November 2004, Fairbanks, R. et. al. proposed a pilot tested and implemented an ED-based clinical pharmacist program in the ED of a level-1 trauma center at an academic medical center with 739 licensed inpatient beds.

This program aims to determine the positive changes when a clinical pharmacist will be assigned to the ED; these changes pertains to reduction of medication errors in the ED.

In the program,  the ED clinical pharmacy specialist (CPS) position was assigned to a clinical pharmacist with a doctor of pharmacy degree who is in the ED Monday through Friday from 10 a.m. to 6 p.m.

The CPS was given a dedicated computer with network access and online references and carried a portable telephone to be easily accessible to nursing and physician staff in the ED.

The roles that was given to the CPS includes:

  • clinical consultation   
  • care of boarded patients
  • patient education     
  • emergency preparedness
  • order screening         
  • staff education
  • dispensing drugs         
  • stocking of medications
  • resuscitation response 
  • preparation of medications

As expected, the program was successful as it positively changed the traditional ED practice.

Fairbanks and his team concluded that “the provision of clinical services in the ED by a  pharmacist appears to have improved medical care, imparted knowledge to ED personnel, and reduced institutional expenditures.”

Some of the positive changes brought by the program were:

  • By intervention in prescribing practice, the CPS was able to reduce the amount of some high-cost medications.
  • There was also a case wherein the CPS was able to prevent administration of contraindicated medications.

EM Pharmacy Received Recognition 

On the 21st of February, 2020, an article was published on the website of Board of Pharmacy Specialties (BPS) stating that Emergency Medicine Pharmacy is formally recognized as the fourteenth pharmacy specialty.

“BPS is pleased to formally acknowledge emergency medicine pharmacy as a new pharmacy specialty. The addition of this specialty underscores the growth of pharmacist specialization as well as the recognition of expanded patient care responsibilities of pharmacists in this practice area. Also noteworthy was the fact that over 200 physicians and 70 nurses submitted public comments in support of the petition”

Karen M. Gunning, PharmD, BCPS, BCACP
-Chair of the BPS Board of Directors

EM Pharmacy as a Growing Specialty

EM pharmacy continues to expand as there is also an increase in the availability of specialty residency training programs.

The number of accredited training positions has risen from 3 (three) in 2007 to 70 in 2020; these proved that there is a 2,000% percent increase in specialty training positions in just over a decade.