ASHP InterSections ASHP InterSections

February 1, 2016

Pharm.D.-M.D. Team Successfully Enacts Opioid-Free ED Shift

ED Intake

A pharmacist-physician team at Maimonides ED successfully substituted non-opioid pain meds for its patients in a recent IRB-approved study.

OPIOIDS ARE OFTEN THE GO-TO ANALGESICS in the emergency department (ED). They’re fast, powerful, and easy to prescribe and administer. But opioids are also addictive and a favorite among drug-seekers.

At Maimonides Medical Center, a 705-bed academic medical facility in Brooklyn, N.Y., a team of pharmacists, physicians, and researchers designed and implemented an eight-hour opioid-free shift in the ED to determine whether non-opioid analgesics could provide sufficient pain relief to help avoid some of the challenges of opioid overuse, such as dependency.

The project arose from a discussion between Victor Cohen, Pharm.D., BCPS, CGP, then clinical pharmacy manager of emergency medicine, Department of Pharmacy, and Sergey Motov, M.D., FAAEM, assistant program director, Department of Emergency Medicine, about the growing national problem of opioid addiction.

Victor Cohen, Pharm.D., BCPS, CGP

Victor Cohen, Pharm.D., BCPS, CGP

“We were getting stories from psychiatry physicians about OxyContin and other opioids. There is a significant OxyContin epidemic,” said Dr. Cohen, who is now corporate clinical director of pharmacy services at the Health and Hospital Corporation of New York City. “I thought we really needed to try to achieve an opioid-free ED for a day.”

Because Dr. Motov had conducted prior research on the effectiveness of ketamine vs. morphine in the ED, he was on board with the idea from the start and went to the Maimonides ED administration and institutional review board with the concept.

“I let them know that I would take full responsibility for provider education and for writing the protocol,” he said. “We were very clear that we didn’t want anyone to suffer, and we promised to designate a time limit for patients. If they were still in pain after other alternatives were used, we would use an opioid such as morphine, fentanyl, or hydromorphone as a rescue therapy.”

We knew based on personal experience that we would get a reasonable response to the [non-opioid] medications.

From there, Dr. Motov assembled a team of staff from the departments of emergency medicine, pharmacy, and clinical informatics to design a pain management strategy based on channel/enzyme/ receptor-targeted analgesia.

The team then developed a corresponding order set for input into their computerized prescriber order entry system. Options for treatment depended on the type and severity of pain and included acetaminophen PO/IV, dexamethasone sodium phosphate, diazepam, ibuprofen, ketamine, ketorolac IV, lidocaine IV, and methocarbamol

Challenges and Results

One of the greatest challenges to implementing the opioid-free day was in getting other clinicians acclimated to using other medications, according to Dr. Motov. “There was a fair amount of discomfort [among the team] about using unfamiliar medications,” he noted. “The nursing team, in particular, was uncomfortable with off-label uses.”

Sergey Motov, M.D., FAAEM

Sergey Motov, M.D., FAAEM

Fortunately, Drs. Cohen and Motov had conducted comparative studies of the medications to be used that allowed them to assemble provider education that set the other clinicians at ease. “We had extremely high-level safety guidance in how to do these activities in the ED due to the studies we did,” said Dr. Cohen. “The protocols were all within accepted standards of care.”

The team’s combined clinical experience also came in handy, said Dr. Motov. “We knew based on personal experience that we would get a reasonable response to the [non-opioid] medications. But we actually had a higher rate of patient satisfaction than we anticipated.”

Of the 17 patients who were managed during the shift, 83 percent were satisfied with their pain relief after 30 minutes of treatment, and 86.7 percent were satisfied after 60 minutes. Two patients were admitted, and four received no prescriptions for pain medications. Of the remaining patients, only one received a prescription for an opioid. The rest received prescriptions for non-opioid analgesics. The details of the protocol and study appear in the December 1, 2015, issue of AJHP, co-authored in part by Drs. Cohen and Motov.

This represents a real opportunity to change patient care for the better.

As part of the initiative, the team also developed a pocket-sized card for acute pain management that includes the protocol. The cards have ensured that ED physicians continued the process after the opioid-free day, said Dr. Cohen.

“We found that attending physicians who weren’t part of the research team did not continue the process,” he noted. “Although some would do it intermittently, many of the seasoned practitioners didn’t change their typical prescribing behavior. The card has helped more physicians adapt to the new protocol.”

Pharmacists were integral to both the protocol development and the project’s implementation. According to Dr. Cohen, the team conducted the study as a public health exercise with the blessing of Fredrick Cassera, MBA, R.Ph., Maimonides vice president of outpatient pharmacy services and director of pharmacy.

An Opportunity to Reduce Opioid Addiction

Dr. Cohen feels there is a large and important role for pharmacists in the implementation of new non-opioid pain management protocols in both the ED and across the healthcare enterprise.

“Our roles lie in conception, adjudicating guidelines, preparing admixtures, developing order sets, assisting physicians in entering orders, and implementing the protocols,” he said. “This represents a real opportunity to change patient care for the better.”

For pharmacists in other hospitals and health systems who wish to do something similar, Dr. Motov had some helpful advice.

“Pharmacists know better than physicians what medications can do for patients,” he said, adding that pharmacists should actively collaborate with physicians when pursuing this new protocol. “You only need one doctor to agree to try something, and then that doctor will bring another one on board, who will bring another one. All it takes is that first physician, and it will all fall into place.”

Protocols for non-opioid pain management stand to have a great impact on emergency department care, according to Dr. Cohen. “We can’t get rid of opioids altogether, but we can certainly streamline their use and help to cut down on abuse and dependency in this country.”

–By Terri D’Arrigo

 

October 27, 2015

Pharmacists Find Ways to Make ADCs Work in the ED

Filed under: AJHP News,Clinical,Current Issue,Innovation — Tags: , , , — Kathy Biesecker @ 11:03 am

PHARMACISTS SAY AUTOMATED DISPENSING CABINETS (ADCs) can bring efficiencies to the care of patients in the emergency department (ED), but it’s important to ensure that nurses aren’t worried about being administratively locked out of the devices during a crisis.

PatriciaKienlePatricia C. Kienle, director of accreditation and medication safety for Cardinal Health Innovative Delivery Solutions, gave two examples of how such a crisis might come about: “A patient presents as a ‘John Doe,’ or it’s a trauma patient who you just have to take care of right away.”

At such times, she said, patient care trumps everything—including the usual procedures for logging the patient into the electronic medical record (EMR) system, routing medication orders to the pharmacy for verification, and releasing the drugs to nurses at the ADC.

“It happens in every hospital,” Kienle said. And, she said, hospitals devise different solutions to give ED nurses quick access to medications in such situations.

Michelle C. Corrado, system director of pharmacy services for Hallmark Health System Inc., of Medford, Massachusetts, said her organization’s ED nurses can use a “911 dummy” account in the Pyxis ADC when medications are needed for a patient whose information has not been entered into the EMR system.

“This was a way . . . for them to get access to the life-saving meds that they need without the patient’s name,” Corrado said. “It’s [for] somebody who’s unresponsive or unconscious or has no identification, and there’s no family there to help with the registration process, and they just need meds to get the patient out of the critical stage.”

William W. Churchill, chief of pharmacy services at Brigham and Women’s Hospital in Boston, said there’s no such dummy account to allow urgent access to the Omnicell ADCs in his institution’s ED. But nurses can manually create an entry in the devices for specific patients whose information isn’t available when a medication is urgently needed.

“They might type in ‘Smith, John, medical record number 123456789.’ And the Omnicell will accept that, and the nurse can get the drug,” Churchill said.

Corrado said any medication in the ADC can be removed by using the 911 dummy account. But she said the nursing staff is expected to use the patient’s correct account as soon as it’s available instead of continuing to remove medications using the 911 dummy code.

Both pharmacists said these solutions require pharmacy staff to be diligent about following up to make sure their dispensing records are accurate.

“Our informatics team gets a report of all the 911 entries that are made,” Corrado said. “So we can go back and get the information from the nurse in terms of who is ultimately attached to that so that we can get all the billing and everything correct.”

MichelleCorradoCorrado said the reconciliation process isn’t difficult, but it does involve manual data entry to correct the patients’ accounts.

A critical component of ADC use at Brigham and Women’s was the development of a list of medications subject to automatic pharmacy verification through the EMR system. Nurses can pull those medications from the ADCs, effectively overriding the pharmacy review.

“We have a defined list, which was done collaboratively between the ED, medical, nursing, and pharmacy. And we also collaborated and agreed upon which orders would be ‘autoverify’ and which would require a pharmacist’s review,” Churchill said.

He said an ADC in a trauma room will contain more autoverify medications than a dispensing device located elsewhere in of the ED.

“When a patient is in need, we need to be able to provide that drug,” Churchill said.

Overrides, like dummy accounts, must be reconciled, he said.

“We get a report that’s generated the next day. Then we ask the pharmacists that are staffing in the area to take a look at the overrides and make sure that they’re appropriate,” Churchill said.

Andrew Kaplan, pharmacy supervisor at St. Catherine of Siena Medical Center in Smithtown, New York, said his hospital installed ADCs in the ED nearly a decade ago after consulting with the ED staff about which medications to stock in the cabinets.

For situations when seconds count, as during “an absolute emergency,” Kaplan said, “we’ve created a dummy patient account called ’emergency patient’ to allow them to pull something out that’s urgently needed.”

We’re trying to leverage our electronic medical record and our automated dispensing cabinets to improve patient care.

In somewhat less urgent situations (e.g., a patient is not yet registered), nurses can type whatever information they have about the patient directly into the Pyxis unit and then obtain the medications, he explained.

“We encourage them to put in as much information as possible, so at least it gets entered as a temporary patient,” Kaplan said.

He said the hospital’s Epic EMR system is the brains behind the successful deployment of the Pyxis unit in the ED and the ability to reconcile dispensing records.

“Our Epic EMR knows everything that happens in Pyxis. So there’s a linkage between the two,” Kaplan said.

Kaplan said ADCs allow the pharmacy to store and manage “hundreds of units of medicines” in the ED and improve the drug delivery process in various ways.

“We’re trying to leverage our electronic medical record and our automated dispensing cabinets to improve patient care,” Kaplan said.

For example, he said, the Pyxis unit in the ED has “auxiliary towers” for the storage of i.v. antimicrobials and large-volume medication preparations. With this feature and changes to the EMR system, he said, nurses no longer “run back and forth from the emergency department to the pharmacy” to obtain i.v. aztreonam for patients with penicillin allergy. Now, he said, the drug is administered within an hour of ordering 64% of the time, compared with 16% of the time before the changes were made.

Linda Lipsky, director of pharmaceutical services at Methodist North Hospital in Memphis, Tennessee, since 1992, recalled that drug dispensing in the ED used to be “kind of a free-for-all,” with nurses essentially taking whatever they needed for their patients from medication carts.

When ADCs were first introduced, they didn’t really fix that problem, she said.

“There was no control over it at that point, because we didn’t have profiles,” Lipsky said, referring to the system through which the pharmacy views information in the EMR and reviews and verifies drug orders, allowing the release of medications from the ADCs. Without the profile process, she said, every medication in the ADC was essentially on override status.

Now, she said, her community hospital uses Omnicell ADCs with profiling enabled to ensure that a pharmacist reviews the orders before administration, with overrides allowed for emergencies.

Lipsky said pharmacy, nursing, and medical staff worked together to create the override list. Once the nurses became familiar with the profiling capabilities and the override drugs, the ADCs were better accepted, Lipsky said.

“Like any change that you make, it’s slow when you start because you’re not real familiar. But then once you get into it, it’s no big deal,” she said.

–By Kate Traynor, reprinted with permission from AJHP
(November 15, 2015; volume 72, pages 1921-1922)

 

 

 

 

July 22, 2015

Pharmacists Integrate into Geriatric Emergency Department

EDITOR’S NOTE: The American College of Emergency Physicians (ACEP) recently approved a policy supporting clinical pharmacy services in emergency departments (EDs). ACEP’s policy notes that pharmacists serve a “critical role in ensuring efficient, safe, and effective medication use,” and calls on health systems to support dedicated roles for pharmacists in the ED that involve pharmacists as active participants in patient care decisions, including resuscitations, transitions of care, and medication reconciliation. Members of the ASHP Section of Clinical Specialists and Scientists’ advisory group on emergency medicine worked with the ACEP’s New York affiliate to introduce and champion a resolution that led to the formal policy statement. The below story originally appeared in ASHP InterSections on Jan. 19, 2015.

ACEP recently endorsed the valuable role of pharmacists in the ED, including an active role in  resuscitations, transitions of care, and medication reconciliation.

ACEP recently endorsed the valuable role of pharmacists in the ED, including an active role in resuscitations, transitions of care, and medication reconciliation.

 

WHEN UPSTATE UNIVERSITY HOSPITAL in Syracuse, New York, began looking at adding a geriatric emergency department (ED) to Community Campus, the pharmacy department did not have to ask about participating, said director Beth Szymaniak.

“We were invited to be on the committee, and we were automatically assumed . . . to be a part of it,” Szymaniak said of the eight-bed geriatric ED, which opened in July 2013. “We just had to figure out how many FTEs [full-time equivalents] we wanted.”

The number of pharmacist FTEs in the geriatric ED is now 2, which was the pharmacy department’s original request, said the long-time director.

Pharmacist services should be an ancillary service of all geriatric EDs, according to a set of guidelines developed by two nonpharmacy organizations.

Approved in October 2012 by the American College of Emergency Physicians Geriatric Section and the Academy of Geriatric Emergency Medicine, the document “Geriatric Emergency Department Guidelines” supports dual goals for an ED specializing in the care of people 65 years of age or older:

•    Recognize the patients who will benefit from inpatient care.
•    Efficiently provide outpatient care to those who do not require inpatient resources.

The guidelines recommend completion of a medication list for all patients 65 years of age or older arriving to the ED.

The guidelines do not recommend a specific professional for completing the medication list. But they do recommend a multidisciplinary approach to managing patients who are taking more than five medications, using any “high-risk” medication, or experiencing signs or symptoms of an adverse drug event.

Nikolas Onufrak, one of the two pharmacists in Upstate University Hospital at Community Campus’s geriatric ED, said the multidisciplinary team strives to prevent initial hospitalizations and also repeat visits due to lack of comprehensive care.

Kelly_BrahamSo far, said pharmacist Kelly R. Braham, the admission rate for patients from the geriatric ED, which operates 8 a.m. to 10 p.m. daily, has decreased to 35% from an initial 42%.

Braham and Onufrak said their primary responsibility as geriatric emergency medicine pharmacists is to analyze patients’ medication regimens.

However, getting to the point of being able to analyze the regimens, Onufrak noted, requires “a little detective work.”

That means a lot of phone calls to pharmacies and physician offices and conversations with patients and family members, he said.

“We do the best we can to figure out what they actually are taking and reconcile that with the reason why they’re presenting to us,” he said. Then attention turns to assessing the appropriateness of all the medication regimens and determining whether any relate to the ED visit.

Braham said she and Onufrak pay particular attention to the overall anticholinergic burden of patients’ medications and use two tools—the STOPP (Screening Tool of Older People’s Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria—to identify potentially inappropriate prescribing in older people.

The two pharmacists also check for drug interactions before recommending interventions, she said.

And the pharmacists educate the patient as much as possible about every medication on the list and the drug’s purpose.

For a substantial percentage of the patients, said Onufrak, “there are significant [medication-related] interventions to be made at the point of care when they come into the ED.”

For a substantial percentage of the patients, there are significant [medication-related] interventions to be made at the point of care when they come into the ED.

Braham recounted one such case from just the previous week.

“He came in and he was taking both apixaban and rivaroxaban,” she said of the patient, who did not speak English.

“They were prescribed by two different providers; neither was his primary care doctor. However, he had been on this regimen since May.”

A computed tomography scan of the man’s head showed no sign of bleeding despite his taking the two anticoagulants for six months and recently falling down, Braham said.

“How he got by for that long I don’t know, but that’s something that we definitely rectified,” she said.

More common, Braham said, is the pharmacist’s recommendation to change a patient’s hypertension therapy to avoid a medication that causes orthostatic hypotension, which is a fall risk.

Onufrak said he and Braham typically see 20–30 patients over the course of a 10-hour workday. Not all of these patients are in the geriatric ED, however.

Nikolas_OnufrakAs time permits, the two pharmacists also see patients in the transitional care unit and general ED. Whether geriatric EDs lower costs remains uncertain, however.

An observational study at a community hospital in Ann Arbor, Michigan, found that after its geriatric ED opened in October 2010, patients 65 years of age or older had a lower risk of hospital admission than when that population was seen in the general ED.

But there were no differences in the risks of a repeat ED visit within 30 and 180 days. Neither was there a change in the average length of stay for those patients admitted to the hospital. The researchers reported that the pharmacists evaluated only selected patients in the geriatric ED.

A three-hospital study of geriatric EDs in Illinois, New Jersey, and New York is underway, funded with $12.7 million from the Centers for Medicare and Medicaid Services’ Innovation Center.

Known as Geriatric Emergency Department Innovations in care through Workforce, Informatics, and Structural Enhancements (or GEDI WISE), the study is projected to yield $40.1 million in cost savings.

These savings, the study investigators stated, will come from reductions in hospital admissions, readmissions within 30 days, ED visits, repeat ED visits, and days in the intensive care unit.

“Geriatric Emergency Department Guidelines” is available from www.acep.org/geriEDguidelines.

 

 –By Cheryl A. Thompson, reprinted with permission from AJHP (Jan. 15, 2015; volume 72, pages 92, 94)

December 20, 2011

Innovative Technician Practices Debuting in Hospitals

Technicians at Wishard Health Services in Indianapolis are an integral part of the pharmacy team.

ASHP has long advocated that properly educated and trained pharmacy technicians take a more active role in drug-dispensing duties, thus freeing up pharmacists to spend more time on medication management and direct patient care.

“Highly skilled technicians are key players on a pharmacy team,” said Stan Kent, M.S., FASHP, ASHP president. “As we move forward with pharmacy practice model change, we must deploy our workforce in a way that optimizes pharmacists’ clinical capabilities.”

A number of pioneering pharmacy departments are leading the way with innovative technician services. One of them is at Mercy Hospital in Coon Rapids, Minn. In 2008, the pharmacy department instituted a tech-check-tech program, in which a certified pharmacy technician checks the accuracy of orders filled by another technician and provides final verification prior to patient administration.

“We have technicians checking other technicians for 75 to 80 percent of our medications,” said Brent Kosel, Pharm.D., M.S., pharmacy operations manager. “Our auditing data shows that technicians do just as good a job as pharmacists. The pharmacists are champions of this program because they can focus more on our patients’ clinical needs.”

Samantha Murray, CPhT

The last audit, which covered about 7,500 doses, resulted in a 99.8 percent accuracy rate, according to Kosel. For now, the technicians check doses for automated dispensers, while pharmacists still conduct the final review for high-risk and intravenous drugs. According to an article in the American Journal of Health-System Pharmacy, some form of “tech-check-tech” is authorized for use in at least nine states. The results of 11 studies published since 1978 indicate that technicians’ accuracy in performing final dispensing checks is comparable to pharmacists’ accuracy.

Fulfilling a Core Purpose
“I’ve found tech-check-tech to be a great way to extend my role and feel more accomplished and gratified in my work,” said Heather Burley, CPhT, an inpatient pharmacy technician at Mercy. “Our core purpose, especially in a hospital, is to assist the pharmacists in any way we can. This really gives us an opportunity to do that.”

Burley’s training involved a didactic component with a written test, followed by one-on-one, hands-on sessions with pharmacists and an extensive validation test. “We had to correctly check a total of 500 line items with a 99.8 percent accuracy rate,” she said.

In another initiative at Mercy, pharmacy technicians now review medication dose adjustments of bedtime medications in adults age 65 and older (such as benzodiazepines), which can increase a patient’s risk of falling. Such dose adjustments are frequently overlooked during the order verification process.

An evaluation of the pilot program found that “technicians are as capable as pharmacists in performing tasks not requiring clinical judgment (i.e., identifying bedtime medications in need for dose adjustments in certain patient populations).”

Dianna Gatto, Pharm.D., BCPS

Techs and Med Rec
At Good Samaritan Hospital in Puyallup, Wash., pharmacy technicians have pretty much taken over the medication-reconciliation process at admission. In too many cases, the medication lists at the time of a patient’s admission are inaccurate—a common story at hospitals across the country.

“We wanted to see how we could get a better list up front, because it’s not a primary focus of nursing and we don’t have enough pharmacists to obtain medication histories on all of our patients,” said Dianna Gatto, Pharm.D., BCPS, manager of pharmacy clinical services. “I thought we could train our technicians to do this.” So she did.

Gatto discovered that there was no precedent in the state for technicians doing reconciliations, so she went before the Washington State Board of Pharmacy to make her case. The board quickly granted permission.

After a month-long pilot program involving two technicians, the program rolled out in the emergency department (ED), which treats about 175 patients daily (20 percent of whom are admitted). Since the program’s debut, it has expanded significantly, with three technicians working daily to spend an overlapping 28 hours on medication reconciliation. Medication lists are obtained for ED patients and direct admissions. A pharmacist reviews each updated medication list before physician reconciliation.

Samantha Murray, CPhT, a pharmacy technician at Good Samaritan, enjoys the social aspect of medication reconciliation, which occupies most of her work day.

“I’m constantly dealing with patients, their families, doctors, nurses and retail pharmacies. It’s more hands-on than what I was doing before,” she said.

The work is also more challenging: “You have to be a people person because the last thing that people want to do when they’re in the ED and don’t feel well is talk about their
medications when they’ve already talked about them three or four times,” Murray said. “You have to meet them on their own level and make them feel comfortable enough to tell you what you need to know.”

March 1, 2008

Pharmacists Learn Ins & Outs of Creating New ED Position

            Tanya Claiborne, Pharm.D., had just been hired as the first emergency department (ED) pharmacist at Sentara Healthcare System in Tidewater, Va., when she discovered a new ASHP program to help her navigate the challenges of her new position.
            The six-month certificate patient-care impact program—“Introducing an Emergency Pharmacist into Your Institution”—brought together 20 pharmacists under the mentorship of three pharmacists and one physician in emergency medicine.
            “It was a wonderful coincidence,” Claiborne said, of the inau­gural program that launched at ASHP’s 2007 Summer Meeting in San Francisco and concluded at the Midyear Clinical Meeting in Las Vegas. “This is a new position, so it was great to have a program where you can learn what does work and what doesn’t.”

Monitoring Performance and Quality
            Participants focused on safe medication use in the intense, pressure-filled environment of the ED, including how to moni­tor pharmacists’ performance and conduct quality assurance. They learned how to develop a pharmacist position in emergency medicine, from devising a job description to obtaining support from hospital leaders. While some of the participants hadn’t worked in EDs prior to starting the program, all of them were working in EDs upon completing it.
            Participants, who hailed from as far away as Dublin, Ireland, completed projects detailing how they would successfully implement pharmacy services in the EDs within their own organizations. They also described the duties of the pharmacist in emergency medicine, which included verifying medication orders, assisting with trauma victims, providing drug information to other health profes­sionals, and performing medica­tion reconciliation. After months of emailing their mentors and meeting in groups via teleconference, the participants displayed their projects on posters viewed by thousands of Midyear attendees.
            Participants said their projects have measurable, positive impacts on patient care, including timely administration of pain medication. They also said they have provided valuable medication education to the nursing staff and decreased the opportunities for adverse drug events.
            One of the program mentors, Daniel P. Hays, Pharm.D., BCPS, clinical pharmacy specialist at the University of Rochester Medical Center Department of Pharmacy and Emergency Medi­cine, Rochester, N.Y., said the program is important because there aren’t many emergency medicine pharmacists, let alone training programs for them.
            “We need to increase our numbers in these roles,” he said. “There are so few post-graduate training opportunities in emer­gency departments. We get these people excited about becoming emergency pharmacists and then jumpstart their abilities.”

Interventions and the ED Pharmacist
            Rebecca Drake, Pharm.D., BCPS, emergency medicine clinical pharmacist at Union Memorial Hospital in Baltimore, joined the program with one goal: to convince the pharmacy’s administration that her presence as a full-time ED pharmacist would increase medical interventions that potentially save lives—and money. At the time, Drake was working in the ED for only one-fifth of her workweek.
            “I really wanted to put myself in the ED full time so that people there would know who I am and could ask me questions,” Drake said.
            For her project, Drake calculated the cost savings associated with the interventions she performed in the ED for a three-month period. She recorded a savings of $8,836 for 136 interventions, which included educating patients and obtaining their medication histories.
            Drake presented her findings to the pharmacy’s administra­tion, which subsequently approved her full-time position in the ED.
            Meanwhile, Claiborne successfully integrated herself in the ED at Sentara and is working to improve the quality and safety of medication use in the institution.
            “Slowly I’m getting things accomplished,” Claiborne said. “But there’s a lot of work to do.”
            ASHP believes every hospital pharmacy department should provide pharmacy services to EDs for safe and effective patient care. But only 3.5 percent of hospitals surveyed had a pharmacist assigned to the ED for any period of time, according to the 2005 ASHP National Survey. In June, ASHP’s House of Delegates will consider approving the new Statement on Pharmacy Ser­vices to the Emergency Department, which calls on pharmacists to collaborate with other healthcare professionals to develop medication-use systems in EDs to promote safe and effective medication use.
             The ASHP Research and Education Foundation; University of Rochester; Johns Hopkins University, Baltimore; Cedars-Sinai Medical Center, Los Angeles; and the Agency for Healthcare Research and Quality collaborated with ASHP on the program.

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