This document discusses the justification and roles of an Emergency Medicine Pharmacist (EMP). It begins by outlining the objectives which include explaining the justification for an EMP, describing their core roles and strategies for implementation, and ways EMPs can improve patient care. It then discusses how the emergency department is inherently a patient safety risk due to factors like high volume and distractions. Having an EMP can help fill gaps in medication safety. The document outlines the roles of an EMP which include clinical consultation, order screening, high-risk medication preparation, and education. It concludes by providing strategies for implementing an EMP position, overcoming challenges, and demonstrating return on investment through cost savings from reducing adverse drug events.
1) All health care professionals and pharmaceutical companies can report any suspected adverse drug reactions (ADRs), regardless of severity, to the nearest ADR monitoring center.
2) The ADR reporting process involves reporting to peripheral centers, then regional, zonal, and finally the national coordinating center (NPC) and Central Drugs Standard Control Organization (CDSCO). International reporting also occurs to the WHO Uppsala Monitoring Centre (WHO-UMC).
3) Complete information is required for ADR reporting, including patient information, a description of the adverse reaction, details on the suspected drug, management of the reaction, and reporter information.
Patient counselling ,steps of patient ppunseling,communication skill in patie...MerrinJoseph1
Dr.Merrin,Joseph,Department of pharmacy practice,Community Pharmacy , Pharm D Second year, patient counseling,definition,outcome/scope of patient counseling,steps in patient counseling,communication skill in patient couseling,verbal skills and non-verbal skills.
Medication errors are a major concern in the healthcare fraternity. Although unintended, medication errors continue to happen everyday resulting in patient harm.
This document defines and outlines the functions and objectives of a hospital pharmacy. It discusses that a hospital pharmacy deals with procurement, storage, compounding, dispensing, manufacturing, testing, packaging and distribution of drugs under the control of a qualified pharmacist. The key functions of a hospital pharmacy include purchasing and inventory control, dispensing, manufacturing, teaching and providing drug information. The objectives are to ensure availability of correct medications at low cost and participate in research and education. It also discusses the location, layout, personnel, space and equipment requirements for an effective hospital pharmacy.
This document discusses medication errors, including definitions, types, causes, and ways to improve safety. Some key points:
- Medication errors are preventable events that may harm patients and are caused by failures in prescribing, dispensing, administration, or monitoring.
- Errors can occur at various stages of the medication use process and be due to factors like high workload, look-alike drug names, and poor communication.
- High-risk medications like anticoagulants require special precautions. Healthcare professionals should know drugs well, use memory aids, and develop checking habits to minimize errors.
- Encouraging patient involvement, thorough documentation, learning from past errors, and clear communication can also
This document discusses clinical pharmacy and provides information on how clinical pharmacists perceive their roles differently than traditional pharmacy roles. It outlines the requirements, goals, and levels of action for clinical pharmacists. Some key roles of clinical pharmacists during inpatient stays include reviewing medication charts, contributing to prescribing decisions, and educating patients. The document also discusses functions of clinical pharmacists like counseling, therapeutic drug monitoring, and adverse drug reaction reporting. It provides examples of clinical pharmacy practice areas and uses case studies to illustrate how clinical pharmacists can assess patients and make therapeutic recommendations.
1) All health care professionals and pharmaceutical companies can report any suspected adverse drug reactions (ADRs), regardless of severity, to the nearest ADR monitoring center.
2) The ADR reporting process involves reporting to peripheral centers, then regional, zonal, and finally the national coordinating center (NPC) and Central Drugs Standard Control Organization (CDSCO). International reporting also occurs to the WHO Uppsala Monitoring Centre (WHO-UMC).
3) Complete information is required for ADR reporting, including patient information, a description of the adverse reaction, details on the suspected drug, management of the reaction, and reporter information.
Patient counselling ,steps of patient ppunseling,communication skill in patie...MerrinJoseph1
Dr.Merrin,Joseph,Department of pharmacy practice,Community Pharmacy , Pharm D Second year, patient counseling,definition,outcome/scope of patient counseling,steps in patient counseling,communication skill in patient couseling,verbal skills and non-verbal skills.
Medication errors are a major concern in the healthcare fraternity. Although unintended, medication errors continue to happen everyday resulting in patient harm.
This document defines and outlines the functions and objectives of a hospital pharmacy. It discusses that a hospital pharmacy deals with procurement, storage, compounding, dispensing, manufacturing, testing, packaging and distribution of drugs under the control of a qualified pharmacist. The key functions of a hospital pharmacy include purchasing and inventory control, dispensing, manufacturing, teaching and providing drug information. The objectives are to ensure availability of correct medications at low cost and participate in research and education. It also discusses the location, layout, personnel, space and equipment requirements for an effective hospital pharmacy.
This document discusses medication errors, including definitions, types, causes, and ways to improve safety. Some key points:
- Medication errors are preventable events that may harm patients and are caused by failures in prescribing, dispensing, administration, or monitoring.
- Errors can occur at various stages of the medication use process and be due to factors like high workload, look-alike drug names, and poor communication.
- High-risk medications like anticoagulants require special precautions. Healthcare professionals should know drugs well, use memory aids, and develop checking habits to minimize errors.
- Encouraging patient involvement, thorough documentation, learning from past errors, and clear communication can also
This document discusses clinical pharmacy and provides information on how clinical pharmacists perceive their roles differently than traditional pharmacy roles. It outlines the requirements, goals, and levels of action for clinical pharmacists. Some key roles of clinical pharmacists during inpatient stays include reviewing medication charts, contributing to prescribing decisions, and educating patients. The document also discusses functions of clinical pharmacists like counseling, therapeutic drug monitoring, and adverse drug reaction reporting. It provides examples of clinical pharmacy practice areas and uses case studies to illustrate how clinical pharmacists can assess patients and make therapeutic recommendations.
Describes in detail the concept of compliance to therapeutic regimen, difference between adherence and compliance, factors which influence compliance, methods of assessing, reasons for non-compliance and strategies to improve compliance to the therapy.
The document discusses various types and causes of medication errors that can occur in healthcare settings. It identifies human factors, systems issues, abbreviations, verbal orders, look-alike and sound-alike drug names, and dosage calculation errors as common contributing factors. Specific examples of errors of commission, omission, unauthorized drug administration, and improper dosing are provided. The rights of medication administration and strategies for prevention of errors are also outlined.
1. A medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of a healthcare professional, patient, or consumer.
2. Medication errors can occur at various stages including prescribing, transcribing, dispensing, administration, and monitoring of medication. Common causes include distractions, lack of knowledge, incomplete patient information, and systemic issues.
3. When a medication error occurs, the patient's safety is the top priority and the error must be reported according to the institution's policies to help prevent future errors.
Medication adherence refers to the extent to which a patient follows medical advice regarding prescribed medications. It is important for therapeutic outcomes, especially for chronic illnesses. While many factors can influence adherence, it is difficult to predict. Pharmacists are well-positioned to improve adherence through patient education about their medications, potential side effects, and the importance of adherence. Strategies like simplifying dosing regimens, using medication organizers, and addressing specific barriers can also help. Further research is still needed to better understand and promote adherence.
This document discusses pharmacovigilance, which involves monitoring the safety of drugs after they have been approved. It defines pharmacovigilance and explains why it is needed given limitations of clinical trials. It describes types of adverse drug reactions and how they are classified. It outlines the goals and processes of pharmacovigilance programs, including reporting adverse reactions, conducting causality assessments, and submitting periodic safety update reports. The overall aim is to ensure safe and effective use of medicines through continual monitoring and regulatory action.
I. This document discusses different methods of drug distribution in hospitals including individual prescription orders, floor stock systems, unit dose dispensing, and outpatient versus inpatient distribution.
II. The main types of drug distribution systems covered are individual prescription ordering, complete floor stocking, a combination of the two, and unit dose dispensing.
III. Key aspects of each system like advantages, disadvantages, and procedures are summarized.
Medication errors can occur at any point during the medication use process and can cause patient harm if not prevented. This presentation defines medication errors as any preventable event that may cause inappropriate medication use or patient harm. It then describes common types of medication errors such as prescribing errors, omission errors, wrong time errors, unauthorized drug errors, and more. The presentation emphasizes that medication errors are a particular problem in low and middle income countries. It concludes by stating that prevention of medication errors is important but does not provide specifics on prevention strategies.
The document discusses community pharmacies, including their organization, services provided such as dispensing prescriptions and providing patient counseling, and minimum standards for facilities, equipment, and operations. Community pharmacies serve an important role by being conveniently located and providing direct access and services to the public for their pharmaceutical needs. They must be properly organized and equipped according to regulatory standards to safely and effectively provide pharmaceutical care and services to patients.
Here are the key steps I would take:
1. Return to Mrs. Veena immediately to inform her of the error and assess for any allergic reaction symptoms. Her safety is the top priority.
2. Notify the physician right away about the error so they can determine the appropriate treatment and monitoring plan for Mrs. Veena.
3. Fill out an incident report per hospital policy documenting exactly what occurred, the medications involved, actions taken, patient assessment and outcome.
4. Review the situation to understand what factors may have contributed to the error so I can learn and help prevent similar mistakes going forward. Proper documentation and reporting of all errors is important for quality improvement.
5. Apologize to
Medication errors are a significant problem, accounting for 10-18% of hospital injuries and 44,000-98,000 deaths annually in the US. Nurses have legal and ethical responsibilities to administer medications correctly by verifying the six rights - right patient, drug, route, dose, time, and documentation. They must clarify any unclear orders, know drug information and the patient's condition, use correct administration techniques, monitor effects, and educate patients. Nurses can prevent errors by communicating effectively, using multiple checks, and being vigilant about high-alert medications and look-alike/sound-alike drugs.
This document provides guidance for nursing students on safe medication administration at Seattle Children's hospital. It outlines key objectives around appropriate delivery methods, documentation, and safety. It emphasizes the importance of preventing medication errors and describes steps students should take like checking the 5 rights, knowing drug indications, and consulting instructors with any uncertainties. The document also outlines nursing student limitations and responsibilities to ensure supervision and follow hospital policies. It provides a case example of catching a wrong medication order and emphasizes always verifying orders match the patient's condition. Overall, the document stresses meticulous processes, communication, and vigilance to maintain patient safety during medication administration.
This document discusses different methods for assessing the causality of adverse drug reactions (ADRs). It describes three main types of methods: 1) Expert opinion or clinical judgment methods like the WHO causality assessment scale, 2) Algorithmic methods like the Naranjo scale that use questionnaires and scoring systems, 3) Probabilistic or Bayesian methods that calculate the probability of drug causation based on prior probabilities. The WHO scale and Naranjo scale are discussed in detail as examples of each method.
Hospital and its organisation, BUDGET AND pHARMACY AND tHERAPEUTIC COMMITTEESanju Kaladharan
Hospital administration oversees hospital operations and policies. Therapeutic services provide medical treatment to patients, including physical, occupational, speech and respiratory therapy. Diagnostic services determine the cause of illness through medical testing. Support services maintain hospital facilities and equipment. The pharmacy and therapeutics committee advises on drug selection and use to ensure cost-effective and quality patient care.
1. Drug Use Evaluation (DUE) is a performance improvement method that focuses on evaluating and improving medication use processes to optimize patient outcomes.
2. Clinical pharmacists can positively impact mortality rates through services like DUE, patient education, adverse drug reaction management, and participating on patient rounds.
3. The DUE process involves establishing criteria to evaluate medication use, collecting and analyzing data, developing and implementing improvement plans, and repeating the cycle for ongoing enhancements.
Medication errors can occur during prescribing, dispensing, or administration of drugs and include errors like using the wrong drug, wrong dose, or wrong route of administration. Common causes of errors include illegible handwriting, look-alike or sound-alike drug names, distractions, and lack of concentration. Types of errors include prescribing errors, dispensing errors, and administration errors. Reducing errors requires strategies like electronic prescribing, minimizing interruptions during drug administration, verifying patient identity, and ensuring the right drug is given to the right patient at the right time. When errors occur, they must be reported so the safety of the patient can be ensured and steps can be taken to prevent future errors.
Medication errors are preventable causes of patient harm and can occur at any stage of the medication process from prescribing to administration. There are many types of medication errors including omission errors, unauthorized drug errors, wrong dose errors, and wrong route errors. Factors that contribute to medication errors include illegible handwriting, confusion over drug names, lack of knowledge about drugs, and interruptions during medication administration. Some steps to prevent medication errors are following the rights of medication administration, double checking all calculations, avoiding distractions, and questioning any unclear or unusual orders.
The document outlines guidelines for developing hospital formularies and therapeutic guidelines. It states that a pharmacy and therapeutics committee composed of physicians and pharmacists should be appointed to prepare the hospital formulary system. The committee will develop policies and procedures governing drug selection, procurement, storage, distribution, and use. Therapeutic guidelines are developed by independent organizations to provide evidence-based recommendations for treating common medical conditions through comparative disease guidelines. The guidelines are clinically oriented, cover common treatment areas, and provide authorized interpretations of evidence from medical experts. An example therapeutic guideline for treating acute cystitis is provided.
This document provides information on various drugs used in emergency situations:
- Oxygen is essential to prevent brain death within 6 minutes of hypoxia. The ideal oxygen saturation is 95% or higher.
- Nitroglycerin is a vasodilator used for angina and myocardial infarction. Morphine sulfate is used for chest pain associated with myocardial infarction.
- Atropine sulfate, isoproterenol, and epinephrine are used to treat bradycardia, asystole, AV block, and hypotension.
- Sodium bicarbonate is used for acidotic states from cardiac arrest. Antiarrhythmics include adenosine, amiodarone,
Burl Che Miranda Johnson is applying for the lead service technician position at JohnStewart. He currently maintains and runs a 202 unit apartment complex, ensuring minimal disruptions during repairs. He is a self-starter who excels at appliance repairs, plumbing, painting, and electrical system upkeep. Burl is familiar with OSHA regulations and learns new procedures quickly. He would bring a service-focused and hard-working attitude to the role of lead technician.
Describes in detail the concept of compliance to therapeutic regimen, difference between adherence and compliance, factors which influence compliance, methods of assessing, reasons for non-compliance and strategies to improve compliance to the therapy.
The document discusses various types and causes of medication errors that can occur in healthcare settings. It identifies human factors, systems issues, abbreviations, verbal orders, look-alike and sound-alike drug names, and dosage calculation errors as common contributing factors. Specific examples of errors of commission, omission, unauthorized drug administration, and improper dosing are provided. The rights of medication administration and strategies for prevention of errors are also outlined.
1. A medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of a healthcare professional, patient, or consumer.
2. Medication errors can occur at various stages including prescribing, transcribing, dispensing, administration, and monitoring of medication. Common causes include distractions, lack of knowledge, incomplete patient information, and systemic issues.
3. When a medication error occurs, the patient's safety is the top priority and the error must be reported according to the institution's policies to help prevent future errors.
Medication adherence refers to the extent to which a patient follows medical advice regarding prescribed medications. It is important for therapeutic outcomes, especially for chronic illnesses. While many factors can influence adherence, it is difficult to predict. Pharmacists are well-positioned to improve adherence through patient education about their medications, potential side effects, and the importance of adherence. Strategies like simplifying dosing regimens, using medication organizers, and addressing specific barriers can also help. Further research is still needed to better understand and promote adherence.
This document discusses pharmacovigilance, which involves monitoring the safety of drugs after they have been approved. It defines pharmacovigilance and explains why it is needed given limitations of clinical trials. It describes types of adverse drug reactions and how they are classified. It outlines the goals and processes of pharmacovigilance programs, including reporting adverse reactions, conducting causality assessments, and submitting periodic safety update reports. The overall aim is to ensure safe and effective use of medicines through continual monitoring and regulatory action.
I. This document discusses different methods of drug distribution in hospitals including individual prescription orders, floor stock systems, unit dose dispensing, and outpatient versus inpatient distribution.
II. The main types of drug distribution systems covered are individual prescription ordering, complete floor stocking, a combination of the two, and unit dose dispensing.
III. Key aspects of each system like advantages, disadvantages, and procedures are summarized.
Medication errors can occur at any point during the medication use process and can cause patient harm if not prevented. This presentation defines medication errors as any preventable event that may cause inappropriate medication use or patient harm. It then describes common types of medication errors such as prescribing errors, omission errors, wrong time errors, unauthorized drug errors, and more. The presentation emphasizes that medication errors are a particular problem in low and middle income countries. It concludes by stating that prevention of medication errors is important but does not provide specifics on prevention strategies.
The document discusses community pharmacies, including their organization, services provided such as dispensing prescriptions and providing patient counseling, and minimum standards for facilities, equipment, and operations. Community pharmacies serve an important role by being conveniently located and providing direct access and services to the public for their pharmaceutical needs. They must be properly organized and equipped according to regulatory standards to safely and effectively provide pharmaceutical care and services to patients.
Here are the key steps I would take:
1. Return to Mrs. Veena immediately to inform her of the error and assess for any allergic reaction symptoms. Her safety is the top priority.
2. Notify the physician right away about the error so they can determine the appropriate treatment and monitoring plan for Mrs. Veena.
3. Fill out an incident report per hospital policy documenting exactly what occurred, the medications involved, actions taken, patient assessment and outcome.
4. Review the situation to understand what factors may have contributed to the error so I can learn and help prevent similar mistakes going forward. Proper documentation and reporting of all errors is important for quality improvement.
5. Apologize to
Medication errors are a significant problem, accounting for 10-18% of hospital injuries and 44,000-98,000 deaths annually in the US. Nurses have legal and ethical responsibilities to administer medications correctly by verifying the six rights - right patient, drug, route, dose, time, and documentation. They must clarify any unclear orders, know drug information and the patient's condition, use correct administration techniques, monitor effects, and educate patients. Nurses can prevent errors by communicating effectively, using multiple checks, and being vigilant about high-alert medications and look-alike/sound-alike drugs.
This document provides guidance for nursing students on safe medication administration at Seattle Children's hospital. It outlines key objectives around appropriate delivery methods, documentation, and safety. It emphasizes the importance of preventing medication errors and describes steps students should take like checking the 5 rights, knowing drug indications, and consulting instructors with any uncertainties. The document also outlines nursing student limitations and responsibilities to ensure supervision and follow hospital policies. It provides a case example of catching a wrong medication order and emphasizes always verifying orders match the patient's condition. Overall, the document stresses meticulous processes, communication, and vigilance to maintain patient safety during medication administration.
This document discusses different methods for assessing the causality of adverse drug reactions (ADRs). It describes three main types of methods: 1) Expert opinion or clinical judgment methods like the WHO causality assessment scale, 2) Algorithmic methods like the Naranjo scale that use questionnaires and scoring systems, 3) Probabilistic or Bayesian methods that calculate the probability of drug causation based on prior probabilities. The WHO scale and Naranjo scale are discussed in detail as examples of each method.
Hospital and its organisation, BUDGET AND pHARMACY AND tHERAPEUTIC COMMITTEESanju Kaladharan
Hospital administration oversees hospital operations and policies. Therapeutic services provide medical treatment to patients, including physical, occupational, speech and respiratory therapy. Diagnostic services determine the cause of illness through medical testing. Support services maintain hospital facilities and equipment. The pharmacy and therapeutics committee advises on drug selection and use to ensure cost-effective and quality patient care.
1. Drug Use Evaluation (DUE) is a performance improvement method that focuses on evaluating and improving medication use processes to optimize patient outcomes.
2. Clinical pharmacists can positively impact mortality rates through services like DUE, patient education, adverse drug reaction management, and participating on patient rounds.
3. The DUE process involves establishing criteria to evaluate medication use, collecting and analyzing data, developing and implementing improvement plans, and repeating the cycle for ongoing enhancements.
Medication errors can occur during prescribing, dispensing, or administration of drugs and include errors like using the wrong drug, wrong dose, or wrong route of administration. Common causes of errors include illegible handwriting, look-alike or sound-alike drug names, distractions, and lack of concentration. Types of errors include prescribing errors, dispensing errors, and administration errors. Reducing errors requires strategies like electronic prescribing, minimizing interruptions during drug administration, verifying patient identity, and ensuring the right drug is given to the right patient at the right time. When errors occur, they must be reported so the safety of the patient can be ensured and steps can be taken to prevent future errors.
Medication errors are preventable causes of patient harm and can occur at any stage of the medication process from prescribing to administration. There are many types of medication errors including omission errors, unauthorized drug errors, wrong dose errors, and wrong route errors. Factors that contribute to medication errors include illegible handwriting, confusion over drug names, lack of knowledge about drugs, and interruptions during medication administration. Some steps to prevent medication errors are following the rights of medication administration, double checking all calculations, avoiding distractions, and questioning any unclear or unusual orders.
The document outlines guidelines for developing hospital formularies and therapeutic guidelines. It states that a pharmacy and therapeutics committee composed of physicians and pharmacists should be appointed to prepare the hospital formulary system. The committee will develop policies and procedures governing drug selection, procurement, storage, distribution, and use. Therapeutic guidelines are developed by independent organizations to provide evidence-based recommendations for treating common medical conditions through comparative disease guidelines. The guidelines are clinically oriented, cover common treatment areas, and provide authorized interpretations of evidence from medical experts. An example therapeutic guideline for treating acute cystitis is provided.
This document provides information on various drugs used in emergency situations:
- Oxygen is essential to prevent brain death within 6 minutes of hypoxia. The ideal oxygen saturation is 95% or higher.
- Nitroglycerin is a vasodilator used for angina and myocardial infarction. Morphine sulfate is used for chest pain associated with myocardial infarction.
- Atropine sulfate, isoproterenol, and epinephrine are used to treat bradycardia, asystole, AV block, and hypotension.
- Sodium bicarbonate is used for acidotic states from cardiac arrest. Antiarrhythmics include adenosine, amiodarone,
Burl Che Miranda Johnson is applying for the lead service technician position at JohnStewart. He currently maintains and runs a 202 unit apartment complex, ensuring minimal disruptions during repairs. He is a self-starter who excels at appliance repairs, plumbing, painting, and electrical system upkeep. Burl is familiar with OSHA regulations and learns new procedures quickly. He would bring a service-focused and hard-working attitude to the role of lead technician.
This document discusses toxicology and the management of poisoning. It provides an overview of the epidemiology of poisoning cases by age group. There are two main types of poisoning - acute and chronic. The general management of poisoning involves initial resuscitation and stabilization, removal of toxins from the gastrointestinal tract through various decontamination methods, preventing further absorption, and increasing toxin elimination. The role of the pharmacist includes managing poisoning cases, operating poison control centers, educating others on poisons and antidotes, and providing prevention services to the community.
This document provides information on emergency drugs and their uses. It lists epinephrine, atropine, amiodarone, and adenosine as cardiac emergency drugs with dosages for cardiac arrest, bradycardia, pulsless ventricular tachycardia/fibrillation, and stable supraventricular tachycardia respectively. It also lists drugs for respiratory emergencies like nebulizers, hydrocortisone, magnesium sulfate, and aminophylline. Other emergency drugs mentioned include phenytoin, chlorpheniramine, midazolam, flumazenil, naloxone, potassium chloride, and sodium bicarbonate.
This document provides an overview of pharmacology basics for EMTs, including medication indications, contraindications, dose, mechanism of action, effects, and side effects. It describes various medication names, forms, routes of administration, and the steps to administering medications, which include obtaining an order, selecting the proper medication, verifying the form and route, informing the patient, and reassessing after administration.
Medications in Crash Trolley ..in PHC OMAN By Elizabeth Joseph KElizabeth Joseph
This document provides information on common emergency medications including indications, dosages, routes of administration, monitoring parameters, and dilution instructions. It includes entries for adenosine, atropine, adrenaline, haloperidol, dopamine, dexamethasone, frusemide, magnesium sulfate, calcium gluconate, naloxone, hydrocortisone, amidarone, procyclidine, glucagon, syntometrine, dextrose 50%, aspirin, glyceryl trinitrate, captopril, morphine, pethidine, and diazepam. For each medication, concise details are given about its use in emergency situations.
There are three phases of fracture healing: reactive, reparative, and remodeling. The reparative phase involves cartilage callus formation and lamellar bone deposition. Recent advances to enhance fracture healing include the use of bone grafts, bone marrow aspirate, growth factors, and platelet rich plasma to stimulate cell proliferation and new bone formation. Monitoring serum markers can help evaluate the bone formation process during healing. Other techniques like pulsed electromagnetic fields, low-intensity ultrasound, and vertebroplasty have also been used to promote healing.
This document provides guidelines for critical care medication administration at Lucile Packard Children's Hospital. It lists various drugs used in continuous infusions or bolus administrations, including usual dosing, administration details, dose ranges, mechanisms of action, and important nursing considerations for each drug. The guidelines cover a range of drug classes and indications, such as analgesics, sedatives, paralytics, pressors, inotropes, antiarrhythmics and more.
This document summarizes medications used in advanced cardiac life support (ACLS). It discusses drug classifications and provides indications, dosing, and precautions for oxygen, epinephrine, vasopressin, amiodarone, lidocaine, magnesium sulfate, procainamide, atropine sulfate, and calcium chloride as they relate to treating ventricular fibrillation/pulseless ventricular tachycardia, pulseless electrical activity, and asystole in cardiac arrest patients.
A crash cart or code cart contains medications, supplies, and equipment needed to respond to medical emergencies like cardiac arrest. It includes a defibrillator, ambu bags, oxygen, IV supplies and medications like epinephrine, atropine, lidocaine, sodium bicarbonate. The crash cart must be checked regularly, standardized, and placed in an easily accessible location. It is organized with equipment and medications grouped by function in drawers and sections for quick access during emergencies. Common arrhythmias include premature beats, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias which can be harmless or potentially fatal depending on their type and underlying heart condition.
The document provides information on several emergency drugs, including atropine, adrenaline, noradrenaline, and dopamine hydrochloride. It describes the purpose of emergency drugs as providing initial treatment for life-threatening illnesses and injuries to control symptoms and save lives. For each drug, it outlines the description, mechanism of action, indications and dosing, interactions, contraindications, adverse effects, and nursing considerations to closely monitor patients and vital signs when administering these powerful medications.
The document provides an overview of code management for nurses. It describes what a code is, the roles of the code team including the physician, nurse, and respiratory therapist. It outlines the responsibilities during a code such as initiating CPR, intubation, defibrillation, and administering medications. It also discusses managing the family, criteria for stopping resuscitative efforts, and documentation requirements. The overall document serves as a training guide for nurses on their functions and skills needed during a medical emergency.
This document provides summaries of common emergency medications used to treat critical patients. It lists indications, dosages, and considerations for oxygen, epinephrine, atropine, adenosine, amiodarone, dopamine, lidocaine, diltiazem, procainamide, nitroglycerine, magnesium sulfate, and calcium chloride. The document aims to describe the actions and importance of these frequently prescribed critical medications.
This document discusses various emergency drugs used in oral surgery. It provides classifications of emergency drugs as injectables, non-injectables, primary and secondary advanced cardiac support drugs. It then discusses 20 individual emergency drugs in detail including their introduction, indications, contraindications, trade names, dosages and adverse effects. The drugs discussed include adrenaline, atropine, dopamine, metoclopramide, phenaramine maleate, hydrocortisone, dexamethasone, diazepam, fortwin-pentazocin, furosemide, pancuronium bromide, styptochrome, and ethamsylate.
Drugs used in emergency and operation theatreRUCHIT PATEL
The document discusses various emergency drugs used to treat life-threatening conditions in the areas of cardiology, respiratory medicine, neurology, and endocrinology. It states that oxygen should be present on all emergency hospital trays as without it, brain death can occur within six minutes. For cardiac emergencies, it recommends drugs like glyceryl trinitrate for angina, aspirin for myocardial infarction, adrenaline for cardiac arrest, and dopamine or dobutamine for cardiogenic shock. For respiratory emergencies, it suggests salbutamol for asthma, furosemide for pulmonary edema, and cefriaxone for epiglottitis. Common treatments for seizures include diazepam,
This document provides a list of emergency parenteral drugs for adults with their preparations, clinical indications, clinical preparations, and doses. It includes drugs for conditions like supraventricular tachycardia, cardiac arrest, shock, arrhythmias, bradycardia, organophosphate poisoning, hyperkalemia, hypoglycemia, heart failure, hypertension, and status epilepticus. For each drug, it specifies the available preparations, recommended clinical preparations including intravenous access and monitoring, and dosing instructions including bolus or infusion doses. Abbreviations and definitions are also provided.
The document outlines protocols for responding to cardiopulmonary arrests, known as Code Blues. It describes initiating Basic Life Support, Advanced Cardiac Life Support, or Pediatric Advanced Life Support depending on the patient. It provides details on activating emergency codes, assembling code teams, performing immediate interventions like CPR and defibrillation, notifying physicians, and transferring patients to the emergency department. Crash carts and equipment are also discussed, including obtaining replacement carts and charging used items.
The document discusses preparation for and management of medical emergencies in the dental office. It emphasizes the importance of staff training in basic life support. The dental office should have an emergency response team, stock emergency equipment and drugs, and train regularly. Common pediatric emergencies that may occur include allergic reactions, asthma attacks, seizures, hypoglycemia, and airway obstructions. The document provides guidelines for recognizing signs and symptoms of various emergencies and outlines appropriate first aid responses.
This document provides information on various emergency drugs including atropine, adrenaline, mephentermine, ephedrine, and xylocard. It describes the class, mechanism of action, indications, dosing, administration, and side effects of each drug. Atropine is an anticholinergic that acts as a competitive muscarinic receptor antagonist. Adrenaline is a direct-acting sympathomimetic that interacts with both alpha and beta receptors to increase heart rate, contractility and blood pressure. Mephentermine and ephedrine are both sympathomimetic amines that cause increased cardiac output through alpha and beta receptor stimulation. Xylocard is a class IB antiarrhythmic sodium channel block
The document discusses several common medical emergencies including myocardial infarction (heart attack), cardiopulmonary resuscitation (CPR), stroke, hypoglycemia, seizures, asthma, and road traffic accidents. For each emergency, the document outlines symptoms, potential causes, and recommended first aid actions such as calling for an ambulance, giving oxygen, monitoring breathing, providing glucose for low blood sugar, and applying pressure to stop bleeding.
Purpose of the Call:
Women's College Hospital is an academic ambulatory hospital. The speaker will share their hospital’s journey as they sought to implement best practices for medication reconciliation from other settings customized for the ambulatory environment.
Read more and watch the webinar recording: http://bit.ly/1sxHIUP
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptxraviapr7
b) Clinical Pharmacy
Introduction to Clinical Pharmacy, Concept of clinical pharmacy
Functions and responsibilities of clinical pharmacist, Drug therapy monitoring
Medication chart review, clinical review., pharmacist intervention
Ward round participation, Medication history and Pharmaceutical care.
Dosing pattern and drug therapy based on Pharmacokinetic & disease pattern
Slide 1 : Title: ROLE OF PHARMACIST IN INTENSIVE CARE UNIT
By: Falakaara Saiyed
Slide 2: Introduction
Medication management plays a crucial part in managing a critically ill patient.
When it comes to drug therapy, intensivist have plenty of decision making every day including drug selection, dosing, administration, and monitoring strategies to optimize effective pharmacotherapy.
Even though the patient receives appropriate drug, a suboptimal dose or overdosing may result in either therapeutic failure or drug toxicity.
The concept of having a clinical pharmacist in an intensivist-led multidisciplinary team evolved in the early 1980s in USA.
In Today’s World Intensive Care Unit (ICU), the skills of a Critical care pharmacist addresses adverse drug events caused due to drug-related problems and medication errors. It improves the appropriateness, quality of prescribing and increases patient safety.
Slide 5: Aims & Objective
This aims to evaluate the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety.
Even though the contribution of critical care pharmacist to improve the quality of patient care is accepted worldwide, many ICUs have not recognized this important reserve.
This presentation is used to educate other healthcare professionals and administrators on impact of clinical pharmacist in the care of critically ill patients.
Slide 14: Pharmaceutical Care Process
Assess the patient
Identify the problems and opportunities
Develop care plan
Implement Plan
Evaluate for Efficacy and Safety
Slide 24: Desirable activities of ICU pharmacist
Includes formulating guidelines for the critically ill patients, active participation in research, and educating the ICU team.
Guidelines which have been developed and implemented by the clinical pharmacist in our ICU includes protocols for pain, sedation, delirium, stress, drug compatibility chart , drug administration, dilution guidelines, and toxicological management protocols.
Once the protocols are formulated, all the members of the ICU team are educated on how to use the protocol.
Most of these clinical pharmacist enforced protocols are nurse oriented, and hence, it becomes easy for optimizing patient care.
The effectiveness of these guidelines is under the supervision of a critical care pharmacist, and it is well studied in Western countries.
Slide 25: conclusion
Clinical pharmacist as a part of multidisciplinary team in an ICU is associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.
Clinical pharmacists are essential to improve patient safety and outcome, reduce costs, and provide quality of care in critically ill patients.
Slide 26: References
Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Crit Care Med. 2010
This document discusses the role of pharmacists in promoting self-care. It notes that over 80% of medical visits are for minor health problems that could be addressed through self-care. The pharmacist's role is to ensure safe and effective use of nonprescription drugs by providing patients with information and advice. The pharmacist follows the pharmaceutical care process of assessment, care planning, and evaluation to identify any drug-related problems and design treatment plans. Key aspects of the pharmacist's role include conducting therapeutic interviews, identifying issues, suggesting self-care strategies, and making appropriate treatment recommendations or referrals.
PMY 6120_1-2-Pharmaceutical Formulation Systems_Compound and Dispensing Proce...MuungoLungwani
This document discusses a course on pharmaceutical compounding and dispensing. The course covers background topics, dispensing and patient care, and extemporaneous dispensing. It aims to help students understand the roles of compounding pharmacists, resolve problems in making specific preparations, apply techniques to administrative and clinical aspects of drug delivery, determine dosages based on patient conditions, and apply principles of good pharmacy practice. Extemporaneous dispensing involves considerations for the intended use, safety, formula calculation, preparation method, container choice, and labeling for compounded products.
Based on the information provided:
- Mrs. Tigist's drug-related need is for effective treatment of her depression
- Recommending an OTC sleep aid would not meet this need and could potentially cause harm
- The appropriate action would be to advise Mrs. Tigist that her symptoms suggest she may be depressed and recommend she see her physician for evaluation and treatment
I understand you're going through a difficult time with the loss of your husband. While sleep aids can help in the short term, depression often requires longer term treatment. Let me see if I can arrange for you to speak with one of the counselors here - they may be able to provide support that will help you cope and feel better over time. There are also medications and therapies that a doctor can recommend specifically for depression if needed. How does that sound? I'm here if you need anything else.
Clinical pharmacy involves pharmacists taking a patient-centered approach to medication therapy to promote health and wellness. It requires advanced clinical knowledge and skills beyond traditional dispensing roles. Clinical pharmacists work directly with patients, physicians, and other healthcare providers to optimize medication use, identify and resolve medication-related problems, educate patients, and ensure the safe, effective, and economical use of medications. They are integral members of the healthcare team across various clinical practice settings and specialties.
1. The document discusses good pharmacy practice (GPP) in India, which aims to optimize patient care through appropriate medication use.
2. Key aspects of GPP include supplying quality medications, providing patients with information and advice, monitoring medication effects, and promoting rational prescribing and use.
3. The roles of pharmacists in GPP are to prepare, obtain, store, distribute, administer, dispense, and dispose of medications properly, provide medication therapy management, maintain professional competency, and contribute to healthcare system effectiveness.
1. The document discusses good pharmacy practice (GPP) in India, which aims to optimize patient care through appropriate medication use.
2. Key aspects of GPP include supplying quality medications, providing patients with information and advice, monitoring medication effects, and promoting rational prescribing and use.
3. The roles of pharmacists in GPP are to prepare, obtain, store, distribute, administer, dispense, and dispose of medications properly, provide medication therapy management, maintain professional competency, and contribute to healthcare system effectiveness.
The purpose of this call is to learn how the Department of Family Medicine at Queen’s University was able to:
•Raise awareness about medication safety issues ‐ specifically medication reconciliation in primary care.
•Highlight the need for better communication and connectivity between hospitals, pharmacies, and primary care. (And how we can help each other.)
•Suggest that primary care take on a leadership role in medication safety ‐ we can (and should!) "own" the list.
•Stress the importance of medication reconciliation as a continuous, interdisciplinary, and collaborative activity.
This document discusses opportunities for medication safety research. It defines medication errors and outlines the National Coordinating Council for Medication Error Reporting and Prevention's classifications of medication errors. Research on medication safety is important to understand error causes and reduce errors. Key areas for research include outcomes, target populations, factors that cause errors, and intervention studies. Quantitative research using large databases can study prescribing patterns and adverse drug events while qualitative research explores human, process, and system factors contributing to errors. The document provides examples of potential medication safety studies.
This document discusses medication errors, including definitions of key terms like adverse drug events and adverse drug reactions. It provides classifications and reasons for medication errors, as well as methods to prevent, identify, and minimize errors. These include implementing systems-based approaches, reducing reliance on memory through automation, standardizing processes, and employing checks and policies. Reporting of medication errors is also addressed.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
1) The document discusses critical issues in prescribing opioids for adult patients in the emergency department. It provides recommendations on 4 critical questions related to opioid prescribing based on a review of the available medical literature.
2) The first critical question addresses whether prescription drug monitoring programs can help identify patients at high risk for opioid abuse. The recommendation is that PDMPs may help with this.
3) The second critical question discusses whether opioids are more effective than other medications for acute low back pain. The recommendations are to consider non-opioid options first and avoid routine opioid prescribing.
4) The third and fourth critical questions and recommendations address appropriate opioid selection and prescribing considerations on discharge for acute pain patients.
Effective communication between physician and pharmacist.Dr. Praveen kumar
This document discusses effective communication between physicians and pharmacists. It describes the roles and professional development of physicians and pharmacists. Pharmacists were traditionally seen as "lick, stick, and pour" dispensers but are now clinical pharmacists who work directly with physicians and patients to optimize medication use. The document outlines several ways physicians and pharmacists can communicate effectively, including through prescribing guidelines, drug information services, patient counseling, and pharmacy and therapeutics committees. Developing relationships and understanding each other's roles is important for collaborative patient care.
An introduction to medication therapy managementKabito Kiwanuka
Pharmacists: An Untapped Resource: Pharmacists receive more training on the safe, effective and appropriate use of medications than any other healthcare professional
This document discusses medication errors that can occur in hospitals. It defines medication errors as any error in prescribing, dispensing, or administering drugs, regardless of whether harm occurs. Medication errors are a major cause of preventable patient harm. The document classifies medication errors as mistakes, slips, or lapses, depending on where the error occurs in the medication use process. It also discusses different ways medication errors have been estimated to cause deaths in other countries to highlight the significant impact of these errors.
This randomized clinical trial compared medication administration error rates between dedicated medication nurses and general nurses across two hospitals. The main findings were:
1) Overall error rates were similar between medication nurses (15.7%) and general nurses (14.9%).
2) At one hospital, medication nurses had a significantly lower error rate than general nurses in surgical units but not medical units.
3) Differences in medication processes and settings highlighted the role of systems design in errors. The study suggests simple interventions may not reduce errors without broader system changes.
Similar to ED Pharmacist PSHP CE Final - Rob Notes V.5 (20)
1. Establishing Emergency Department
Pharmacy Services and Pharmacist
Impact
Glenn R. Oettinger, PharmD, BCPS
and
Robert S. Pugliese, PharmD, BCPS
1
The Pennsylvania Society of Health System Pharmacists
October 29th, 2015
2. Objectives
1) Explain justification for an Emergency Medicine
Pharmacist (EMP)
2) Describe the core roles of the EMP
3) Describe strategies for implementing an EMP position
4) Identify how to encourage growth in the specialty of
Emergency Medicine (EM) Pharmacy
5) Describe some ways in which EMPs can systematically
improve the care of patients in ED
6) Discuss other key administrative roles of EMPs
2
3. The Emergency Medicine
Pharmacist
A Safety Measure for Hospitals
Glenn Oettinger, PharmD, BCPS
glenn.oettinger@jefferson.edu
@GlennOettinger
3
Part 1
4. The Emergency Medicine Pharmacist: A Safety
Measure for Hospitals1
• Justification
• Role
• Implementation
4
7. The Ideal ED
• No patient is overlooked
• Adequate support for all clinical staff
• Appropriate supervision of all residents and
students
• All patients rest assured medications ordered
are reviewed by a pharmacist
7
9. Reality
• ED is Vulnerable
• High volume and overcrowding
• Wide spectrum of diseases
• Frequent interruptions and distractions
• Fast paced
• Verbal orders
9
10. ED is Inherently a Patient Safety Risk2,3,4
• Established safety mechanisms missing from most EDs
• Pharmacy review of medications
• Pharmacy preparation of medications
• Pharmacist involvement in clinical decision making
• Medication-related adverse events in the ED
• 3.6% of ED patients receive inappropriate medication
• 5.6% of ED patients receive inappropriate discharge Rx
10
11. Gaps in the Average ED Medication
Use System5
11
Dispensing
(pharmacist)
Data Entry and
Screening
Preparing, mixing,
compounding
Pharmacist double
check
Dispensing to Unit
Transcribing
(Pharmacist, nurse,
unit clerk)
Receive order or
retrieve from MAR
Check if correct
Prescribing
(physician, nurse
practitioner,
pharmacist)
Clinical decision
making
Drug Choice
Drug regimen
determination
Medical Record
Documentation
Order (written,
verbal, electronic)
Monitoring
(Nurse, physician,
pharmacist)
Assess for
therapeutic effect
and adverse affect
Review laboratory
results if necessary
Treat adverse drug
event if occurring
Medical record
documentation
Administering
(nurse)
Drug preparation for
administering
Nurse verifies
orders
Drug administered
Documentation in
MAR
12. Most ED Medication Events are Preventable!
• ED has highest rate of preventable adverse
events in the US6
• 110 million ED visits annually in US
• 5% experience potential events = 550,000 potential
events per year
• 70% are PREVENTABLE = 38,500 preventable events
12
13. ED Systems are Stretched7,8
ED overcrowding = Reduced capacity to deliver safe care
• Over last decade
• ED visits 26%
• 9% of EDs closing nationwide
• 198,000 hospital beds closed
• Reduced capacity to deliver safe care
• Boarding inpatients
• Contributes to overcrowding and elevated risk
13
14. Safety Benefits of an ED Pharmacist Program
Providing an extra layer of protection
• Available for immediate high risk med review
• Respond to all traumas, resuscitations, and
critical patients
• Pharmacotherapy consults with physicians for
medication selection
• Staff education
14
15. Joint Commission Compliance9,10
ED Pharmacist improves JC compliance
• Increased oversight of high yield medications
• Increased monitoring of drug effect
• Enhanced degree of communication with nurses and
physicians
• Development of processes for managing high risk
medications (i.e. TPA, sepsis antibiotics, pediatric
meds)
15
16. Adding Value
It has been shown that staff value the ED Pharmacist
• 26 item survey to random ED staff with 82%
response11
• 99% felt ED pharmacist improves quality of care
• 96% felt ED pharmacist was an integral part of ED team
• 95% indicated they had consulted with ED pharmacist at
least a few times during last 5 shifts
16
17. The ED Pharmacist – A Safety Measure in
Emergency Medicine
• ED pharmacist improves process measures such as:
• Time to cath lab, abx in pna, pain management, etc12
• Adds critical layer of safety to vulnerable patients13
• Adds cost-saving benefit to the ED14
17
18. Cost-savings in the Emergency Room:
A Four Month Study of ED Pharmacist
Interventions14
Type of
Intervention
No.Interventio
ns
Average Cost
Avoidance per
Intervention ($)
Cost Avoidance ($)
Drug-drug or drug
disease
interactions
or drug
incompatibilities
identified
334 1,647 297,053
Therapeutic
recommendation
523 1,188 273,383
Adverse drug
event
prevented
48 1,098 23,190
Medication error
prevented
488 1,375 436,150
Total 1393 5,308 $1,029,776 18
20. Role of the ED Pharmacist
• Clinical Consultation Duties
• Responds to pharmacotherapy consultations
• Provides drug selection and dose recommendations
• Therapeutic substitutions
• Recognizes disease state specific pharmacotherapy
• Implements patient-specific pharmacokinetics
20
21. Other Clinical Duties
• Order screening
• Focus on allergies, drug interactions, and
appropriate dosing
• Selection and preparation of medications
• High Risk Medications, RSI, codes
• Resuscitations and trauma response
• ED pharmacist at bedside actively overseeing
medication use process
21
22. Pediatric ADE’s in the ED15
• For every 1000 pediatric patients
• 100 prescribing errors
• 39 administration errors
• 22% of acetaminophen doses incorrect
22
23. Pediatric patients at risk
• Most ED’s generally not well-prepared to
manage pediatrics16
• 6% “well” prepared nationwide
• Pediatrics account for 27% of ED visits
• All children need weight-based dosing, increasing the
likelihood for errors
23
24. ED Pharmacist – An Educator
• New medications
• Drug warnings
• Drug-drug interactions
• Provides current, evidenced-based information on
pharmacological therapy
• Simulation exercises
• Becomes an established authority through education
24
25. Benefits of Having an ED Pharmacist17,18,19
• Research and educational advancements
• Vulnerable populations
• i.e. Severe sepsis, severe trauma, patients
requiring sedation, pediatrics
• Patient safety
• Reduced rate of adverse events
• Medication selection, order screening, stat
bedside preparation
25
27. National Implementation20
• 3-5% of EDs in U.S. have a dedicated clinical pharmacist
• 18.3% have attempted to gain funding for a pharmacist
position
• Primarily through pharmacy budget
• 30.1% plan to request funding
• demand
27
28. Bottom Line
• ED’s across America are in need of dedicated
pharmacy specialists
• Arrive with a plan and they will embrace you
28
29. Step I: Assess Individual ED Environment
• Size of hospital
• Academic center vs. non-academic
• Urban vs. rural
• Patient demographics
• Annual patient volume
• Trauma center
Have potential ED pharmacist candidate shadow medical staff
• Determine needs
29
30. Step 2: Recruitment
Finding a full time dedicated ED Pharmacist
• Education
• PharmD
• Residency – PGY1 preferred
• PGY2 accredited emergency pharmacist
programs emerging
• ACLS, PALS certification
30
32. What to Look for
Characteristics
• Proactive – continually offers assistance
• Build relationships with all medical staff
• Actively seeks out patients that can benefit from
ED pharmacist intervention
• Ability to appear helpful and not confrontational
• Ability to work well under pressure and time
constraints
32
33. Step 3: Overcoming Challenges
Funding
• Grants
• EM department co-funding
• Couple implementation with a residency project
Staff Resistance
• Temporary response to change
33
34. Financial Challenges
Important to demonstrate return on investment
• ED pharmacist save money
• Recommend lower cost meds with equal or
better efficacy
• Reduce adverse drug events
• Waste reduction
34
35. ROI
4 month study – 2150 interventions21
• 1393 directly related to ADE’s
• Cost avoidance of estimated $1,029,776
35
36. Availability, Accessibility, and Visibility
• Dedicated to the ED
• Physically located in ED (not isolated to a satellite)
• Easily accessible and visible to all staff with frequent
“walk-through”
36
37. Resources
Provide ED Pharmacist with necessary equipment (laptop,
cell phone, pager, computer space centrally located in ED)
37
39. References – Part One
1. Emergency Pharmacist Research Team, University of Rochester Department of Emergency Medicine. Rollin J. (Terry)
Fairbanks, Principal Investigator; Karen E. Kolstee, Project Coordinator; Daniel P. Hays, Lead Pharmacist.
www.EmergencyPharmacist.org Supported by The Agency for Healthcare Research and Quality, Partnerships in
Patient Safety, Grant no. 1 U18 HS015818
2. Hafner JW, et al. Annals of Emergency Medicine, 2002; 39(3).
3. Leape LL, et al. JAMA, 1995; 27(1).
4. Sanders MS, et al. Human Factors Engineering and Design. 7th ed. McGraw Hill, Inc.,1993.
5. Aspden P et al, Preventing Medication errors: Quality Chasm Series. Nat’l Academy Press: 1st ed, 2007
6. USP Patient Safety CAPS
7. Institute of Medicine, The Future of Emergency Care. Nat’l Academies Press; 2007
8. Derlet RW. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg Med.
2002;39(4):430-2.
9. Fairbanks, Patel, and Shannon. EPh Time-Motion Study (2007). Results presented at AHSP Mid-Year Clinical Meeting,
December 5, 2007. (available at www.emergencypharmacist.org/toolkit.html)
10. Conners GP, Hays D. Emergency Department Drug Orders: Does Drug Storage Location Make a Difference? Annals of
Emergency Medicine. 2007;50:414-418
11. Fairbanks RJ, Hildebrand JM, Kolstee KE, Schneider SM, Shah MN. Medical and nursing staff value and utilize clinical
pharmacists in the Emergency Department. Emergency Medicine Journal Oct 2007; 24:716-719.
12. Fairbanks RJ, Results of the AHRQ Emergency Pharmacist Outcomes Study. American Society of Health-System
Pharmacists 42nd Mid-Year Clinical Meeting, Las Vegas: 12/5/07. (available at www.EmergencyPharmacist.org).
13. Fairbanks RJ et al, The Optimized Emergency Pharmacist Role, Presented at AHRQ Patient Safety & Health IT
Conference, June 2006 (available at www.EmergencyPharmacist.org).
14. Lada P, Delgardo G. Documentation of Pharmacists' Interventions in an Emergency Department and Associated Cost
Avoidance. Am J Health-Syst Pharm-Vol 64 Jan 1, 2007
15. Aspden P et al, Preventing Medication errors: Quality Chasm Series. Nat’l Academy Press: 1st ed, 2007
16. Institute of Medicine, The Future of Emergency Care. Nat’l Academies Press; 2007
17. Bond CA, et al, Pharmacotherapy, 1999; 19(6).
18. Leape LL, et al JAMA, Mar 2000; 283(10).
19. Gattis WH, et al, Arch Internal Med, 1999; 159(16).
20. Thomasset and Faris, Am J Health-Syst Pharm, Aug 2003; 60
21. Lada, P. et al, Am J Health-Syst Pharm, Jan 2007; 61(4)
39
41. Emergency Medicine Pharmacists recognized by
American College of Emergency Physicians (ACEP)
“RESOLVED, That ACEP create a policy statement that
supports clinical pharmacy services in emergency
departments and collaboration among emergency medicine
providers to promote safe, effective, and evidence-based
medication practices, to conduct emergency-medicine-
related clinical research, and to foster an environment
supporting pharmacy residency training in emergency
medicine”2
41
Resolution 44
42. Emergency Medicine Pharmacists recognized by
American College of Emergency Physicians (ACEP)
“Any of us who’s ever had access to
clinical pharmacy services in the
[emergency room] know it’s really
important”
–Louise A Prince, President, ACEP New York1
42
43. Surprise!?
• Many Emergency Departments:
• Overcrowded (primary care)
• Understaffed (5-to-1 nursing ratio!)
• Provide ICU level care (and fix tummy aches)
• Mixed population (inpatient/outpatient)
• Lack common medication safety protections
• Prospective medication order review not
mandated by Joint Commission
43
45. First mention of EM Pharmacy service was in 1977
published in American Journal of Hospital Pharmacy3
Yes
14%
No
86%
ER Pharmacist Survey 2000
(n=119)4
Yes
30%
No
70%
ER Pharmacist Survey 2007
(n=99)5
Pharmacy residency
programs surveyed
Emergency Medicine
residency programs surveyed
45
Yes
62%
No
38%
?
46. Yes
14%
No
86%
ER Pharmacist Survey 2000
(n=119) 4
Yes
30%
No
70%
ER Pharmacist Survey 2007
(n=99) 5
Yes
62%
No
38%
Critical Care Pharmacist Survey
2006 (n=382) 6
Hospitals with ICUs surveyed
46
47. We need more Emergency Medicine
Pharmacists
116
27
0
20
40
60
80
100
120
140
Critical Care Emergency Medicine
ASHP Accredited PGY2 Residency
Programs*
*Source: ASHP Online Residency Directory. Available at:
http://accred.ashp.org/aps/pages/directory/residencyProgramSearch.aspx. Accessed 1-8-2015
47
49. Emergency Medicine Pharmacists
are Great Collaborators!
• ED pharmacists find themselves at the crossroads of the
hospital
• ED pharmacists often must act as intermediaries and
facilitators in interdepartmental collaborations
• ED pharmacists are a trusted team member and are looked
to when problems arise
• ED Pharmacists in unique position to identify systematic
problems and develop solutions
• Many initiatives begin in the ED and we are there at the
ground floor
49
51. ASHP Guidelines on Emergency Medicine
Pharmacist Services
Essential/Desirable Administrative Roles of EM Pharmacists7
1. Medication and Patient Safety
2. Quality Improvement Initiatives
3. Leadership and Professional Service
4. Emergency Preparedness
5. Education
6. Research and Scholarly Activity
51
52. 1. Medication and Patient Safety
• Intervention documentation
• ADE/ADR Reporting
• ED Performance Improvement (PI) Leadership
52
56. Emergency Medicine Pharmacist Impact
Conclusions
• A majority of interventions occurred through prospective
consults where EMPs assisted in determining patient
treatment.
• An average of 16 interventions occurred each day, roughly
equating to one intervention per hour between 0800 and 2330.
• All EMP interventions were accepted except for 1 of 478
(0.002%)
• Due to the fast paced nature of the ED, almost 100%
documentation capture was only possible with the support of
students documenting all EMP interventions
56
57. 2. Quality Improvement Initiatives
• Jeff FAST Program – Facilitating Anticoagulation for Safer
Transitions
• Pediatric ED Workgroup – Develops and promotes evidence
based protocols for pediatric ED population
• Sepsis Initiative – ED Pilot now house wide evidence based
care bundle leading to mortality benefits
• Sickle Cell Workgroup – collaboration between outpatient
Sickle Cell Center and ED
• Stroke Committee – decreased time-to-TPA to <60 min; TPA
made centrally (not at the bedside) with average 11 min
turnaround
57
64. Antibiotic Compatibilities in Sepsis Treatment
Amik Anid Azith Aztre Cefe Ceft Ceftri Dopa Epi Line Mero Met Mica Moxi Norepi P/T Tig Tobra Vanco
Amikacin (Amik) - C - C C C - C C C - C - - - C C - C
Anidulafungin (Anid) C - - - C C C C C C C C - - C C - C C
Azithromycin (Azith) - - - - C - - - - - - - - - - - C - -
Aztreonam (Aztre) C C - - C C C C C C - - - - - C C C C
Cefepime (Cefe) C C C C - - - C - C - C - - - - C C C
Ceftazidime (Ceft) C C - C - - - C C C - C - - C - C C -
Ceftriaxone (Ceftri) - C - C - - - - - C - - - - - - C - C
Dopamine (Dopa) - C - C C C - - C C - C C - C C C - C
Epinephrine (Epi) - C - C - C - C - - - - - - C - C - C
Linezolid (Line) C C - C C C C C - - C C - - - C C C C
Meropenem (Mero) - C - - - - - - - C - - - - C - - - C
Metronidazole (Met) C C - - C C - C - C - - - - - C - - -
Micafungin (Mica) - - - - - - - C - - - - - - C - - - -
Moxifloxacin (Moxi) - - - - - - - - - - - - - - - - - - -
Norepinephrine (Norepi) - C - - - C - C C - C - C - - - C - -
Piperacillin/Tazobactam (P/T) C C - C - - - C - C - C - - - - C - C
Tigecycline (Tig) C - C C C C C C C C - - - - C C - C C
Tobramycin (Tobra) - C - C C C - - - C - - - - - - C - C
Vancomycin (Vanco) C C - C C - C C C C C - - - - C C C -
66. Quality
Improvement
Initiatives –
Pediatric/ED
Workgroup
Triage
• Vital Signs
• Peak Flow
• Pulse Ox
Physician Order Set
Pediatric Asthma
• First series Bronchodilators (if not previously
ordered):
• Albuterol q 20 min x3 +Ipratropium x 2
with 2nd and 3rd nebs
• CXR if:
• Fever (Temp ≥ 100.4
• Foreign Born
• First-time Wheeze
• Focal Lung Findings
• Assess Severity
Treatment
• Oral
Steroids
Nursing ED FLO
Pediatric Wheezing
• Peak Flow pre-Rx
• First series Bronchodilators:
• Albuterol q 20 min x3
• +Ipratropium x2 with 2nd and 3rd nebs
• Peak Flow post-Rx
• O2 NC if < 93%
Mild
• O2 Sat > 93%
• RR WNL for age
• If > 7 yrs PF >
70%
Meets ALL Discharge
Criteria?
• O2 Sat > 93%
• RR WNL for age
Treatment
• Oral Steroids
• Second series bronchodilators:
• High dose albuterol q2h
• Ipratropium q4h
• Peds consult 877-656-5559
• Peds RT consult pager 2141
• Admit
Moderate
• O2 Sat > 93%
• RR elevated for age
• If > 7 yrs PF 40-70%
Home
• Asthma action plan (can consult peds RT
to assist with plan and/or teaching)
• F/U PMD within 1 week
• Equipment at home (Spacer/nebulizer)
• Prescriptions for Albuterol +/- ICS
Treatment
• Steroids
• Continuous albuterol
• Magnesium
• Peds consult
• Peds RT consult
• Admit
Severe
• O2 Sat ≤ 93%
• If > 7 yrs PF <
40%
Yes
No
DangerousPediatric
Respiratoryrates
0-60 days over 60
60 days- 1year over 40
1-5 years over 30
5-18 years over 20
Expected 70% 40%
Height (cm) Peak Flow Expected Expected
43 (108) 147 103 59
44 (112) 160 112 64
45 (114) 173 121 69
46 (117) 187 131 75
47 (119) 200 140 80
48 (122) 214 150 86
49 (124) 227 159 91
50 (127) 240 168 96
51 (130) 254 178 102
52 (132) 267 187 107
53 (135) 280 196 112
54 (137) 293 205 117
55 (140) 307 215 123
56 (142) 320 224 128
57 (145) 334 234 134
58 (147) 347 243 139
59 (150) 360 252 144
60 (152) 373 261 149
61 (155) 387 271 155
62 (157) 400 280 160
63 (160) 413 289 165
64 (163) 427 299 171
65 (165) 440 308 176
66 (168) 454 318 182
67 (170) 487 341 195
Pediatric
Wheezing/Asthma
ED Pathway
Pts <20kg Albuterol 2.5mg q20min x3 +
Ipratropium 0.5mg q20min x2
Pts >20kg Albuterol 5mg q20min x3 +
Ipratropium 0.5mg q20min x2
Pts <20kg Albuterol 5mg q2h
Pts >20kg Albuterol 10mg q2h
Pts <20kg 5mg/hr
Pts >20kg 10mg/hr
Prednisone 2mg/kg MAX 60mg PO
Prednisolone Sol 2mg/kg MAX 60mg PO
Methylprednisolone 2mg/kg MAX 60mg IV
Magnesium Sulfate 50mg/kg MAX 2gm IV
administer over 20 minutes
First Series Bronchodilators
Second Series Bronchodilators
First Dose Steroids
Adjunct Medication
High Dose Albuterol
Continuous Albuterol
Issue Date January 2013 66
67. Quality
Improvement
Initiatives –
Pediatric/ED
Workgroup
67
Pathway – Neonate/Infant 0-90d Fever ED Management Algorithm
Definitions
o Neonate: 0 – 28 days of life
o Infant: 29 – 90 days of life
o Fever: Rectal temperature ≥ 38ºC (100.4 ºF)
Obtain IV access
Initiate Medications (C)
Admit to pediatrics
Rectal temperature ≥ 38ºC (100.4 ºF)
Neonates 0 – 28 days old
Initiate Neonate/Infant Fever Pathway
(Assure FLO orders are placed if not done)
Call pediatric consult (CC)
Obtain IV access
Initiate Medications (B)
UA and urine culture (use Cath Kit)
Blood culture x1
LP with HSV PCR
Stool culture if diarrhea
CXR, Flu antigen, RSV PCR if respiratory symptoms
Admission to pediatrics
ESI 2
Notify Physician
FLO/Nurse initiated orders
-Heelstick for CBC + diff
-Accucheck for glucose
-Lido 4% cream x1 prn IV place (A)
-Sucrose Sol oral (Sweet-Ease) prn
for painful procedures
Infants 29 – 60 days old
Initiate Neonate/Infant Fever Pathway
(Assure FLO orders are place if not done)
Call pediatric consult (CC)
UA and urine culture (use Cath Kit)
Blood culture x1
LP with Enterovirus PCR
Stool culture if diarrhea
CXR, Flu antigen, RSV PCR if respiratory symptoms
Infants 61 – 90 days old
Initiate Neonate/Infant Fever Pathway
(Assure FLO orders are place if not done)
Call pediatric consult (CC)
UA and urine culture (use Cath Kit)
Blood culture x1
LP (if NOT Low Risk) with Enterovirus PCR
Stool culture if diarrhea
CXR, Flu antigen, RSV PCR if respiratory symptoms
Is the patient LOW risk?
Clinical criteria:
Previously healthy
Term infant with uncomplicated nursery stay
Nontoxic clinical appearance
No focal bacterial infection on examination (EXCEPT otitis
media)
Laboratory criteria:
WBC count 5 – 15,000/mm3
Bands <20%
Negative gram stain of unspun urine (preferred) OR
negative leukocyte esterase and nitrite, OR
<5 WBCs/hpf in stool (if diarrhea)
If LP done
o CSF <8 WBCs/mm3
AND negative gram stain
o Corrected: <1 WBC/500 RBC
Social criteria:
Reliable care taker
Assured follow up within 24 hours
A) Lidocaine 4% Cream (Anecream/LMX-4) Dosing:
1 gram = 5 cm ribbon = 40 mg lidocaine
Wt(kg) Recommended Dose
(Amount of Cream
Applied) Per Site
Max Dose (Amount of Cream
Per Application)
TOTAL AMT USED ON ALL
SITES*
Max
Application
Time (hr)
< 5 0.5 g (2.5 cm) 1 g (5 cm) 1
5-10 0.5-1 g (2.5-5 cm) 2 g (10 cm) 2
11-20 1-2 g (5-10 cm) 10 g (50 cm) 2
> 20 1-2 g (5-10 cm) 20 g (100 cm) 2
*Maximum amount of cream per application may be repeated in 2 hours; not to be applied more than
3 times in a 24 hour period / NO MORE THAN 2 SITE APPLICATIONS
B) Medications 0 – 28 days old (x1 doses only in ED)
-Ampicillin
0-7 days: 100 mg/kg/dose IV q8h (max: 2 grams/dose)
8-28 days: 75 mg/kg/dose IV q6h (max: 2 grams/dose)
-Cefotaxime
0-7 days: 50 mg/kg/dose IV q12h (max: 2 grams/dose)
8-28 days: 50 mg/kg/dose IV q8h (max: 2 grams/dose)
-Acyclovir 20 mg/kg/dose IV q8h
-Sodium Chloride 0.9% Bolus (20 ml/kg) prn dehydration
-Acetaminophen 15mg/kg/dose PO or PR q6h prn fever ≥100.4°F
C) Medications 29 – 90 days old (x1 dose in ED)
-Vancomycin 15 mg/kg/dose IV q6h (max: 500 mg/dose)
-Cefotaxime 75 mg/kg/dose IV q6h (max: 2 grams/dose)
-Sodium Chloride 0.9% Bolus (20 ml/kg) prn dehydration
-Acetaminophen 15mg/kg/dose PO or PR q6h prn fever ≥100.4°F
D) Medication for Low Risk patients (post-LP)
-Ceftriaxone 50 mg/kg/dose IM once (max: 1000 mg/dose)
Was LP done?
NO YES
Medication (D)
Discharge
Reevaluation in 24 hours
Reevaluation in 24 hours
HIGH RISK
LOW RISK
No Medication
Discharge
Reevaluation in 24 hours
Reevaluation in 24 hours
69. 3. Leadership and Professional Service
• ED Medication Reconciliation
Project (Coming Soon!)
• Goal is to establish a model for
technician/intern based
medication reconciliation for
100% of patients coming
through the ED
• LEAN Leaders – Interdepartmental LEAN ED Medication
Distribution Project
• Pharmacy Techs are content experts
69
71. 71
Patient's Pharmacy (and cross street):___________________________
Please write down the medications you take. If you do not remember your medication names, you can call your pharmacy, ask a caregiver/family
member, or ask a staff member for help.
Medication History
Drug and Food allergies (describe what happens when you have a reaction):
Pharmacy Phone Number:________________________
Patient Name:________________________________ Date of Birth: ___/___/_____ Recently hospitalized at Jefferson? ○ Yes ○ No
Do you see a physician at Jefferson? ○ Yes ○ No
ED Staff Only: Med Rec Start Time and Date: Med Rec Completion Time: Notes:
○ Once daily ○ Twice daily○ Other ________________
○ By mouth○ Other: ________________
○ By mouth○ Other: ________________
○ By mouth○ Other: ________________
List any Over the Counter (OTC) medications you take and when you last took them (for example: Aspirin or Benadryl):
Prescription Medication Name and Dose
List any herbal supplements or vitamins you take and when you last took them (for example: St. Johns Wort or Fish Oil products):
○ By mouth○ Other: ________________
○ By mouth○ Other: ________________
○ Once daily ○ Twice daily○ Other ________________
○ Once daily ○ Twice daily○ Other ________________
○ Once daily ○ Twice daily○ Other ________________
○ Once daily ○ Twice daily○ Other ________________
Last dose?
○ By mouth○ Other: ________________
○ By mouth○ Other: ________________
○ Once daily ○ Twice daily○ Other ________________
○ Once daily ○ Twice daily○ Other ________________
How do you take the medication? How Often?
○ Once daily ○ Twice daily○ Other ________________
○ By mouth○ Other: ________________
○ By mouth○ Other: ________________
○ Once daily ○ Twice daily○ Other ________________
72. 4. Emergency Preparedness
• Disaster Management Workgroup – ED
Pharmacists act as department liaisons for
disaster management support
• Antidote Inventory Management – Developed
formulary antidote database to identify critical
antidotes, identify storage locations, set supply
par levels, and monitor stock
72
73. 5. Education
• Pharmacy Resident Rotation
• ED rotation provides unique environment for resident
to work on a wide range of skills
• Always opportunities for research in the ED
• Many residency grads are finding opportunities as ED
pharmacists
• Pharmacy Student Rotations (IPPE/APPE)
• #1 most requested rotation site at TJU
• Students get the opportunity to apply concepts in a
wide range of disease states
• Formal Lectures
73
74. 6. Research and Scholarly Activity
• Nitrous oxide toxicity case report – AJHP8
• The Jeff FAST Program – Presentation to National
Anticoagulation Forum
• The Jeff FAST Program – Journal of Hospital Practice9
• ED Interventions Student Poster - ASHP Midyear
• The Sepsis Initiative – Critical Care Medicine (Abstract)
• The Sepsis Initiative - Presentation to University Health
System Consortium and IHI National Meetings
• The Sepsis Initiative - ASHP Foundation for Medication
Use Excellence Finalist
74
75. 6. Research and Scholarly Activity
Pharmacy Resident Research Manuscripts
• Post Intubation Sedation ED Protocol
• Establishing the Jeff FAST Program
• ED Pharmacist Effect on Sepsis Protocol
Adherence
• Pharmacy Led Med Rec in ED
• Improving the Pharmacologic Management of
Severe Sepsis
75
80. References – Part Deux
1. American College of Emergency Physicians. 2014 Council Resolutions, Chicago. Resolution
44: Support for Clinical Pharmacists as Part of the Emergency Medicine Team. Available at:
https://www.acep.org/uploadedFiles/ACEP/About_Us/Leadership/Council/2014%20Resolutio
ns%20Compendium.pdf. Accessed January 8, 2015.
2. Cheryl A. Thompson. Pharmacy News: Emergency Physicians Group Supports ED Clinical
Pharmacy Services. AJHP News. December 15, 2014. Available at:
http://www.ashp.org/menu/News/PharmacyNews/NewsArticle.aspx?id=4140. Accessed
January 8, 2015.
3. Elenbaas RM, Waeckerle JF, Mcnabney WK. The clinical pharmacist in emergency medicine.
Am J Hosp Pharm. 1977;34(8):843-6.
4. Thomasset KB, Faris R. Survey of pharmacy services provision in the emergency department.
Am J Health Syst Pharm. 2003;60(15):1561-4.
5. Szczesiul JM, Fairbanks RJ, Hildebrand JM, Hays DP, Shah MN. Survey of physicians regarding
clinical pharmacy services in academic emergency departments. Am J Health Syst Pharm.
2009;66(6):576-9.
6. Maclaren R, Devlin JW, Martin SJ, Dasta JF, Rudis MI, Bond CA. Critical care pharmacy
services in United States hospitals. Ann Pharmacother. 2006;40(4):612-8.
7. Eppert HD, Reznek AJ. ASHP guidelines on emergency medicine pharmacist services. Am J
Health Syst Pharm. 2011;68(23):e81-95.
8. Pugliese RS, Slagle EJ, Oettinger GR, Neuburger KJ, Ambrose TM. Subacute combined
degeneration of the spinal cord in a patient abusing nitrous oxide and self-medicating with
cyanocobalamin. Am J Health Syst Pharm. 2015;72(11):952-7.
9. Falconieri L, Thomson L, Oettinger G, et al. Facilitating anticoagulation for safer transitions:
preliminary outcomes from an emergency department deep vein thrombosis discharge
program. Hosp Pract (1995). 2014;42(4):16-45.
80