We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist.
In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know well these faceless interactions with a human reminding you to renally dose your Zosyn, stop ordering the bicarb drip that way…and did you really mean to order so much tPA? Probably a bad idea.
Enter the decentralized, physically present ED pharmacist. These folks will be a tremendous resource to you both clinically and educationally; please take advantage! Utilize their knowledge and incorporate them into your team structure, particularly in resus.
To be clear, the ED pharmacist’s primary role is still order verification for all adult ED patients. This amounts to roughly 200-300 patients in a given shift. However, in addition, the pharmacist can assist in the following ways:
- Cardiac arrests: your ED pharmacist can assist with simple ACLS meds (i.e., preparing syringes for injection), but also with compounding more advanced preparations at the bedside like sodium bicarbonate infusions, vasopressors (epi, levo, etc), and more. They can also be a resource in considering potential medication-related causes associated with an episode of cardiac arrest. Please get them involved!
- Stroke codes: as already is procedure, the ED pharmacist will continue to attend code strokes as they always have since pharmacy took up the role in the administration of Alteplase.
- Antibiotic therapy: act as a resource for recommendations regarding empiric antimicrobial therapy. As per pharmacy: “We would be more than happy to assist providers…so that not everybody is getting piperacillin-tazobactam and vancomycin for every infectious issue.” (No one should get Zosyn any more, by the way.)
- Medication reconciliation: particularly for high risk patients or patients whose home medication list or history poses a problem. (Obviously not for every ED patient.)
- Other acute medication management issues: e.g., addressing missed medications, obtaining medication in a timely manner from pharmacy, addressing nursing concerns about medication orders.
And more! This will be an evolving role over the next several months so please feel free to give feedback.