The ED Pharmacist as a safety measure in Emergency Medi*

背景：急诊科（ED）是医学中一个独特的环境，许多在其他医院环境中使用的安全机制不能应用于急诊科。例如，临床药剂师传统上通过交叉检查提供者的订单来为住院病人提供额外的保护，以确定适当的剂量、禁忌症和相互作用。由于急诊科的药物必须立即获得，而且通常是一次性剂量，使用中央药房服务将导致不可接受的药物管理延迟。尽管一些医院有药剂师响应急诊科心脏骤停或创伤小组活动的项目，但很少有报道称有专门分配给急诊科的临床药剂师参与的项目。尽管如此，已发表的报告断言，以ed为基础的药剂师可以提高患者的安全。虽然这一概念似乎合乎逻辑，但没有研究试图表明这些计划可以减少急诊科潜在的药物不良事件。项目总结：我们建议在大型急诊科实施和优化急诊科药剂师（EDP）计划，作为一种安全实践干预措施。从奖励期开始，医院已经为两个永久全职职位提供了资金。在初始阶段，将对医生、护士、药剂师和患者进行访谈，结果将用于优化EDP的作用。随后，将进行一项大规模的图表审查研究，以评估在医务人员当值期间，潜在和不良药物事件的发生频率是否有所减少。还将评估工作人员对该计划有效性的看法。这项倡议的总体目标是创建一个有效的EDP计划，以降低急诊科患者药物不良事件的发生率，并创建一个“工具包”，以促进将类似的计划引入其他急诊科。该工具包将包括对EDP的正式、优化作用的描述、实施过程中的挑战和解决方案，以及支持该计划有效性的证据。相关性：药剂师的使用已被证明可以减少医院环境中的用药错误和不良事件。将这一概念应用于急诊科环境预计会产生同样的效果，从而通过减少药物错误率和对急诊科照顾的患者的伤害，对公共卫生产生影响。

DESCRIPTION (provided by the applicant): BACKGROUND: The Emergency Department (ED) is a unique environment in medicine, and many safety mechanisms used in other hospital settings cannot be applied in the ED. For example, clinical pharmacists have traditionally provided extra layers of protection to hospital inpatients by cross-checking provider orders for appropriate dosing, contraindications, and interactions. Because medications in the ED must be accessed immediately and are often one-time doses, the use of central pharmacy services would introduce an unacceptable delay to the administration of medication. Although some hospitals have programs in place in which a pharmacist responds to the ED for cardiac arrests or trauma team activations, few have reported programs which involve a clinical pharmacist assigned exclusively to the emergency department. Nonetheless, published reports have asserted that ED-based pharmacists can increase patient safety. Although this concept appears logical, no study has attempted to show that these programs reduce potential adverse drug events in the ED. PROJECT SUMMARY: We propose to implement and optimize an ED Pharmacist (EDP) program as a safe practice intervention in a large ED. The hospital has provided funding for two permanent full time positions starting at the beginning of the award period. In the initial phase interviews of physicians, nurses, pharmacists, and patients will be conducted and the results will be used to optimize the EDP role. A large-scale chart review study will then be conducted to evaluate whether there is a reduction in frequency of potential and adverse drug events during times that the EDP is on duty. Staff perceptions of the effectiveness of this program will also be evaluated. The overall goal of this initiative is to create an effective EDP program that will decrease the rate of adverse drug events in ED patients, and to create a "toolkit" to facilitate the introduction of similar programs into other EDs. This toolkit will include a description of the formal, optimized role of the EDP, challenges and solutions in implementation, and evidence to support the efficacy of such a program. RELEVANCE: The use of a pharmacist has been proven to reduce medication error and adverse events in the hospital setting. Applying this concept to the ED setting is expected to have the same effect, thus will have an impact on public health by reducing the rate of medication error and harm to patients cared for in the ED.