Initiation of an emergency department pharmacy program during economically challenging times.

PURPOSE: The initiation of a medication reconciliation program and other pharmacy services in the emergency department (ED) of a community hospital is described.

SUMMARY: Despite a lack of funding for additional staff, the pharmacy department of a community hospital led an initiative to establish an ED pharmacy program; a major goal of the program was to address errors and inconsistencies in ED admission and discharge medication reconciliations. Implementing the program in a cost-neutral manner required the realignment of staff duties and schedules and an arrangement with the hospital's off-site central order-entry pharmacy contractor for expanded coverage hours. Other challenges during program implementation included securing ED workspace that afforded high visibility and easy access to the pharmacist and ensuring that pharmacy staff were qualified to provide critical care services (e.g., advanced life support, attendance at code responses, critical care drug information). After two months of operation, a review of a random sample (n = 102) of admission medication reconciliations indicated that those performed by pharmacists were significantly (p < 0.05) more likely than those conducted by nurses to meet specified accuracy criteria. An informal survey of ED physicians and nurses indicated that pharmacist involvement on the ED team was generally well received and viewed as integral to optimal ED services.

CONCLUSION: Implementation of an ED pharmacist program improved the admission medication reconciliation process and provided additional services to improve patient safety and quality of care.