Role of Pharmacist in Emergency Department

The primary role of the pharmacist in an emergency department is divided into two main roles:

a) Essential Role: 

The essential role of a pharmacist includes direct involvement in pharmacotherapy management. Essential roles include things like 

1. Direct patient care rounds,
2. Drug prescription review etc. 

Parts of the essential role include things like:

Direct patient care Rounds

• In this case, the pharmacist is involved in the optimization of therapy by controlling errors in drug selection and prescribing. A whole team of healthcare is involved in this scenario including nurses and physicians. 
• A complete review or selected review of drug use is done in an emergency depending upon the number of pharmacists available. For example, when a limited number of pharmacists are available then a triage system may be followed instead of focusing on all critically ill, high-risk patients, or selected drugs with a high chance of interaction are selected to be checked. 
•  This triage system just like the first priority” critically ill patient only” then “high-risk patient” and/or “selected drug with a high chance of drug interactions” is preferred when the number of pharmacists is not according to the need.

Medication order review

A prospective review of the medication order must be done by the pharmacist before the drug is administered to the patient. In some case,, the review if not done is not compulsory. Just like

1. In- Case of Emergency: when the patient is critical and review time may fall his life in danger so it is good not to have a review. Although the selection is done along with the physician.
2. If the Delay in the review harms the patient.
3. If a medical practitioner is present there.

When serving in an emergency the services provided by the pharmacist depend on the number of patients and the number of pharmacists available. When a low number of pharmacists are hired in an Emergency department the pharmacist's work is overloaded. So in this case the medication orders coming for review, the pharmacist will review the orders according to the need.

The majority of emergency orders are one-time orders so it is necessary that the pharmacist review the order before administration. Similarly to direct patient care rounds a triage system is also followed here. When running short of time other department pharmacists may be involved through a computerized provider order entry (CPOE) system where all of the pharmacists are linked through a computerized system with an emergency department. An alarm system may be developed where Emergency pharmacists require the help of other pharmacists and is done quickly.

Medication Therapy Management

• Medication therapy management is necessary for the Medication use process, whether the therapy selected was safe and effective, sub-optimal, or failed, and whether changes to the therapy regimen are needed. Medication therapy management prevents the insecure use of medicines in the future and promotes regular use of medicines.

Patient care involving high-risk medications and procedures

• High-risk medications include medicines with narrow therapeutic Index (NTIs). Such drugs must be used under the strict supervision of a pharmacist. similarly, alternate procedures used in the life-saving processes must be observed by pharmacists from the bedside of the patient. 
• Emergency pharmacists should evaluate current procedures associated with the use of high-risk medications. Participation of pharmacists in such a process includes proper selection, proper doses, preparation of medications and monitoring of therapy. Several recommendations for reducing errors associated with high-risk medications and procedures must be followed i.e smart infusion technology and a double medication check system for high-risk medications.

Resuscitation

• The role of the pharmacist in stabilizing (resuscitation) the patient is crucial. As previously said pharmacists prevent medication errors thus preventing any harm to the patient. Other things pharmacists must do is immediate medication preparation, providing an instant source of knowledge, making recommendations for alternate routes of administration, answering questions regarding drugs in the emergency room, and assessing physicians with differential diagnoses related to medication cause and resuscitation documentation.

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Toxicological emergencies

• The role of the pharmacist can't be neglected here. The pharmacist provides as a primary source of drug information. No toxicological emergency can be done in a better manner without the involvement of a pharmacist. 
• In toxicological management, Emergency pharmacists should have a proper and thorough knowledge of antidotes and their administration, supportive therapies, antidote preparation, and monitoring of antidote effectiveness and safety.
• In order to become a successful and complete member of a toxicological team pharmacist must have knowledge and skills or must have gone through some post-graduation courses and exams in this varied field.

Medication procurement and Preparation

• Medication procurement in the emergency department presents challenges as compared to the central pharmacy department. Because of the urgent treatment drugs must be readily available. The medication procurement process in the emergency department depends on the number of pharmacists, the average number of patients entertained, and the number of patients available. In case of low-profile pharmacy services provided by hospital emergency, drugs may be kept in the pavilion, emergency kits which keep all required drugs for emergencies and similarly automated emergency cabinets. 

• A satellite pharmacy with compounding ability is the best source of medications available to the emergency department. As a separate sterile room may not be possible in emergency departments so a laminar flow hood may be a last choice for IV preparations. If a satellite pharmacy is not available the central pharmacy with rapid preparations processes must be set up to provide the needs. The emergency pharmacist should be competent in performing such processes.

Medication Information

• The cause of nearly all medication interactions and errors is a lack of information. As an expert in pharmacology and toxicology, pharmacists must ensure to delivery of the information to the health care personnel involved in the emergency department. 
• Information provided by the pharmacist includes information about the rationale use of the drug, proper dosing, route of administration, way of administration, etc. Pharmacists should be able to be concerned with primary, secondary, and tertiary sources of literature when the provision of information needs to be delivered to healthcare personnel.

Documentation

• Documentation provides future records about the patient's condition and therapy used in an emergency. It may be a legal process required in some states. Documentation may be done in various manners and through various ways depending on the institution. It may include electronic devices, the internet in a hospital linking various departments or done manually. 
• Manual documentation is done on paper and is a tedious process and loss of record is a prominent chance. Electronic documentation provides a better way of documentation and retrieval of records can be done easily.

b) Desirable Roles

The desirable role of a pharmacist includes that role that is optional and depends upon the skills of the pharmacist, time, and workload. if desirable roles can be delivered it adds prestige to the standing of pharmacists.

Desirable roles of pharmacists include

Education

The role of EMPs in education can be variable and broad, and it has been mentioned in conjunction with other responsibilities throughout these guidelines. It is desirable for EMPs to participate in the education of other healthcare providers, including pharmacists and pharmacy staff, pharmacy students, pharmacy residents, physicians, medical residents, mid-level practitioners, nurses, and emergency medical support personnel. The types and levels of education will vary with patient care and administrative workload.

Research and Scholarly Activities

Three types of research are conducted by emergency pharmacists. These include “trauma and injury control research” pre-hospital Emergency research and research attributed to other fields but affect emergencies.

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