Pharmacists working in Emergency Department to reduce risk of medication-related harm

Catherine Wong and Helen Lo, from the EPIC Pharmacy Team at Middlemore Hospital, presenting their innovative and collaborative service at the Pharmaceutical Society of New Zealand's 2019 Conference.

The Early Pharmacist Intervention and Care (EPIC) pharmacy team at Middlemore Hospital provide a referral-based service to doctors and nurses in the Emergency Department and Admission Units, targeting patients at risk of medication-related harm.

Pharmacist Catherine Wong says, “This innovative service model aims to improve patient and medication safety, by targeting patients at the earliest possible point during their hospital admission.”

The EPIC pharmacy team provide services based on the individual needs of the patient, which may include medicines reconciliation, medicines review, facilitation of medication access and patient education.

Wong says, “The new service model delivers excellent patient health outcomes by enabling front-line staff at the hospital to work collaboratively and for clinical pharmacists’ skills to be effectively utilised in an acute, fast-paced environment.”

The service has definitely “improved awareness of how clinical pharmacists can have an integral role in the Emergency Department,” says Wong.

The EPIC pharmacy team’s referral criteria include; education required on discharge, polypharmacy, issues relating to medications or poor compliance.

Apart from the referral criteria the service also provides a baseline service focusing on; patients who are over 65 years of age, patients taking more than four regular medications, patients taking high-risk medication (e.g. insulin, warfarin, medication requiring therapeutic drug monitoring such as aminoglycosides, lithium and phenytoin), patients admitted who meet the orthogeriatric inclusion criteria and frequent presenters.

Wong hopes this unique service model may inspire other Emergency Departments around New Zealand.

“This model promotes a shift of pharmacist involvement in patient care, toward the front-end of the hospital, at the beginning of the patient’s admission. This further minimises medication-related harm and optimises therapy,” explains Wong.

“This service model may also provide growth in the scope of clinical pharmacy practice with increased involvement in acute care. Pharmacist prescribing roles could also emerge from this service model,” adds Wong.

However, barriers include limited funding, staff resource and the ability to provide a wide-ranging service to keep up with the patient influx in the busiest Emergency Department in Australasia.

“We feel very proud that we have re-invented a service that is now fit-for-purpose and worthwhile for everyone - pharmacists, doctors, nurses and most importantly, patients,” says Wong.