Implementing a comprehensive, 24-hour emergency department pharmacy program

The implementation of a comprehensive, 24-hour emergency department pharmacy program (EDPP) is described.

An EDPP was created at the Veterans Affairs San Diego Healthcare System to address deficiencies identified by the pharmacy service within the ED, including medication tracking, documentation of doses administered, and formulary management. The documentation system used in the EDPP, including a computerized spreadsheet and documentation cards, allowed the activities of the ED pharmacists to be tracked on a 24-hour basis. This type of data collection allowed us to evaluate the impact of the program based on the quality of patient care delivered as well as cost. During the initial six-month implementation period, the ED pharmacists recorded 9,568 interventions. The information from these interventions was used to assess the safety components and to estimate the cost avoidance of their activities. A staff satisfaction survey was also created to assess the pharmacist's impact on providers and nurses, as well as its effect on workflow within the ED. Among the many benefits realized, the EDPP improved the quality of patient care, decreased medication errors and patient wait times, improved the medication reconciliation process, enhanced formulary management, ensured prospective medication order review, and increased overall patient safety, as evidenced by the documented interventions and staff satisfaction survey. The projected cost savings for the medical center during the first year of EDPP implementation was calculated as $1,691,185.

A tertiary care teaching hospital successfully implemented a 24-hour, comprehensive ED pharmacy service that enhanced the efficiency and delivery of patient care and resulted in significant cost savings.