Emergency Medicine Pharmacist Prescriptive Authority for Resolution of Outpatient Prescription Issues

To describe the implementation and impact of a collaborative practice agreement (CPA) for emergency medicine pharmacists (EMPs) that grants them broad prescriptive authority to resolve outpatient discharge prescription issues independently.

We conducted a retrospective chart review of all prescriptions written by EMPs under a CPA to resolve discharge prescription issues at a 70-bed emergency department (ED) within a large health system in South Dallas, Texas. This review covered the period from November 1, 2021, to June 30, 2023. EMPs were authorized to independently address prescription problems without a provider's direct involvement. We collected data on patient demographics, the types of issues encountered, pharmacist interventions, and the rates of patient revisits at 3 and 6 months related to the original prescription issue.

EMPs resolved 295 discharge prescription issues by sending a total of 340 prescriptions, representing 11.6% of the 2919 prescriptions issued by EMPs during the study period. The most common issues addressed were related to insurance or affordability (28.1%) and medication unavailability (22%). EMPs most frequently responded by prescribing therapeutic alternatives (59.7%). Among the 295 patients with resolved prescription issues, 11.2% returned to the ED within 3 months, primarily due to persistent symptoms. At the 6-month mark, 13.2% of the 295 patients had returned to the ED, with all additional revisits citing an inability to follow-up with their provider. Analgesics were the most prescribed medication class (37.3%). No major safety concerns were identified, and all prescriptive actions were retrospectively met with provider agreement.

Broad EMP prescriptive authority through CPAs enables independent resolution of postdischarge prescription issues, improving care continuity, potentially reducing ED revisits, and sparing provider time to optimally take care of patients. This model can serve as a framework for other institutions aiming to optimize pharmacist-driven transitions of care.