ER Pharmacy – Lovin 8th Block!

Emergency Dept!

Emergency Dept!

I’m just starting my 3rd week on rotation in the Emergency Department (my patient care rotation), and while the ED in general is not like television depictions, it definitely is a really awesome setting to work in. It is one of the newer and growing areas for pharmacy practice, and a lot of studies show our worth at improving patient outcomes, decreasing costs, and serving as a valuable member of the healthcare team.

As the ER is a main source of hospital admissions, a part of the pharmacist’s role is similar to anywhere else in the hospital

Essentia Saint Mary's Medical Center in Duluth (so maybe I borrowed this picture from online)

Essentia Saint Mary’s Medical Center (okay so maybe I borrowed this picture from online)

—to review all orders for appropriateness of selection, dosing, administration, timing, etc. However, they are very involved in a lot of unique roles, which mainly involve working as a full-time troubleshooters and consultants to the doctors, nurses, and other clinicians on the critical care team. The goal is to improve patient care and reduce costs. They make dosing recommendations, follow-up on antibiotic recommendations, help provide toxicology information (including herbal medications, an important source of OD’s and medication interaction-related admissions), medication counseling, medication reconciliation interviewing, and much more. They are also helpful in reducing costs by avoiding wasted medication, suggesting less-expensive drugs or pointing out less expensive ways to deliver the medication.

Codes really do basically look like this - room packed full of people taking care of the patient.

Codes really do basically look like this – room packed full of people taking care of the patient.

Of course, probably the most interesting aspect IS being involved in traumas. Pharmacists are trained in advanced cardiac life support medication algorithms and are

extremely effective at accessing medications, anticipating what will be needed, communicating with the provider calling the code, pulling up doses, being aware of exactly how long it takes agents to start working, how quickly they will wear off, and thinking ahead to have the next dose ready or make recommendations. This frees the nurses and providers to focus on things that are happening bedside. Examples include Rapid Sequence Intubation (RSI), MI’s, strokes, arrhythmias, etc.

I have learned a few things I have learned about the ED in general that make complete sense but that hadn’t necessarily

Not my most flattering ID Picture

Essentia!

occurred to me before—One is- how many of the cases are psych-related, from suicide attempts to erratic behavior, intoxicated patients, threatening patients, etc. Another: The patients either have more mild problems that can be addressed and then discharged, or more major ones that get admitted to the floor—but basically, they don’t stay in the ED. That’s not surprising, but it is a different kind of patient care, in which you only see people for short periods of time, as opposed to seeing them for a few-to-many days when working in-patient, or for repeat appointments or medication-fills over long periods of time such as in ambulatory care or community/retail practice. It’s also an interesting setting in which you really do see a little bit of everything, from pediatrics to geriatrics, heart issues to infectious disease to trauma. Finally- It really is a bustling place where everyone is constantly moving in a kaleidoscope of business. I think also with the pace and lifestyle down here comes a very unique, close knit (and AWESOME) crew.

So happy to be back in this gorgeous city.

So happy to be back in this gorgeous city.

So far I am loving this rotation, even though I haven’t actually been in the ED that much yet. Starting now, I will be much more often, but I’ve had a lot of excellent opportunities arranged by my preceptors to do shadowing opportunities- I followed the IV-Team, the respiratory therapy team, a chaplain, watched a surgery (laparoscopic hysterectomy using a da Vinci surgical robot—very very cool), spend time with the OR pharmacist, shadow a nurse anesthetist, shadow the ER Care Coordinator RN and Social Worker, shadow the ER psychiatry nurse team, shadow the central pharmacy team from med distribution to IV team, etc. I also have a lot of cool independent articles to read, projects to work on, and patients to follow. From here on out, I will be working in the ER much more, and my shifts are noon-10pm to match the ED pharmacist as this is when the majority of traumas happen during the day. Hoping to really work on improving my Infectious Disease knowledge during it all.

Just another day loving life on rotations!! (SO so glad I’m not studying for exams like the rest of my fellow bloggers-may the multiple choice deities be with you all!)

Love,

BK

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