title: Pharmacist improves timely administration of medications to boarded patients in the emergency department.
abstract: OBJECTIVE
  Our purpose was to assess the variations in timely administration of medications based on differences in nursing staff (ED nurses who are responsible for emergency and boarded patients vs inpatient nurses who are responsible for only boarded patients) and to determine whether a pharmacist's interventions can improve the timely administration of medications to boarded patients in the emergency department.
  
  
  METHODS
  This was a prospective observational study. Patients were included in the study if they were aged 18 years or older, were physically located in the emergency department but had already been admitted to the medical center, and had medication orders. The pharmacist documented the medication orders and the allotted time for administration. Once the upper limit of the allotted time frame for administration had passed, the pharmacist determined whether the medications were given and interventions were then carried out for those medications that were not administered. Successful interventions were documented when the medication was given within 1 hour from the time of intervention.
  
  
  RESULTS
  Seventy-nine patients were included in the study, resulting in 266 medication administration opportunities (emergency department, 146; inpatient, 120). Inpatient nurses administered medications in a timely manner at a significantly greater rate than ED nurses (83.3% vs 63.7%, P < .0001). The greatest difference was observed during the evening hours (95.2% vs 53.8% of medications administered for inpatient vs ED nurses, P = .002). The most common reason for medications not being administered by ED nurses was insufficient time (51.4%), and for inpatient nurses, it was that the medication order was not verified (77.8%). The pharmacist's interventions were successful with both the ED and inpatient nurses (95.5% and 94.1%, respectively).
  
  
  CONCLUSIONS
  This study illustrates that assigning nurses with varying workloads as a means to manage overcrowding is likely to result in boarded patients in the emergency department not receiving their medications. ED pharmacists' interventions may fill the gap, ensuring compliance with the administration of medication orders prescribed for boarded patients and ensuring more timely administration. A multidisciplinary team approach is needed to manage current overcrowding issues.
authors.affiliation: Department of Pharmaceutical Services, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219, USA. sjelline@maimonidesmed.org
authors.forename: Samantha P
authors.initials: SP
authors.lastname: Jellinek
authors.forename: Victor
authors.initials: V
authors.lastname: Cohen
authors.forename: Lydia B
authors.initials: LB
authors.lastname: Fancher
authors.forename: Antonios
authors.initials: A
authors.lastname: Likourezos
authors.forename: Mary
authors.initials: M
authors.lastname: Lyke
authors.forename: Kathy
authors.initials: K
authors.lastname: Peterson
authors.forename: Eustace
authors.initials: E
authors.lastname: Lashley
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Davidson
mesh_terms: D004334:Drug Administration Schedule; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D006801:Humans; D007297:Inpatients; D008510:Medication Systems, Hospital; D010595:Pharmacists; D024382:Professional Role; D013997:Time Factors; D016526:Workload