title: Can a redesign of emergency pharmacist roles improve medication management? A prospective study in three Australian hospitals.
abstract: BACKGROUND
  Emergency departments (EDs) face increasing service demands and the imposition of treatment targets which has led to continual process redesign and changes in staff skill mix and functions.
  
  
  OBJECTIVE
  To identify extended ED pharmacist roles that could improve medication management and to implement and evaluate one such role change.
  
  
  METHODS
  A focus group of clinicians sought to redesign processes around ED medication management. Preparation of medication charts for patients admitted from ED was selected. Baseline data were obtained to define elements of existing medication charting processes. Suitably trained ED pharmacists' trialled the effectiveness of making therapeutic suggestions on a medication chart 'sticker' or by direct 'consultation' with medical staff. At the conclusion of the study focus groups at each site evaluated clinical staff perceptions of the change.
  
  
  RESULTS
  Focus group participants thought that ED pharmacists could undertake extended roles in analgesia, nausea control, antibiotic cover, addiction management and preparation of medication charts for admitted patients. In the pre-intervention audit (n = 140), 74% required at least one intervention by the ward pharmacists to address medication discrepancies. Ward pharmacists detected 292 medication discrepancies (median 1, IQR 0-3). In the 'sticker' intervention the ED pharmacist made 84 therapeutic suggestions of which 66 (78.6%) were accepted by medical staff. In the 'consultation' intervention 230 therapeutic suggestions were made of which 219 (95.2%) were accepted. The qualitative evaluation found that pharmacist-prepared medication charts within the processes established were deemed safe, timely, accurate, complete and legible.
  
  
  CONCLUSIONS
  Support exists for ED pharmacists to expand their medication-related roles. ED pharmacists can safely prepare medication charts in a timely fashion and their therapeutic suggestions within a 'consultative' framework are more beneficial than written advice. However, issues relating to resourcing, hours of service, service focus, statutory restrictions and training support for extended roles require resolution.
authors.affiliation: Centre for Medicine Use and Safety, Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Pharmacy Department, Barwon Health, Geelong, Australia. Electronic address: greg@barwonhealth.org.au.
authors.forename: Greg R
authors.initials: GR
authors.lastname: Weeks
authors.affiliation: Pharmacy Department, Southern Health, Melbourne, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ciabotti
authors.affiliation: St Vincent's Hospital, Melbourne, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Gorman
authors.affiliation: Pharmacy Department, Barwon Health, Geelong, Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Abbott
authors.affiliation: Centre for Medicine Use and Safety, Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Marriott
authors.affiliation: Centre for Medicine Use and Safety, Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
authors.forename: Johnson
authors.initials: J
authors.lastname: George
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D006784:Hospitals, Teaching / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000639:trends; D008875:Middle Aged; D010595:Pharmacists / Q000639:trends; D024382:Professional Role; D011446:Prospective Studies; D012017:Referral and Consultation / Q000639:trends; D014739:Victoria
keywords: Collaborative prescribing; Emergency pharmacist role; Medication safety