title: Impact of Clinical Pharmacists on Initiation of Postintubation Analgesia in the Emergency Department.
abstract: BACKGROUND
  Pain and anxiety are common in mechanically ventilated patients, and frequently undertreated in the emergency department (ED) setting.
  
  
  OBJECTIVE
  We sought to compare the rate of initiation of postintubation analgesia in the ED before and after intervention by pharmacists specialized in emergency medicine.
  
  
  METHODS
  This was a retrospective cohort study of patients who underwent rapid sequence intubation (RSI) in the ED. The primary endpoint was overall frequency of analgesia initiation, with subset analysis of RSI during the ED pharmacist (EDP) duty hours. Secondary endpoints included frequency of sedative or anxiolytic use without analgesia, time to initiation of postintubation analgesia, and adverse drug events (ADEs) resulting in analgesia discontinuation.
  
  
  RESULTS
  Forty-one patients were included in each group. The overall rate of postintubation analgesia increased after pharmacist intervention, from 20% to 49% (p = 0.005). Analgesia initiation during EDP hours was 50% and 85% in the pre- and postintervention groups, respectively. In the preintervention group, more patients received sedation without analgesia (73% vs. 51%; p = 0.04), and a small percentage (7%) received neither sedation nor analgesia. Time to initiation of postintubation analgesia decreased from 98 min to 45 min. ADEs were rare: there were no discontinuations of analgesic therapy in the preintervention group and one temporary discontinuation because of hypotension in the postintervention group.
  
  
  CONCLUSIONS
  Analgesic use after RSI in the ED significantly increased after the implementation of ED pharmacy services. The large proportion of patients receiving analgesia during the EDP duty hours suggest the increase may be related to direct pharmacist involvement in postintubation management.
authors.affiliation: Department of Pharmacy, Mercy Hospital and Medical Center, Chicago, Illinois.
authors.forename: Erin
authors.initials: E
authors.lastname: Robey-Gavin
authors.affiliation: Department of Pharmacy, Mercy Hospital and Medical Center, Chicago, Illinois.
authors.forename: Lamies
authors.initials: L
authors.lastname: Abuakar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000706:statistics & numerical data*; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010595:Pharmacists; D024382:Professional Role; D013997:Time Factors
chemical_list: D000700:Analgesics; D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives
keywords: emergency service, hospital; hypnotics and sedatives; intubation, intratracheal; pain management; pharmacy service, hospital