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Emergency Physicians Group Supports ED Clinical Pharmacy Services

Cheryl A. Thompson

The nation’s largest professional organization of emergency medicine physicians decided at its recent annual meeting to create a policy statement that supports clinical pharmacists as a part of the emergency medicine team.

This policy statement, according to the American College of Emergency Physicians (ACEP), will support “clinical pharmacy services in emergency departments and collaboration among emergency medicine providers to promote safe, effective, and evidence-based medication practices, to conduct emergency-medicine-related clinical research, and to foster an environment supporting pharmacy residency training in emergency medicine.”

The decision to create the policy statement stemmed directly from the late-October passage of a resolution submitted by ACEP’s New York chapter.

New York ACEP President Louise A. Prince said her board of directors had an easy decision to make when a longtime, active member asked the group to submit the resolution.

“Any of us who’s ever had access to clinical pharmacy services in the [emergency room] knows it’s really important,” Prince said.

The resolution, she said, addresses collaboration and collective research and, just as importantly, specialty training.

“Emergency medicine is its own brand of pharmacy, if you will,” Prince said. Thus, emergency medicine needs clinical pharmacists who have been trained to practice that specialty.

“It’s a really specialized, unique area,” said the residency-trained emergency department (ED) physician. “And we need the kind of collaboration that occurs at the bedside at the time that the patient is being taken care of and not from a distance and not spread out over time. We have to make a decision immediately.”

Maria Raven, a member of the board of directors of California ACEP, said her group supported the resolution.

During a hearing at ACEP’s recent annual meeting, Raven spoke in favor of the resolution’s approval.

“I worked for 10 years in a public hospital system in New York City, and we did not have pharmacists on our team,” said the ED physician, now at University of California, San Francisco (UCSF) Medical Center. “So I got to UCSF, and it was sort of a novel concept. But it is so amazing.”

Raven said she told the assemblage at the hearing about the clinical pharmacists working in her ED and how they enhance the team in unique ways.

Zlatan Coralic is one of those pharmacists.

Coralic, who started UCSF Medical Center’s ED pharmacy service in late 2009, said he raised the idea of pursuing a national-level policy statement a year ago at the ASHP Midyear Clinical Meeting.

After all, he reasoned, critical care pharmacists had succeeded a decade earlier in getting national recognition as members of the intensive care unit team.

“We’ve been accumulating data for the past three or four decades in emergency medicine,” Coralic said. “We have a substantial amount of data that we can present to ACEP.”

So at the 2013 Midyear Clinical Meeting, he voiced his idea to the ASHP Section of Clinical Specialists and Scientists’ Advisory Group on Emergency Care.

The response, he said, was “extremely supportive.”

Fellow advisory group member Nicole Acquisto acted quickly.

Sandra M. Schneider, former chair of the emergency medicine department at the University of Rochester Medical Center in New York, where Acquisto works, happened to be a presenter at an educational session later in the week.

The emergency medicine physician also happened to be a past president of ACEP and past board member of New York ACEP.

Acquisto said she approached Schneider after the session, explained the advisory group’s idea, and asked whether the idea was good and how to proceed through ACEP’s policymaking process.

In the end, Acquisto said, the advisory group decided some of its members would write the resolution. Schneider offered to present that resolution to New York ACEP.

When New York ACEP presented the resolution at the national organization’s annual Council Meeting, physicians from elsewhere in the nation, including California, stepped up to the microphone to voice support, Coralic said.

Acquisto, with the permission of the chair of the committee conducting the hearing, stepped up to the microphone as well.

“There was pretty much no opposition” to adoption of the resolution, she said.

Also at the hearing were advisory group chair Katelyn Dervay of Tampa General Hospital and former advisory group member Suprat S. Wilson of Detroit Receiving Hospital.

Prince said New York ACEP’s members strongly believe that “having 24-hour-a-day pharmacists in our emergency departments is a good safety practice.”

But that safety practice, she added, can be “very expensive.”

A policy statement by ACEP in support of clinical pharmacy services in the ED may encourage hospital systems to consider paying for those services for safety purposes, Prince said.

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