388 Integration of Clinical Pharmacy Services in Emergency Medicine: Cost Avoidance and Qualitative Outcomes

S. Murad; Z. Bowles; C. Eastin

doi:10.1016/j.annemergmed.2018.08.393

Study Objectives The purpose of this study is to obtain qualitative and quantitative evidence to study the effect and reception of implementation of an emergency department (ED) pharmacist at a large academic medical and level 1 trauma center that may aid in further developing guidelines and recommendations for effective ED pharmacist implementation, and to add to the available quantitative data illustrating potential cost-avoidance associated with a dedicated ED pharmacist. Methods This prospective, institutional review board-approved 4-month study (August 2015 – November 2015) was conducted at a single-center, tertiary care, academic medical center, adult level 1 trauma center with approximately 60,000 annual ED visits and included a mixed-methods approach. The pharmacy specialist documented interventions in the electronic medical record. At the end of the 4-month investigational period, all interventions were categorized into Cost Avoidance, Therapeutic Recommendations, Adverse Drug Event Prevented, and Medication Error Prevented. Qualitative analysis included 16 semi-structured interviews that occurred between April 2016 and September 2016. The interviews were conducted individually with ED staff including registered nurses, nurse management, ED resident physicians, ED attending physicians, and ED service line director. Interviews included a multi-stakeholder analysis of feasibility and acceptability of pharmacist clinical roles in ED teams. Interviews were guided around the implementation and integration of a pharmacist’s position in the ED and then recorded, transcribed, and coded to reveal relevant and common themes. Results 352 pharmacist interventions were analyzed in the ED for a total of 227 hours of investigation. Cost avoidance was estimated at a saving of $610.58/pharmacist staffed hour. Projected cost avoidance over the course of a year was estimated to be 1,221,160.09, with Medication Error Prevented at 65,243.75 or 47% of the total cost avoided. Interview data showed that implementation was met with overall departmental support. Those with previous experience of working with an ED dedicated pharmacist were likely to support the addition to the team. Use of an observational period was beneficial to determining the maximum utility of a pharmacist in the ED. Beneficial roles that were most noted included aiding with antibiotic stewardship, medical reconciliation, medication stock use and awareness, as well as direct pharmacy-to-ED interface. Recommendations for future implementation included preference for EM/critical care training, formal introduction of the new staff member with explicitly listed potential roles and responsibilities. Conclusions This study revealed significant cost avoidance as a result of ED pharmacist interventions that should serve to offset potential financial barriers and suggests reduction in patient harm. Qualitative interview results yielded an overall positive response and generated further insights into successful ED pharmacist implementation.

388 Integration of Clinical Pharmacy Services in Emergency Medicine: Cost Avoidance and Qualitative Outcomes

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