Ellis Medicine is expanding its emergency department pharmacist program to include weekend coverage with the help of CDPHP.
For the last two years, the Schenectady hospital has employed a full-time pharmacist who is dedicated solely to patients in its Nott Street emergency room, but it’s only been on weekdays. The program was innovative and effective, helping to reduce medical errors and ensuring that 99 percent of patients seen by the pharmacist had a complete medical and medication history by the time they were actually admitted.
Now, with a three-year, $240,000 grant from CDPHP, Ellis can add a second full-time pharmacist to handle emergency room patients on weekends. It comes at an ideal time, Dr. Robert Dachs said at a Friday morning news conference, since summer is one of the busiest times for emergency departments everywhere.
“Too often, patients arrive in our ED without all their medication and medical history and we know that for our nurses and physicians who treat these patients, having the most accurate information is obviously very important to have in a timely manner,” said Dachs, vice chair of emergency services at Ellis Medicine. “This information helps us make decisions in how we care for our patients.”
The pharmacist helps fill in the holes, allowing nurses and physicians to better treat patients in the often unpredictable and urgent atmosphere of the emergency department. They review a patient’s known medication history and medication orders and find out whether the patient is taking any over-the-counter drugs and whether they’ve been taking their medications correctly.
In addition, once the patient receives treatment, the pharmacist can work with ED staff and the patient’s primary care physician to offer advice on which medications and delivery systems, if any, would be best for the patient going forward.
Several years ago, the Joint Commission urged hospitals to adopt national patient safety standards that would better capture a patient’s medication history, in particular, through the use of an emergency pharmacist.
“It sounds simple enough,” Ellis Medicine Clinical Pharmacy Manager Michael Pasquarella said at Friday’s news conference. “But Ellis Hospital, as did most institutions at that time, realized just how difficult that was to do at a time when medications and therapies were becoming more and more complex.”
So about four years ago, Ellis conducted a pilot study that had pharmacy students take medication histories of its ED patients.
“What we gleaned from that study was that there was a real need for improving how we managed medications and how we captured that information in the emergency department,” he said. “Physicians often need accurate medication histories at a moment’s notice. This history cannot be restricted to just prescription medications, but also must include many of the over-the-counter medications, as well. So without that physical presence there, it was becoming increasingly difficult to catch these potential discrepancies.”
It’s apparently not enough for an ED physician to get a patient’s history by just pulling up their electronic medical records through a regional health information organization like the Healthcare Information Xchange New York, or HIXNY. The Latham-based medical records network is great at offering the data in the first place, said officials gathered at Friday’s news conference, but treatment is often best decided when a trained pharmacist can interpret that data and sort out any discrepancies by talking to patients on-site.
Andrea Kufel noticed one of these discrepancies one day when a patient came into the emergency room with breathing problems and chest pains. The woman had been in previously with blood pressure so high it was causing nosebleeds. She was prescribed medication that lowered her blood pressure. Once the nosebleeds stopped, though, she assumed it was safe to stop taking her medication.
“Fast forward six months after she stopped taking them, and she was being readmitted because her blood pressure had skyrocketed again,” said Kufel, Ellis’ newest Emergency Department pharmacist. “She stated to the nurse that she had medication, but never said that she had stopped taking it. So when the cardiologist went over her medications, he bumped up her doses without realizing she hadn’t been taking them.
The emergency pharmacist’s goal is to help prevent harm down the road, she added.
This type of program was a natural fit for CDPHP. The health insurer has long worked with organizations to bolster coordination of care, improve transitional care and get programs off the ground that focus more on population management than on traditional individual care.
“We’ve learned that improved communication around care coordination and transitions of care are essential to ultimately lead to higher quality and lower costs,” said CDPHP President and CEO Dr. John Bennett. “The success of the weekday emergency department pharmacist program is really proof-positive that this expansion into the busier weekends is paramount to Ellis’ continued commitment to the safety and wellbeing of patients in their community.”
The emergency pharmacist program is available only at Ellis’ Nott Street Emergency Department. The hospital has a second, smaller emergency department at McClellan Street campus, which it consolidated into an expanded emergency room on Nott Street. Construction on this expansion is currently under way and slated for completion by early 2015, at which time Ellis Medicine will absorb the cost of the weekend pharmacist program.