Struggling emergency departments turn to pharmacist practitioners to plug gaps

University of Manchester study highlights extended role, including performing examinations, diagnosis, prescribing, treatment and discharge

Emergency department pharmacist practitioners are now performing examinations, diagnosis, prescribing, treatment and discharge

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Pharmacists in emergency departments (EDs) with additional clinical skills are able to take on overall clinical responsibility for patients to cover a shortage of nurses and doctors, a study has found.

The University of Manchester study – published in the International Journal of Clinical Pharmacy last month – highlights that hospitals have started to employ ED pharmacist practitioners (EDPPs) to help deliver services.

Hands-on clinical skills training

Researchers studied the work of 20 EDPPs who had completed hands-on clinical skills training from 15 NHS trusts across the UK over a ten-day period.

The EDPPs examined more than one third of patients and also carried out tests and procedures, including resuscitation and anaesthetic sedation.

The study also found that pharmacists performed a wide range of roles, including performing or reviewing clinical examinations, diagnosis, prescribing, treatment and discharge.

Out of 682 patients the EDPPs examined 264 (38.7%) and diagnosed 238 (34.9%).

For treatment, the EDPPs prescribed a total of 603 medicines for administration in the ED to 266 patients and performed procedures for 63.

Designated care provider

Eleven of the practitioners also took on the role of designated care provider with overall clinical responsibility for at least some of their patients.

According to the research, although there are advanced clinical practice qualifications available, there is no common recognised training pathway for pharmacists to work in an advanced ED role.

Cliff Evans, emergency medicine consultant nurse and educationalist warned some EDs have had to close overnight due to insufficient staff numbers.

‘Evidence shows that other healthcare professionals can deliver equally effective care for patients if their continuing professional development is supported.

‘Governance supporting new roles is paramount and all organisations will require an overarching multidisciplinary group who ensure the quality and safety of new roles and monitor the effect they are having on patient experience and outcomes,’ he said.

Pharmacist and lead author of the study Daniel Greenwood said the enhanced role of the EDPP has helped to plug gaps in the ED.

‘EDPPs who work as a designated care provider can fill gaps in doctor and nurse practitioner rotas, something that can only be welcomed given ongoing staff shortages,’ he said.

Monitor patient outcomes

RCN Emergency Care Association chair Janet Youd highlighted the advantages of the multidisciplinary role: ‘As long as people are assessed as competent for the advanced clinical practitioner role they are undertaking, and have the necessary level of education and supervision, there are many benefits to having physiotherapists, paramedics, and pharmacists, as well as nurses in these roles.’

Further information

International Journal of Clinical Pharmacy (2019) The Description and Definition of Emergency Department Pharmacist Practitioners in the United Kingdom (the ENDPAPER study)

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