Improving emergency department care with pharmacist expertise
In the fast-paced, high-stakes environment of an emergency department (ED), the presence of a pharmacist can significantly improve patient safety, advance antimicrobial stewardship, and increase the efficiency of the medication process. As patient cases become more complex and healthcare costs continue to increase. Pharmacists are tasked with finding ways to improve cost containment, patient safety, and transitions of care within this demanding setting. The surveillance of high-cost medications and real-time management of shortages are critical functions that require advanced support.
The evolving role of pharmacists in emergency departments
The involvement of clinical pharmacists in the emergency department has grown substantially over the last decade. Historically, this field of clinical practice was largely left to nursing and physician colleagues, with pharmacists having minimal interaction beyond order review. There was a time when very few U.S. hospitals had pharmacists providing services directly in their EDs. Over time, the medical community has recognized the value that pharmacists can bring to patient care experiences in emergent situations where adverse drug events are more likely to occur. The percentage of hospitals with pharmacists assigned to emergency departments for eight or more hours a day rose from 10.9% in 2011 to 46.5% in 2025, according to the ASHP.
The most common roles of ED pharmacists include serving as part of the care team to assist with trauma and resuscitation, selecting proper medications in concert with appropriate dosing recommendations, providing drug information for patients and staff, management of critically ill patients, management of boarded patients, and assisting with antimicrobial stewardship.
Strategies for pharmacist involvement in emergency departments
To address these challenges and enhance patient care, hospitals can implement tangible steps to increase and optimize the role of the pharmacist in the emergency department.
1. Support a culture of safety
EDs are high-risk environments that are more prone to errors, which can result in patient or staff harm. Pharmacists can help support a culture of safety in simple ways:
- Share examples of adverse drug events from the Institute of Safe Medication Practices (ISMP) and/or local data during staff meetings
- Participate in rapid response, sepsis, and/or other urgent collaborative team efforts in cohort with our nursing and physician colleagues
- Leverage technology to identify the potential for drug optimization via solutions, such as Sentri7® Pharmacy.
- Utilize software solutions to swiftly identify admitted patients requiring additional attention to reconcile home medications
- Engage in policy and procedure creation surrounding clinical care pathways such as sepsis, opioid stewardship, cardiac care, and antimicrobial stewardship.
For example, a clinical pharmacist-led opioid reduction program at one large tertiary care center resulted in more than a 50% reduction in ED opiate orders and discharge prescriptions. This was achieved through targeted protocol development, clinician education, and leveraging technology to optimize dosing.
2. Educate and share learnings across teams
Pharmacy practice is constantly shifting. With continually evolving literature, it’s essential to remain on the pulse of the latest data and share it across teams. How can pharmacists interact more with the Emergency Department?
- Participate in monthly staff education to network and share ideas.
- Establish brief presentations before the start of a shift from simple posters or handouts created by pharmacists, interns, or students.
- Attend educational sessions with the physicians or create brief written or verbal education tools to facilitate constructive dialogue.
The role of the clinical pharmacist in the emergency department continues to expand and evolve. Establishing strong connections across care teams is essential to meeting the needs of more complex patients and improving patient care.
3. Engage at the point of care
Pharmacists are in a unique position to begin engaging with prescribers within hours of the patient receiving a diagnosis requiring antimicrobial therapy. As medication experts, we are poised to conduct assessments and provide therapy recommendations that will serve the patient, thereby increasing the expediency of access to medications and potentially reducing cost and the length of stay. One study of nearly 200 high-risk adult patients who received a first dose of antibiotics in the ED found that subsequent antimicrobial therapy ordered by ED pharmacists resulted in a significant reduction in delays in antibiotic administration and a decreased incidence of mortality.
