Pharmacy services in SCGH ED

1. PHARMACY SERVICES
IN SCGH EMERGENCY
DEPARTMENT
Danny Soo (ED Pharmacist)

2. Current service
• Monday to Friday from 0724 to 1600
• No extended hours service or weekends
• Current FTE is 1.0
• Daily admission ~ 200 patient per day
• On average can see between 12-20 patients per day
depending on complexity or involvement

3. Current role of ED pharmacist
• Medication history taking and reconciliation
• What is medication reconciliation?
• Medication review and identifying medication related problems
• Facilitating patient discharge by reviewing prescriptions
and dispensing by pharmacy or liaison with community
pharmacy or health care provider
• Counselling patient on medications
• Supply of medications to patients in a timely manner and
in accordance to best practice
• Providing education
• Involvement and update of drug guidelines

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5. Current role of ED pharmacist
• Governance of medicine use in accordance with Drug and
Therapeutics Committee, hospital policies, hospital
formulary, infectious diseases and PBS
• Orientation of new nurses to the department
• Providing advice on medicines to nurses, prescribers –
administration, use, dosing, interactions, researching
information
• Making therapeutic recommendations
• Identifying medication misadventures
• Promoting quality use of medicines – standard 4
Medication safety standards
• Involvement with projects

6. Some examples of identified problems
• Inappropriate use of broad spectrum antibiotics as empiric
therapy – Tazocin, ceftriaxone,
• Prescribing of antibiotic despite patient allergy
• Patient allergy not documented or incorrect
• Incomplete prescription order
• Incorrect drug, dose, form, frequency,
• Incorrect medication charted due to inaccurate medication
history – old discharge summary
• Prescriptions PBS non compliance – quantities, authority,
• S8s and S4s legal requirements

7. Community Program for Opiod
Pharmacotherapy (CPOP)_
• Patients who are on Community Program for Opiod
Pharmacotherapy (CPOP) like methadone liquid,
buprenorphine/naloxone (Suboxone®) wafers require
their current dose VERIFIED either by your Clinical
Pharmacist or Drug and Alcohol nurse
• Dose must be current and script must be valid. Do not
copy from previous discharge summary or trust patient
• If unable to verify, DO NOT prescribe dose
• OK to skip dose until next day when dose can be
verified

8. Medication Management Pathway

10. Common Pitfalls in Medication History
Taking
• Not asking the patient –how they take their medications,
assessing their compliance, which pharmacy they attend
• Not questioning the patient on allergies or updating it
• Referring to an old discharge summary (3 months
maximum)
• Referring to a GP letter without checking details
• Using only one source
• Transcribing incorrectly
• Webster pack patients – not asking about non-packed
medications such as inhalers, insulin,warfarin

11. Type and frequency of medication prescribing
errors on admission resulting from inaccurate
medication history
Results:
• 100 consecutive patients
• 247 errors
• 165 ‘significant’ / 82 ‘insignificant’
• 69% omission
• 21% incorrect dose
• 3% medications no longer taken
• Remainder: incorrect
formulation/medication/route/timing

12. Type and frequency of medication prescribing
errors on admission resulting from inaccurate
medication history
• Own medications
• 78% patients with own medications had errors
• 67% patients without own medications had errors
• Dose Administration Aids (excluding Nursing
home)
• Of the 27 patients using DAA, 21 had errors (78%)
• Nursing Home or residential care facilities
• Of the 18 N/H patients, 12 had errors (67%)

13. 0
20
40
60
80
100
120
140
160
180
Tier 3 prescribing errors
Incorrect dose
Incorrect formulation
Incorrect medication/fluid
Incorrect route
Incorrect timing of dose
Medication omitted
Medication charted no longer
taken by patient

14. ED Environment
• ED is a high risk area for medication misadventure
• High risk medicines use - APINCH
• High turnover of patients and diversity of patients
• High stress and urgent situations, fast paced environment
• Constant interruption and distraction to workflow
• Lack of continuity
• Pressure of the 4 hour rule, bed pressures,

15. Referring patients to your Pharmacist
• All of this is AVOIDABLE !
• Refer patients to ED pharmacist when:
• There is difficulty obtaining medication history
• Patient requires medication review
• Patient has difficulty managing medicines, accessing medicines,
assessment for DAA
• Review of discharge medications, EpiPen counselling, NOAC or
warfarin counselling, etc
•

16. Referring patients to your Pharmacist
• A referral is made via EDIS by selecting ‘Pharmacy’ under
consultations, similar to when a patient is referred to a
specialty like respiratory or neurology, CCT.
• The ED pharmacist will check the screen periodically to
see any new referrals that are added onto the system.
• Your ED pharmacist can also be reached on DECT
phone: 6731.

19. Pharmacy online resources
• WA Drug Formulary Service (DFS)
• Medication management guidelines
• National Prescribing Services (NPS)

20. Drug Formulary System (DFS)

21. Drug Formulary System (DFS)

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25. Comparison of pharmacy services here
and over East
Hospital State FTE Operation Hours Weekend Extended services Satellite pharmacy
Royal Perth
Hospital
WA 1 0800 to 1630 No No No
Fiona Stanley
Hospital
WA 1.5 0730 to 1800 Yes (8-5pm
pager cover)
Yes until 6pm
(covered by Crit Care
team)
No
Joondalup
Hospital
WA NIL
No
Austin Hospital Victoria 2 0800-2000 Yes (8-5pm) Yes until 8pm
weekdays
Yes
Alfred Hospital Victoria 3 0700-2100 2
pharmacists from
7-4pm and 1
pharmacist from
12-9pm Mon to
Friday
0700-2100
1 pharmacist
7-12pm,
1 pharmacist
7-4pm and
1 pharmacist
12-9pm
Yes No
Sir Charles
Gairdner Hospital
WA 1 0724 to 1600 No No No

26. Where to from here?
• How much do you value pharmacy services in ED?
• What do you want your service to look like?
• Benefit of satellite pharmacy in ED
• Advocacy to Exec for more FTE – patient safety,
medication safety, patient flow

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Questions?