Pharmacists have a critical role to play in hospital emergency departments

Two recently published studies by Health Education England (HEE) on pharmacists in hospital emergency departments (A&E) have demonstrated the potential for pharmacists to manage the pharmaceutical care of up to 36% of patients attending A&E.

Increasing numbers of patients and high throughput puts significant pressure on emergency department staff. In the final two weeks of 2014, performance against the government’s four-hour waiting time target fell for all attendances to 89.6%, compared with 95.9% in the same period in 2013^[1]
. In November 2014, £700m of additional funding was announced to support winter pressures on the NHS^[2]
, while demand is continuously increasing alongside shortages of staff trained in urgent and emergency care.

The
Carter review of efficiency in hospitals, published on 5 February 2016, recommends that the numbers of independent prescribing pharmacists in hospitals should increase and that there is a demonstrable need in emergency departments^[3]
.

The role of the pharmacist in emergency departments varies depending on the case mix and local population profile as well as the amount of funding available. Advanced clinical training for these roles will assure other A&E professionals that pharmacists have the competence to deliver pharmaceutical care and are able to bring a new paradigm to the team.

Pharmacists could carry out a number of roles in A&E, ranging from a supporting role with pharmacy technicians carrying out medication reviews, to prescribing pharmacists in the department who independently manage patients.

Pharmacist prescribers in emergency departments are also able to carry out medicines reconciliation and optimisation when patients first arrive, meaning that any medicines-related issues can be resolved sooner. In traditional pharmaceutical care pathways, these tasks are carried out much later on the ward and only for those patients who have been admitted to hospital. 

Having said this, because most patients who visit A&E aren’t admitted to hospital and medicines reconciliation is most useful for those who will be admitted, pharmacists need to be able to identify and prioritise those patients who would most benefit. It may be that medicines reconciliation in A&E for patients who are not admitted is more like a medicines review, but more research into this will be needed.

In emergency departments, pharmacist prescribers can also explore patients’ over-the-counter medicines, something that doctors often overlook, and can provide a medicines review to identify issues, such as adverse drug reactions (ADRs), which might have led to their admission to A&E.

Many patients present to emergency services with conditions that could have been exclusively managed by the pharmacy team, in terms of identifying ADRs. This relies on excellent working relationships in the A&E and a full understanding of what the pharmacy team has to offer – too often it is this understanding that is missing, which leads to the under-utilisation of pharmacists’ skills.

With an increasingly ageing population with chronic conditions, comorbidities and polypharmacy, the role of the pharmacist in managing medicines in urgent care settings will become ever more critical. One of the recommendations from the HEE report is to establish whether there is a relationship between patients with certain long-term medications and the incidence of admission.

A key campaign led by the Royal Pharmaceutical Society is focused on pharmacists having more involvement in the care of patients with long-term conditions, including those that lead to an A&E admission. It is essential that pharmacists in emergency departments work across patient pathways to ensure that community pharmacy is fully involved in minimising hospital admissions that could have been handled in the community.

With the right support, pharmacists are well placed to manage medicines across patient pathways, including medicines in emergency departments.