Pharmacists can undertake overall clinical responsibility for patients, shows study

The first evaluation of pharmacists based in accident and emergency departments has concluded that with additional clinical skills, they are able to take on overall clinical responsibility for patients.

Daniel Greenwood a PhD student from The University of Manchester studied the work of people they termed Emergency Department Pharmacist Practitioners (EDPPs) from 15 NHS Trusts across the UK over 10 days.

The research, published in the International Journal of Clinical Pharmacy, observed the care they provided to 682 patients, and their contribution to the wider department, using an iPad-based questionnaire.

Because A&E doctors and nurses are in short supply, hospitals have started to employ pharmacists who have additional clinical skills to help deliver services since 2015.

Eleven EDPPs took on the role of designated care provider for at least some of their patients.

All 20 EDPPs carried out both 'traditional' and 'practitioner' activity; 9 of them sometimes provided more 'practitioner' than 'traditional' care to individual patients.

Of all 682 patients, EDPPs examined 264 (38.7%) and diagnosed 238 (34.9%).

Daniel Greenwood said: "This study shows that Emergency Department Pharmacist Practitioners can combine traditional clinical pharmacy with more hands-on medical practice including being designated care provider.

"No other A&E professional has the same medicines expertise.

"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.

"But they can also provide pharmaceutical care that is lacking in some departments, such as checking prescriptions.

He added: "The EDPPs we studied performed a wide range of rolls including performing or reviewing clinical examinations, diagnosis, prescribing, treatment and discharge.

"They worked as members of multidisciplinary teams, supporting and being supported by others. And they often took on overall responsibility as the patient's designated care provider.

"There is no doubt that pharmacists with additional clinical skills training have a role to play in A&E departments."

Victoria Bray has been Advanced Pharmacist Practitioner Emergency Medicine at Kings College Hospital for 4 years. She cares for patients with minor illness and injury as well as more acutely unwell adults, seeing, she says, between 15 and 25 patients per shift.

She said: "I have been able to experience first-hand the value that pharmacists can bring to patient care in the ED both as a practitioner and a clinical pharmacist.

"Pharmacists have the knowledge and skills to personalise a patient's pharmaceutical care plan or to become the patients designated care provider, both supporting the multi-disciplinary teams and to act in an advanced capacity to relieve pressure secondary to staff shortages.

"I find my strength is in managing acute and urgent medical illnesses such as infections, pain, exacerbations of asthma and COPD and electrolyte disturbance, all of which require strong pharmaceutical knowledge as well as the application of assessment and diagnostic skills and interventions.

"And I also value the difference I make to a patients journey and the direct impact I am able to have to their healthcare."

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