Placing pharmacists in emergency departments could help 36% of patients

Studies carried out by Health Education England suggest pharmacists can take pressure off hospital emergency departments

Hospital emergency department

Pharmacists have the potential to manage the care of up to 36% of patients attending hospital emergency departments (ED), according to the results of two studies by Health Education England (HEE). 

According to HEE, which is responsible for NHS workforce training and development in England, community pharmacists and qualified independent prescribers already have the skills to manage up to 8% of patients attending an ED. 

With additional advanced clinical practice training, pharmacists who can already prescribe could take care of another 28% of patients, the researchers say. 

The conclusions follow the results of two test-of-concept trials: a national study which looked at 18,613 patients attending 49 EDs across England, and a regional pilot which evaluated 782 patients who attended two acute trust EDs in the West Midlands. 

The results show that with additional advanced practice training, there is potential for independent prescriber pharmacists to manage up to 36% of ED attendees, where patients present with symptoms likely to be seen in the minor injury area of the ED under the overall supervision of a doctor. 

“Based specifically on completion of a 12-month, level 7, postgraduate diploma advanced practice… training course, with modules in clinical examination skills and clinical health assessment and diagnostics, it is estimated that the achievable level of pharmacist management may be 27% of all cases,” the HEE report says. “This study provides an evidence base for maximising advanced clinical training for ED pharmacists.” 

The national study found that 4% of patients attending an ED could be seen by a community pharmacist, another 4% by a pharmacist qualified as an independent prescriber, and another 28% by an independent prescriber who had undertaken specific advanced training. 

The majority of patients included in the national study (36.4%) had a general medicine need; 16.5% had an orthopaedic issue; 5% presented with a cardiology problem; 4.9% had a general surgery need while another 4% had respiratory problems. 

Results show that the pharmacists had the greatest potential impact in the management of the general medicine cases (13.2%), followed by orthopaedics (9.7%), respiratory (1.8%), ear nose and throat (1.6%) and gastroenterology (1.3%). 

The results of the regional study also confirmed the potential of pharmacists to manage cases in EDs. “[The West Midlands pilot fulfilled] its primary aim of demonstrating an evidence base to justify further study (suggesting the potential for pharmacists to manage up to 48.2% of ED attendees),” the HEE report says. 

Daniel Greenwood, a pharmacist from the Manchester pharmacy school, which offers a postgraduate diploma in advanced specialist training in emergency medicine to pharmacists keen to develop a career in A&E, says the studies have identified a clear potential for the enhanced clinical pharmacist to manage ED patients. 

“We know that there are now a number of pharmacists working in an enhanced clinical role, independently managing emergency department patients,” he says. “Looking ahead, due to the introduction of postgraduate programmes such as ours, the number of pharmacists working in this role is likely to increase.” 

Greenwood says the idea of putting pharmacists in EDs mirrors what took place in nursing during the 1990s, as they developed more medical skills. 

“For both the pharmacy profession and patients, it is important that this novel practice is grounded in what only pharmacists can offer – medicines expertise. Over the coming years, it will be interesting to see how pharmacists working in this enhanced clinical role deliver both pharmaceutical and medical care to emergency department patients.”

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Citation
The Pharmaceutical Journal, PJ, May 2016, Vol 296, No 7889;296(7889):DOI:10.1211/PJ.2016.20201143