Journal of Medical Toxicology

, Volume 14, Issue 1, pp 114–116 | Cite as

The Role of Clinical Pharmacists in the Emergency Department

  • Brenna M. Farmer
  • Bryan D. Hayes
  • Rama Rao
  • Natalija Farrell
  • Lewis Nelson
Position Statement


Sources of Funding


Compliance with Ethical Standards

Conflict of Interest



The position of the American College of Medical Toxicology (ACMT) is as follows: clinical pharmacists are integral to the care and safety of emergency department (ED) patients. Emergency department pharmacists positively impact time to critical therapies, including antibiotics for sepsis and door-to-balloon time for acute myocardial infarction. Pharmacists optimize pharmacotherapy regimens involving high-risk therapeutic classes, such as thrombolytics. Clinical pharmacists improve patient safety by intercepting prescription errors and recognizing adverse drug events. The potential cost avoidance of reducing errors and meeting standards for reimbursement provides financial justification for dedicated ED clinical pharmacist staffing. We support 24-h staffing of emergency departments with dedicated ED pharmacists.

While individual practices may differ, this is the position of the American College of Medical Toxicology (ACMT) at the time written, after a review of the issue and pertinent literature.


  1. 1.
    Coil CJ, Flood JD, Beyeu BM, et al. The effect of emergency boarding on order completion. Ann Emerg Med. 2016;67:730–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Kulstad EB, Sikka R, Sweis S, et al. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010;28:340–9.CrossRefGoogle Scholar
  3. 3.
    Manias E, Gerdtz MF, Weiland TJ, Collins M. Medication use across transition points from the emergency department: identifying factors associated with medication discrepancies. Ann Pharmacother. 2009;43(11):1755–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Marconi GP, Claudicus I. Impact of emergency department pharmacy on medication omission and delay. Pediatr Emerg Care. 2012;28:30–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Fairbanks RJ, Hays DP, Webster DF, et al. Clinical pharmacy services in an emergency department. Am J Health Syst Pharm. 2004;61:934–7.PubMedGoogle Scholar
  6. 6.
    Morganti KG, Bauhoff S, Blanchard JC, et al. The evolving role of emergency departments in the United States. Research report. Rand Corporation 2013. Accessed 22 Mar 2016.
  7. 7.
    Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104–12.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Farley HL, Baumlin KM, Hamedani AG, et al. Quality and safety implications of emergency department information systems. Ann Emerg Med. 2013;62(4):399–407.CrossRefPubMedGoogle Scholar
  9. 9.
    Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203.CrossRefPubMedGoogle Scholar
  10. 10.
    American College of Emergency Physicians (ACEP). Clinical pharmacist services in the emergency department. Ann Emerg Med. 2015;66:444–5.Google Scholar
  11. 11.
    DeFrates SR, Weant KA, Seamon JP, et al. Emergency pharmacist impact on health care-associated pneumonia empiric therapy. J Pharm Pract. 2013;26:124–30.CrossRefGoogle Scholar
  12. 12.
    Flynn JD, McConeghy KW, Flannery AH, et al. Utilization of pharmacist responders as a component of a multidisciplinary sepsis bundle. Ann Pharmacother. 2014;48:1145–51.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Moussavi K, Nikitenko V. Pharmacist impact on time to antibiotic administration in patients with sepsis in an ED. Am J Emerg Med. 2016;34(11):2117–21.CrossRefPubMedGoogle Scholar
  14. 14.
    Montgomery K, Hall AB, Keriazes G. Pharmacist’s impact on acute pain management during trauma resuscitation. J Trauma Nurs. 2015;22:87–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Amini A, Faucett EA, Watt JM, et al. Effect of pharmacist on timing of postintubation sedative and analgesic use in trauma resuscitations. Am J Health Syst Pharm. 2013;70:1513–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Johnson EG, Meier A, Shirakbari A, et al. Impact of rocuronium and succinylcholine on sedation initiation after rapid sequence intubation. J Emerg Med. 2015;49:43–9.Google Scholar
  17. 17.
    Montgomery K, Hall AB, Keriazes G. Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke. Am J Emerg Med. 2016;34(10):1997–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Acquisto NM, Hays DP, Fairbanks RJ, et al. The outcomes of emergency pharmacist participation during acute myocardial infarction. J Emerg Med. 2012;42:371–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27:481–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Ernst AA, Weiss SJ, Sullivan A, et al. On-site pharmacists in the ED improve medical errors. Am J Emerg Med. 2012;30:717–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Groth CM, Acquisto NM. Pharmacists as members of the rapid response team. J Pharm Pract. 2016;29(2):116–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Porter E, Barcega B, Kim TY. Analysis of medication errors in simulated pediatric resuscitation by residents. West J Emerg Med. 2014;15:486–90.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Erickson K. An emergency department pharmacist’s experience at the Boston Marathon. Am J Health Syst Pharm. 2013;70(19):1652,1654.CrossRefPubMedGoogle Scholar
  24. 24.
    Sylvester KW, Rocchio MA, Belisle C, et al. Pharmacy response to the Boston Marathon bombings at a tertiary academic medical center. Ann Pharmacother. 2014;48(8):1082–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Weant KA, Baker SN. Emergency medicine pharmacists and sepsis management. J Pharm Pract. 2012;26:401–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Baker SN, Acquisto NM, Ashley ED, et al. Pharmacist-managed anticmicrobial stewardship program for patients discharged from the emergency department. J Pharm Pract. 2012;25:190–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Dumkow LE, Kenney RM, MacDonald NC, et al. Impact of a multidisciplinary culture follow-up program of antimicrobial therapy in the emergency department. Infect Dis Ther. 2014;3:45–53.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Miller K, McGraw MA, Tomsey A, et al. Pharmacist addition to post-ED visit review of discharge antimicrobial regimens. Am J Emerg Med. 2014;32:1270–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Randolph TC, Parker A, Meyer L, et al. Effect of a pharmacist-managed culture review process on antimicrobial therapy in an emergency department. Am J Health Syst Pharm. 2011;68:916–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Van Devender EA. Optimizing antimicrobial therapy through a pharmacist-managed culture review process in the ED. Am J Emerg Med. 2014;32(9):1138.CrossRefPubMedGoogle Scholar
  31. 31.
    Abu-Ramaileh AM, Shane R, Churchill W, et al. Evaluating and classifying pharmacists’ quality interventions in the emergency department. Am J Health Syst Pharm. 2011;68:2271–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Bakhsh HT, Perona SJ, Shields WA, et al. Medication errors in psychiatric patients boarded in the emergency department. Int J Risk Saf Med. 2014;26:191–8.PubMedGoogle Scholar
  33. 33.
    Rothschild JM, Churchill W, Erickson A, et al. Medical errors recovered by emergency department pharmacists. Ann Emerg Med. 2010;55:513–21.CrossRefPubMedGoogle Scholar
  34. 34.
    Cesarz JL, Steffenhagen AL, Svenson J, Hamedani AG. Emergency department discharge prescription interventions by emergency medicine pharmacists. Ann Emerg Med. 2013;61(2):209–14.CrossRefPubMedGoogle Scholar
  35. 35.
    Hohner E, Ortmann M, Murtaza U, Chopra S, et al. Implementation of an emergency department-based clinical pharmacist transitions-of-care program. Am J Health Syst Pharm. 2016;73(15):1180–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Thomas MC, Acquisto NM, Shirk MB, Patanwala AEA. National survey of emergency pharmacy practice in the United States. Am J Health Syst Pharm. 2016;73:386–94.CrossRefPubMedGoogle Scholar
  37. 37.
    Mazer-Amirshahi M, Hawley KL, Zocchi M, et al. Drug shortages: implications for medical toxicology. Clin Toxicol. 2015;53(6):519–24.CrossRefGoogle Scholar
  38. 38.
    Rosoff PM, Patel KR, Scates A, Rhea G, Bush PW, Govert JA. Coping with critical drug shortages. Arch Intern Med. 2012;172(19):1494–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Patanwala AE, Hays DP, Sanders AB, et al. Severity and probability of harm of medication errors intercepted by an emergency department pharmacist. Int J Pharm Pract. 2011;19:358–62.CrossRefPubMedGoogle Scholar
  40. 40.
    Patanwala AE, Sanders AB, Thomas MC, et al. A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department. Ann Emerg Med. 2012;59:369–73.CrossRefPubMedGoogle Scholar
  41. 41.
    Sin B, Yee L, Claudio-Saez M, et al. Implementation of a 24-hour pharmacy service with prospective medication review in the emergency department. Hosp Pharm. 2015;50:134–8.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Brown JN, Barnes CL, Beasley B, et al. Effect of pharmacists on medication errors in an emergency department. Am J Health Syst Pharm. 2008;65:330–3.CrossRefPubMedGoogle Scholar
  43. 43.
    Stasiak P, Afilalo M, Castelino T, et al. Detection and correction of prescription errors by an emergency department pharmacy service. CJEM. 2014;16:193–206.CrossRefPubMedGoogle Scholar
  44. 44.
    Pevnick JM, Shane R, Schnipper JL. The problem with medication reconciliation. BMJ Qual Saf. 2016;25:726–30.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Ajdukovic M, Crook M, Angley C, et al. Pharmacist elicited medication histories in the emergency department: identifying patient groups at risk of medication misadventure. Pharm Pract. 2007;5(4):162–8.Google Scholar
  46. 46.
    Becerra-Camargo J, Martinez-Martinez F, Garcia-Jimenez EA. Multicenter, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department. BMC Health Serv Res. 2013;13:337.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Okere AN, Renier CM, Tomsche JJ. Evaluation of the influence of a pharmacist-led patient-centered medication therapy management and reconciliation service in collaboration with emergency department physicians. J Manag Care Spec Pharm. 2015;21:298–306.CrossRefPubMedGoogle Scholar
  48. 48.
    Hohl CM, Zed PJ, Brubacher JR, Abu-Laban RB, et al. Do emergency physicians attribute drug-related emergency department visits to medication-related problems? Ann Emerg Med. 2010;55:493–502.CrossRefPubMedGoogle Scholar
  49. 49.
    Weant KA, Humphries RL, Hite K, et al. Effect of emergency medicine pharmacists on medication-error reporting in an emergency department. Am J Health Syst Pharm. 2010;67:1851–5.CrossRefPubMedGoogle Scholar
  50. 50.
    Hamblin S, Rumbaugh K, Miller R. Prevention of adverse drug events and cost savings associated with PharmD interventions in an academic level I trauma center: an evidence-based approach. J Trauma Acute Care Surg. 2012;73:1484–90.CrossRefPubMedGoogle Scholar
  51. 51.
    Lada P, Delgado G Jr. Documentation of pharmacists’ interventions in an emergency department and associated cost avoidance. Am J Health Syst Pharm. 2007;64:63–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Coralic Z, Kanzaria HK, Bero L, et al. Staff perceptions of an on-site clinical pharmacist program in an academic emergency department after one year. West J Emerg Med. 2014;15:205–10.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Fairbanks RJ, Hildebrand JM, Kolstee KE, et al. Medical and nursing staff highly value clinical pharmacists in the emergency department. Emerg Med J. 2007;24:716–9.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Nana B, Lee-Such S, Allen G. Initiation of an emergency department pharmacy program during economically challenging times. AJHP. 2012;69:1682–6.PubMedGoogle Scholar

Copyright information

© American College of Medical Toxicology 2017

Authors and Affiliations

  • Brenna M. Farmer
    • 1
  • Bryan D. Hayes
    • 2
  • Rama Rao
    • 1
  • Natalija Farrell
    • 3
  • Lewis Nelson
    • 4
  1. 1.Division of Emergency MedicineWeill Cornell Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Pharmacy, Massachusetts General Hospital and Department of Emergency MedicineHarvard Medical SchoolBostonUSA
  3. 3.Department of PharmacyBoston Medical CenterBostonUSA
  4. 4.Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkUSA

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