Phone A Pharmacist Friend: Telepharmacy Services At Freestanding Emergency Departments

The purpose of this report was to describe clinical interventions provided remotely via telepharmacy to freestanding emergency departments (FSEDs) by emergency medicine (EM) pharmacists. The primary objective was to describe pharmacist interventions provided as part of telepharmacy services. Secondary objectives were to categorize drug therapy recommendations based on therapeutic class of medication, determine the proportion of drug therapy recommendations associated with Institute for Safe Medical Practices (ISMP) high-alert medications, and assess the clinical significance of drug therapy recommendations. This was a retrospective chart review conducted in three freestanding emergency departments that are part of a large health system. EM pharmacists provide on-site support at a tertiary care center ED as well as remote clinical coverage for the three FSEDs. Pharmacist interventions for FSED patients documented between 1/1/2017 and 12/31/2018 were eligible for inclusion. All eligible pharmacist documentation was abstracted from the health system EMR (Epic®) for further analysis by trained reviewers. Reviewers excluded documentation related to non-direct patient care, administrative activities, and educational activities and organized interventions into common themes (Table 1). Data was analyzed descriptively and proportions with 95% confidence intervals are reported. A random sample of interventions was reviewed by two independent reviewers using a previously published scale in order to assess clinical significance of interventions (severity of the medication error avoided by pharmacist intervention and the value of the service). A weighted Kappa statistic was calculated to assess inter-rater reliability. A total of 4313 pharmacist interventions met inclusion criteria. Classification of interventions is summarized in Table 1. Of 1664 drug therapy recommendations, a total of 1424 were linked to a therapeutic class of medications. For these 1424 drug therapy recommendations, the most frequently implicated therapeutic classes were antimicrobial agents (n=732; 51.4%), vaccines (n=168; 11.8%), cardiovascular agents (n=90; 6.3%), and analgesics (n=86; 6%). 11% of recommendations were associated with Institute for Safe Medical Practices (ISMP) high-alert medications. The most common high-alert medication categories were antithrombotic agents (n=51; 32.5%), insulin (34; 21.7%), and opioids (20; 12.7%). In assessing the clinical significance of interventions, 19.2% were rated as significant errors that were intercepted by pharmacists by both reviewers with moderate inter-rater reliability (κ=0.55; SE 0.09). For the value of service assessment, 59% of interventions were rated as significant by both reviewers but inter-rater reliability was only fair (κ=0.22; SE 0.05). Emergency medicine pharmacists documented several types of interventions with approximately 20% of drug therapy recommendations associated with prevention of significant medication errors. Provision of remote telepharmacy services at freestanding emergency departments may represent a novel approach to help optimize patient care and safety.