Phone A Pharmacist: Telepharmacy Services At Freestanding Emergency Departments

Introduction Emergency medicine (EM) pharmacy practice has experienced significant growth in the past decade, but the scope of services provided for freestanding emergency departments (FSEDs) has not been previously described. Objectives The primary objective was to describe EM pharmacist interventions provided through telepharmacy services for three FSEDs. Methods This was a retrospective chart review conducted in three FSEDs that are part of a large health system. EM pharmacists provide remote clinical coverage for the FSEDs. Pharmacist interventions for FSED patients between 1 January 2017 and 31 December 2018 were eligible for inclusion. Documentation related to non-direct patient care activities was excluded. Drug therapy recommendations were categorized by therapeutic drug class and the proportion associated with Institute for Safe Medication Practices (ISMP) high-alert medications was analyzed. The clinical significance of a random sample of drug therapy recommendations was rated using a validated scale. Data was analyzed descriptively and a weighted Kappa statistic was calculated to assess inter-rater reliability. Results A total of 4313 interventions met inclusion criteria with drug therapy recommendations accounting for 38.4% of all interventions. Of 1664 drug therapy recommendations, there were 1424 linked to a medication with the most frequently implicated therapeutic classes being antimicrobial agents (n = 732; 51.4%), vaccines (n = 168; 11.8%), and cardiovascular agents (n = 90; 6.3%). ISMP high-alert medications accounted for 11% (n = 157) of these recommendations with antithrombotic agents (n = 51; 32.5%), insulin (n = 34; 21.7%), and opioids (n = 20; 12.7%) most frequently implicated. In a random sample of drug therapy recommendations, 19.2% were rated as significant errors by both reviewers with moderate inter-rater reliability (kappa = 0.55; SE 0.09). When assessing the value of service, 59% of interventions were rated as significant by both reviewers with fair inter-rater reliability (kappa = 0.22; SE 0.05). Conclusion EM pharmacists provided clinically significant drug therapy recommendations through telepharmacy services which may represent a novel approach to optimize patient care in FSEDs.