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The Role of Pharmacists Expanding into the Emergency Room

By: Sherin Pathickal, PharmD Candidate c/o 2016

In 2006, the Institute of Medicine reported that over 1.5 million people in the US suffered from a medication error, errors that not only cost the economy billions of dollars, but endangered countless lives.1 Each year, approximately 7,000 deaths occur to due to preventable medication related errors.2 These errors include, but are not limited to, the wrong dose, the wrong formulation, and the wrong medication being administered.1 The reasons for medication errors are numerous: medical professionals being overworked and rushed, misreading prescriptions, or administering incorrect sound-alike/ look-alike drugs. With the number of medication related errors remaining at a dangerous high, it is clear that additional safeguards need to be set in place to protect the patients’ lives.

Fortunately, the Children’s Medical Center of Dallas appears to be developing a plan to do just that. It recently employed ten around-the-clock pharmacists who continually review orders placed by physicians and recommend changes, keeping the patient’s wellbeing a top priority.2 Such vigilance is especially important at medical centers such as this one, as it caters to children and adolescents primarily. The pediatric population was once treated as “little adults,” but it has become clear that their metabolism of certain drugs is drastically different from that of adults. Drug treatment that ignores this fact may result in under-dosing, overdosing, and toxic serum concentrations.2 Studies have indicated that children are up to three times as likely to suffer from a medication error as adults.2 With physicians and pharmacists working together, a pediatric patient’s health information such as the weight, allergies, and medication history should all be thoroughly reviewed prior to prescribing and administering a drug.2

Prior to the addition of clinical pharmacists in select hospitals across the country, prescribers depended heavily on the electronic medical record systems to find potential errors. However, these systems were unable to catch all of the potential errors in the emergency room. Dr. James Svenson, a professor at the University of Wisconsin, recently performed a study that looked at the potential risks associated with utilizing the electronic medical record system alone and found that nearly a quarter of a all prescriptions written for children had errors that were not discovered by the system.2 Of the prescriptions written for adults, nearly 10% were found to still contain errors.2 It is clear that even with electronic systems in place, additional help and surveillance provided by pharmacists is needed.

The study performed at the Children’s Medical Center is just one of many studies that exemplify the important role of pharmacists in the emergency department. In 2011, a similar study was performed in Albuquerque at the University of New Mexico.3 The University boasts a well known level 1 trauma center, and the data compiled there compared the frequency of medication related errors with and without the input of pharmacists. The results clearly demonstrated the additional security provided by having qualified pharmacists present, as errors were found to be 13 times more frequent without a pharmacist.3 The data compiled looked at a period of 3 months in 2009.3 The site only has pharmacists on duty for ten hours, so the same three months were compared. Over the three months, 2.5% of the patients monitored suffered from an adverse medication error while a pharmacist was present as opposed to 30.3% without a pharmacist.3 Of note, results indicated that the medications with the most errors were found to be antibiotics, then pain medications, followed by cardiac and GI medications.3

With the number of medication related errors on the rise, it is clear that the pharmacists needs to expand into the emergency room as well as other critical care units. Prescribing errors such as incorrect medication, dosage, or drug form, result in adverse events. If proper care is not taken to review the patients’ profile, many lives could be in danger. Although this is a concern at any department in a hospital, it is highly problematic in the emergency room, where quick thinking is needed at all times. Pharmacists, as drug experts, should take on a more hands-on role to ensure the safety of patients and other health care professionals.


  1. National Patient Safety Foundation. Key Facts About Patient Safety. http://www.npsf.org/for-patients-consumers/patients-and-consumers-key-facts-about-patient-safety/. Accessed July 27, 2014.
  2. Hospitals put pharmacists in the ER to cut medication errors [transcript]. Your Health. Silverman, L. National Public Radio. June 9, 2014.
  3. D’Arrigo T. In Emergency Room, pharmacists slash rate of drug errors. Pharmacy Practice News. October 2011 (38). Accessed July 26, 2014.

[pubmed_related keyword1=”pharmacist” keyword2=”medication” keyword3=”emergency”]

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