Letters 1. Jellinek-Cohen SP, Cohen V, Bucher KL et al. Factors used by pharmacy residency programs to select residents. Am J HealthSyst Pharm. 2012; 69:1105-8. 2. Gohlke AL, Ray DB, El-Ibiary SY et al. Characteristics of the ideal postgraduate year 1 pharmacy practice residency candidate: a survey of residency program directors. J Pharm Pract. 2014; 27:84-8. 3. Clark JS, Khalidi N, Klein KC et al. Using a novel approach to collect, disseminate, and assess residency application materials. Am J Health-Syst Pharm. 2010; 67:741-5. 4. Ensor CR, Walker CL, Rider SK et al. Streamlining the process for initial review of pharmacy residency applications: an analytic approach. Am J Health-Syst Pharm. 2013; 70:1670-5.

Sarah A. Nisly, Pharm.D., BCPS, Associate Professor Department of Pharmacy Practice College of Pharmacy and Health Sciences Butler University Indianapolis, IN [email protected] Meredith L. Howard, Pharm.D., Postgraduate Year 2 Pharmacotherapy Resident Indiana University Health Indianapolis, IN Alex N. Isaacs, Pharm.D., BCPS, Clinical Assistant Professor College of Pharmacy Purdue University Indianapolis, IN

Incorporating prehospital care into emergency medicine residency training

E

mergency medicine (EM) is a rapidly growing subspecialty of pharmacy. EM pharmacists are involved with a wide range of patients, including those being checked for minor ailments, those with sepsis requiring resuscitation and antibiotic therapy, and those with multiple traumas requiring massive transfusions. The combination of a fast-paced environment with the various levels of care required makes the emergency department a prime environment for medication errors.1,2 Across the United States, EM pharmacists are developing services to ensure optimal and safe patient care in the emergency department. As the need for EM specialty–trained pharmacists grows, the number of new postgraduate year 2 (PGY2) pharmacy EM residency programs is increasing. Currently, the curricula of pharmacy EM residencies consist of rotations in the emergency department and other core and elective rotations in intensive care, toxicology, and other areas to fit each resident’s goals. While some residency programs may offer opportunities to complete occasional EM services (EMS) “ride alongs,” few offer formalized rotations in the prehospital care setting. We

describe a prehospital care rotation for a PGY2 EM pharmacy resident at Detroit Receiving Hospital with Detroit emergency services providers. The EM pharmacy resident completes a monthlong rotation with the Detroit EMS paramedics and EM technicians (EMTs). During 12-hour shifts, the resident works closely with EMS to assess chief complaints and treat patients utilizing EMS diagnostic algorithms. As expected, the needs of transported patients vary widely and can include asthma exacerbations, cardiac arrests requiring advanced cardiac life support, and trauma requiring advanced trauma life support. The resident’s role during each transport is to assess the patient, obtain an accurate medication history, identify possible drug-related adverse events contributing to the patient’s chief complaint, and assist with providing emergent care. Pharmacy residents are accustomed to being highly utilized by physicians and nurses to answer questions, but the audience is significantly different on the EMS rotation. While evaluating a patient’s medications, the resident educates the patient, paramedic, and EMT on drugs’

Tate Trujillo, Pharm.D., BCPS, FCCM, FASHP, Director of Pharmacy Indiana University Health—Methodist Hospital Indianapolis, IN

The research assistance of the following students is acknowledged: Allison Boyd, Danielle Stone, Justin Hsu, and Kristina McAtte. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140416

indications for use and adverse effects. Many patients have little knowledge about both their medications and diseases or that their chief complaint may be related to a medication. When not actively transporting patients, the resident provides the EMS personnel with more in-depth information about medications, including brand and generic names, mechanisms of action, adverse effects, monitoring parameters, maximum doses, and contraindications for medications included in the prehospital protocols. As part of the rotation, the resident also works with the Wayne State University EMS physician fellow to build an educational tool for new EMTs as well as provide any drug-related updates for current personnel. Another rotation goal is to enhance the resident’s understanding of the EMS role in transitions of care. Information provided by EMS personnel is often the most reliable and vital to assist with determining the treatment path at the hospital (e.g., chief complaint, environment in which the patient was found, pertinent facts from bystanders), especially with patients with very acute care needs. Because a medication history is frequently an important factor in the treatment plan, the resident assists with patient Continued on page 2114

Am J Health-Syst Pharm—Vol 71 Dec 15, 2014

2113

Letters Continued from page 2113

handoff with the receiving hospital to ensure an accurate history during transitions of care. This rotation is not limited to ride alongs with EMS personnel; the resident is expected to actively participate in meetings of the Detroit East Medical Control Authority (DEMCA). This multidisciplinary council reviews all EMS protocols and discusses methods for improving prehospital patient care. As a pharmacy representative, the resident is to ensure that the recommendations and decisions are appropriate and feasible from the pharmacy’s perspective. The experience with DEMCA allows the resident to see the multifaceted approach to prehospital patient care. In summary, the prehospital experience as an EM pharmacy resident is of great value. Ride alongs give an opportunity for one-on-one education on drug-related topics to paramedics, EMTs, and patients and expose residents to the challenges faced by prehospital healthcare providers. The insight gained during this residency provides a distinct advantage to EM pharmacists and may help to expand the role of EM pharmacists in the future. 1. Santell JP, Hicks RW, Cousins DD. Medication errors in emergency department settings—5 year review. Presented at ASHP Summer Meeting. Las Vegas, NV; 2004 Jun. 2. Brennan TA, Leape LL, Laird NM et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991; 324:370-6.

Elizabeth Giesler Johnson, Pharm.D., BCPS, Clinical Pharmacist, Emergency Medicine/Critical Care John Peter Smith Health Network Fort Worth, TX Suprat S. Wilson, Pharm.D., BCPS, Pharmacy Coordinator, Emergency Medicine Services, and Director, Postgraduate Year 2 Emergency Medicine Pharmacy Residency Program Detroit Receiving Hospital Detroit, MI [email protected]

At the time of writing, Dr. Johnson was Postgraduate Year 2 Emergency Medicine Pharmacy Resident, Detroit Receiving Hospital. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp140496

2114

Am J Health-Syst Pharm—Vol 71 Dec 15, 2014

Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Incorporating prehospital care into emergency medicine residency training.

Incorporating prehospital care into emergency medicine residency training. - PDF Download Free
438KB Sizes 3 Downloads 9 Views