Medicines use in the emergency department: exploring professionals' perceptions.

Som Akudu, Daniel Greenwood, Alan Physick, Douglas Steinke, Sandra Martin

Research output: Contribution to conferenceAbstractpeer-review

Abstract

Introduction: Medicines are a common emergency department (ED) medical intervention. Due to their expertise, there is an increased focus on the potential role for pharmacists in the ED.[1] The use of medicines in this setting (prescribing, dispensing, administration and monitoring) has historically been the concern of doctors and nurses.[2] With ED pharmacist roles seemingly becoming more commonplace, it was important to better understand the use of medicines in the ED and therefore how pharmacists could best support their use. Objective: To investigate ED professionals’ perceptions of medicines use in the ED. Method: Semi‐structured interviews with six doctors and six nurses took place in the two EDs of Lancashire Teaching Hospitals (LTH) after obtaining ethical approval. The topic guide was structured according to the four‐stage medicines use process. Further topics for discussion were identified from a review of relevant literature and an observation visit to the Royal Preston Hospital. Interviews were recorded, transcribed verbatim and analysed thematically. Results: There were clear differences and similarities between doctors’ and nurses’ perceptions of the four major areas of the medicines use process. Most of their perceptions were linked to patients, staff or resources. A majority of participants think prescribing in the ED is “simple” and “straight‐forward” and most of them said they use the British National Formulary to support prescribing. However, one doctor did express their frustrations with the lack of prescribing guidelines and support immediately available in the ED for elderly or obese patients. Participants explained why appointing an ED pharmacist would be “beneficial” to medicines use and described pharmacists as “helpful” and “fantastic”. At LTH, the pharmacy's dispensing services are not available 24/7. Participants recalled times when they would discharge patients from the ED without their discharge medicines and patients would come back the “following day” to get them. Many participants said they would “run out” of medicines either when the pharmacy is closed, over the weekend or during bank holidays. The overall consensus was that the documentation of medicines use is done frequently. Whenever medicines are administered another person would document it and sign for it. One participant believes documentation in the ED is “better than on certain wards”. However, participants did mention that there are sometimes “delays” in the administration of medicines during hectic times. ED professionals sometimes monitor patients’ response to medication. The nature of monitoring depends on the type of medication given and the patient's condition. Monitoring is done “regularly” but when the ED is “busy”, a few doctors admitted that monitoring patients is “difficult”. One nurse explained how poor communication from doctors led to patients being unmonitored. Conclusion: This study has provided a foundation for further research of medicines use in the ED and highlighted areas requiring pharmacy input. Data saturation was not reached so more ED professionals could have been interviewed. However, using semi‐structured interviews helped reveal new and valuable information that can be used to support development of ED pharmacist roles which are of value to both patients and professionals.
Original languageEnglish
DOIs
Publication statusPublished - 23 Mar 2018

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