Category: Professional Posters
Purpose: Utilizing emergency medicine clinical pharmacists to review emergency department discharge cultures has become a well-established practice. Pharmacist staffing in all emergency departments however, especially in rural hospital settings, is not feasible at this time. Clinical pharmacists currently working in an emergency department endeavored to expand their emergency department discharge culture review service to include reviewing cultures at a remote site hospital with no dedicated pharmacist coverage.
Methods: The service expansion was requested by emergency medicine physicians who practiced at the remote site and were accustomed to pharmacists reviewing discharge cultures. The current process for reviewing cultures at the home site was the backbone for establishing the process at the remote site hospital. Both hospitals are under the same parent company and use the same computer system, thereby providing easy access for the pharmacists to view the emergency department visit records at the remote site. Access was granted to the pharmacists within the computer system to the online in-basket with the positive culture results from the remote site. Education was given to the physicians and other staff at the remote site hospital so they were aware of what to expect with regards to pharmacists following up on their discharge cultures. The note template and documentation process for the remote site hospital was the same process the pharmacists had been using for years to review cultures from their home site emergency department.
Results: Once online culture access was obtained and education provided to staff, the pharmacists took responsibility for discharge culture review at the remote site hospital. During the initial phase of implementation, one of the challenges found was that physicians would follow up on cultures with variable documentation of their actions, resulting in duplicated work and more pharmacist time needed during review. Consistent communication with the physicians and reminders of the process helped decrease the physician interruption of the process. Another unforeseen hurdle was cultures routing according to different algorithms at the separate sites, resulting in decreased efficiency; information technology (IT) support was important to adjust in-basket access. The documentation of culture review was consistent with the process at the pharmacists’ home site. Culture results involving complicated patients or visits were discussed with a physician at either the remote site or home site. After four months of coverage at the remote site, the service was reviewed through a quality assurance process. A total of 106 cultures were reviewed over the first four months, with an average time of 9.6 minutes spent per culture reviewed; this finding demonstrated more time was spent per culture reviewed at the remote site than the home site.
Conclusion: Emergency medicine pharmacists currently involved in a collaborative practice agreement-based culture review process at their own hospital have successfully implemented the service at a remote site hospital. Communication between the pharmacists and staff at the remote site, as well as thorough documentation by both parties was found to be an extremely important component to success. The workload and time spent per culture was higher than anticipated for the remote site emergency department. Based off this experience, expansion of an established pharmacist-driven discharge culture review service to a remote site emergency department within the same hospital system is feasible.