I'm already 3 weeks through my emergency med rotation and time is just FLYING by, I can't believe it. I started this rotation in late June on the evening shift (4pm-11:30pm) with my pharmacy preceptor, but recently we've been swing shift (11:30am-8pm). Has this stopped us from seeing some of the most "out there" pharmacy stuff!? Absolutely not.

This is my second rotation in an emergency department (ED) but my first and only one on APPE. Previously I was at a small community hospital in south Philadelphia, so being at a big university hospital for this rotation is a huge change. We experience have a lot of foot traffic through the whole day, and we have 54 beds to accommodate all those in center city who are in need of emergency care. A lot of my friends, and even med students have asked me: what exactly is the role of a pharmacist in the emergency department? To me, the question should be: why doesn't EVERY ED have a pharmacist!?

What we do:

1. Medication verification: although there are clinical aspects to the job, we do not escape the traditional role of the pharmacist completely here. We still need to do some verification and make sure all the meds our ED patients get are safe and appropriate. Pharmacist verification prevents potential medication errors that may not be picked up right away, like drug interactions! We get to do a lot of interventions here, especially on the infectious disease front, so that's always fun!

2. Pharmacy experts: We get questions. A LOT of questions. We get questions from doctors, from nurses, from PAs, and from patients. Questions about pharmacology, med administration, compatibility, you name it! If you know anything about the ED you'll be able to imagine how wild some of the questions are, but they keep us busy with new and interesting things to look up. I've always thought of pharmacists as the doctor's "right hand man" and we certainly fill that role in the ED. The unpredictability of the ED also allows pharmacists to serve as the pharmacology go-to for tough situations that require quick, and accurate answers. Basically, we're ED super stars, and from what I've observed, the healthcare team loves having us around to answer pharm questions.

3. Assist during intubations and trauma: During intubations and/or trauma, the pharmacist is an invaluable resource. We have a lot of knowledge about sedative agents, neuromuscular blockers, and toxin antidotes that needs to be readily available during delicate situations such as these. These agents also have a laundry list of contraindications, side effects, and administration pearls that may not be commonly known (but hey, your ED pharmacist knows them)!

4. Prepare patients for admission or discharge: Sometimes our ED patients need longer term care and end up admitted to the hospital. For these patients we do medication reconciliations to make sure their home medications end up on their list of meds they'll receive in the hospital. If they don't need to be admitted and are allowed to go home, we also help counsel on any medications changes or new meds they'll need to know before leaving!

5. Tdap for everyone: I couldn't finish this post without explaining the title, which also happens to be one of my preceptor's mantras. In his words..."there aren't many people I won't give Tdap to".  My APPE partner, Jill, and I have made it a habit to repeat this every time a Tdap comes up in our verification queue, just for the humor of it. I've quickly discovered that vaccination and a pharmacist's knowledge about vaccinations, plays a role in the ED too!

So you can see we're pretty useful to have around. It's also important to note that we have a lot of responsibilities not mentioned here, and that this is a pretty broad overview. Regardless, I know the healthcare team at our ED is extremely appreciative of the knowledge my preceptor brings to the table. Its really empowering to see pharmacists in a role that a few years ago wasn't common and especially when some EDs still don't have pharmacists present. Our ED is lucky enough to have two!

Thanks for reading everyone! I plan on doing a quick post about my personal thoughts and feelings about APPE while on this rotation too, so keep a look out for that soon (spoiler alert)! It's been an awesome journey thus far, even though my brain seems to poop out on me just about every day (couldn't remember the monitoring parameters with Truvada the other day....still mad about it....)

Till next time!