Evaluation of the impact of a Pharmacy Technician within the Emergency Department, Royal Stoke University Hospital

Abstract

The Emergency Department (ED) at the Royal Stoke University Hospital has come under increasing pressure, and it is well published that patients within the ED are at a higher risk of medication misadventure and missed doses of critical medicines1. This was a particular risk at the Royal Stoke in winter 2022/23 with the re-introduction of ED corridor care and patients waiting over 24 hours for a medical bed. A prescribing pharmacist has been in post in the ED since 2019, but additional funding was obtained for a pharmacy ED technician to support for 6 months during winter pressures. The aim of this service evaluation was to assess the impact of the pharmacy technician within the ED, with a particular focus on medicines reconciliation, allergy status recognition and pharmacist prescribing activity. Ethical approval was not required for this project, as it was a service evaluation. Data was collected over an 11 week period, Monday-Friday from October-December 2022. Data was collated into an Excel® spread sheet and assessed the number of patients reviewed by the pharmacy technician and prescribing pharmacist, the number of medicines prescribed by a prescribing pharmacist (including number of critical and non-critical medicines), and any missed allergy status’ by the clerking practitioner. Over 11 weeks, the pharmacist prescriber was able to prescribe 183 medicines, 46 of which were critical medicines. 23 patients were identified as having allergies (with 61% being penicillin allergy) which had previously not been documented by the clerking practitioner within the ED and/or patients were not wearing the appropriate red allergy wristband. This included 2 patients who had previously experienced anaphylaxis as a result of their drug allergy. Finally, comparing the data from the time period with the pharmacy technician, to without a pharmacy technician, demonstrated an almost 10-fold increase in pharmacist prescribing activity. This service evaluation has demonstrated the significant positive impact of a pharmacy technician within the ED. The data collected for this service evaluation was limited as it was only collected on weekdays, and further work should be done to assess the impact of a 7 day service. It is therefore recommended that permanent funding is secured all year round for ED pharmacy technician support, ideally 7 days per week. This will increase medicines reconciliation activity allowing ED pharmacists to focus on clinical review and prescribing for patients, increasing the number of patients seen by pharmacy, allowing earlier identification of patients on critical medicines, reducing the number of missed doses and potential harm. A pharmacy technician also allows earlier confirmation of patients’ allergy status, further reducing harm within the ED. 1. NICE Guideline (NG5). Medicines Optimisation: the safe and effective use of medicines to enable the best possible outcomes. Published 4th March 2015.