Hospital Pharmacy - June 2017 - 435
435
McAllister and Chestnutt
Table 1. Demographic and Patient Characteristics.
Characteristic
Age, mean (SD)
Gender, male, n (%)
Arrest began prior to arrival, n (%)c
Initial rhythm VF/VT, n (%)c
Duration of resuscitation attempt, min (SD)c
PharmD Present (n = 20)
No PharmD (n = 45)
P value
55.3 (±17.2)
8 (40)
15 (71.4)
4 (19.1)
22.9 (±24.7)
55.7 (±18.3)
29 (64.4)
36 (70.6)
4 (7.8)
16.7 (±12.2)
.9346a
.0662b
.9432b
.2199d
.2843a
VF/VT = Ventricular Fibrillation or Ventricular Tachycardia.
a
2-tailed t test.
b
Chi-square.
c
Several patients arrested multiple times.
d
Fisher exact test.
study was extrapolated to an annual cost avoidance provided
by a single full-time pharmacist.
was no difference in survival to hospital discharge (15% vs
4.4%, respectively; P = .6392).
Results
Cost-Effectiveness and Common Clinical Activities
ACLS Compliance
From October 8, 2012, to February 8, 2013, the pharmacy
residents provided clinical services in the ED for 636.75
hours and performed 1200 interventions with cost avoidance
of US$0 to US$214 assigned with each intervention. The
most common interventions performed include drug therapy
consults, drug therapy recommendations or modifications,
answering drug information questions, and assisting with
medical emergencies (Table 3). When the cost avoidance
data were applied to the interventions, it estimated that the
pharmacy residents provided US$98 362 in cost avoidance
to the health care system during this 4-month period which
was extrapolated to an annual cost avoidance provided by a
single full-time pharmacist of US$321 308 per year.
From August 1, 2012, to January 31, 2013, there were 20
patients who experienced cardiac arrest when a pharmacist
assisted as a member of the ED resuscitation team ("PharmD
Present"). One patient experienced 2 episodes of cardiac
arrest representing a total of 21 separate cardiac arrest events
evaluated. These patients were compared against a control of
45 patients who experienced cardiac arrest in the ED when
no pharmacist was present ("No PharmD"). Five patients
experienced multiple episodes of cardiac arrest accounting
for 51 separate cardiac arrest events evaluated. There were
no statistical differences between either group in regard to
age, sex, location of onset of cardiac arrest, initial presence
of a shockable rhythm, and the duration of the resuscitation
attempt (Table 1).
A total of 153 interventions (119 medications, 34 defibrillations) were performed in the "PharmD Present" group and
248 interventions (231 medications, 17 defibrillations) were
performed in the "No PharmD" group. The percentage of
medications administered in compliance with the ACLS
guidelines significantly increased when a pharmacist assisted
with the resuscitation attempt as compared with when no
pharmacist was present (78% vs 67%, respectively; P =
.0255; Table 2). Also, compliance for the composite of both
medications and defibrillations administered was significantly increased when a pharmacist was present as well (76%
vs 65%, P = .0268). Despite a greater percentage of resuscitation attempts performed without any deviation from ACLS
guidelines in the "PharmD Present" arm, this difference was
not statistically significant (43% vs 27%, respectively; P =
.2000). There were no statistical differences between groups
for compliance with defibrillations administered (68%
"PharmD Present" vs 47% "No PharmD," P = .1557).
Survival to hospital admission was statistically higher in the
"PharmD Present" group compared with the "No PharmD"
group (25% vs 17.8%, respectively; P = .0155) though there
Discussion
ACLS Compliance
Attempting to resuscitate a patient in cardiac arrest is a very
stressful situation, and errors are likely to occur unless a systematic multidisciplinary approach is utilized. Studies have
demonstrated that medication errors occurring during cardiac arrest resuscitation attempts occur frequently and have
higher rates of morbidity and mortality associated with them
compared with errors occurring in other areas of medicine.9
Studies have also demonstrated a decrease in errors during
cardiac arrest resuscitation attempts when pharmacists are
part of the resuscitation team, which supports the Institute
for Safe Medication Practices' recommendation that institutions "include ACLS- and/or PALS-trained pharmacists on
code response teams whenever possible," though to our
knowledge the benefits of a pharmacist on the ED resuscitation team have never been assessed prior to this study.7,9
This study found a significant increase in the percentage of
medications administered in compliance with ACLS guidelines when a pharmacist was present during the cardiac arrest
resuscitation attempt (78% vs 67%, P = .0255) which is
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2017
Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
ISMP Medication Error Report Analysis
Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Formulary Drug Reviews: Plecanatide
Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
Financial Effect of a Drug Distribution Model Change on a Health System
Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
Hospital Pharmacy - June 2017 - 381
Hospital Pharmacy - June 2017 - 382
Hospital Pharmacy - June 2017 - 383
Hospital Pharmacy - June 2017 - 384
Hospital Pharmacy - June 2017 - 385
Hospital Pharmacy - June 2017 - 386
Hospital Pharmacy - June 2017 - 387
Hospital Pharmacy - June 2017 - Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
Hospital Pharmacy - June 2017 - 389
Hospital Pharmacy - June 2017 - ISMP Medication Error Report Analysis
Hospital Pharmacy - June 2017 - 391
Hospital Pharmacy - June 2017 - 392
Hospital Pharmacy - June 2017 - 393
Hospital Pharmacy - June 2017 - Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Hospital Pharmacy - June 2017 - 395
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Hospital Pharmacy - June 2017 - 399
Hospital Pharmacy - June 2017 - Formulary Drug Reviews: Plecanatide
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Hospital Pharmacy - June 2017 - 405
Hospital Pharmacy - June 2017 - Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Hospital Pharmacy - June 2017 - 407
Hospital Pharmacy - June 2017 - Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
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Hospital Pharmacy - June 2017 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
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Hospital Pharmacy - June 2017 - Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Hospital Pharmacy - June 2017 - 429
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Hospital Pharmacy - June 2017 - Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Hospital Pharmacy - June 2017 - 434
Hospital Pharmacy - June 2017 - 435
Hospital Pharmacy - June 2017 - 436
Hospital Pharmacy - June 2017 - 437
Hospital Pharmacy - June 2017 - Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
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