Joe Halfpap, PharmD, BCPS

ED Pharmacy

Joe Halfpap

10 years as a pharmacist

3 Main Things:

Antibiotics

Anticoagulation

Random/Can’t Predict

What is the ED like?

Level 1 Trauma Center

- Sickest of the sick patients (med flight from across the region)

- Doctors are staffed on their medflight, usually other places only have nurses

- adults and pediatrics

- 54 beds total

- 60,000 ED visits per year (trauma, inpatient admission rate, ICU, general care)

40 EM Physicians and Attendings

Tertiary Referral Center

Transplant Center

Neurosurgery

Stroke Center

Pharmacy in the ED

• Responsible for 50-70 patients at one time

• Verify ER doctor prescription orders, but nurses can bypass if super urgent

• Verify all discharge order prescriptions (Important! Can review entire medical history where you can’t do that at the local retail pharmacy)

• Dysrythmias

• Procoagulants

• Toxicology (Overdoses

• Trauma

• Motor vehicle accidents or farming accidents

• Help nurses and Dr prep meds

• Give recommendations

• Transfer and hold patients

• CPR if needed

• Blue Cart (life threatening condition)

• Hands on

• Draw up medications

• Predict what they may need next

• Help nurses prime bags, pumps started

• With the Dr and nurses taking care of patient

• 60-70 medications need to know dose, indications, etc

• Stroke Team

• Certain medication for ischemic stroke with clot

• Assess them with stroke team

• Prep meds at bedside

• Dysrythmias

• Procoagulants

• Toxicology (Overdoses

• Seizing

• Allergy (Anaphylaxis)

• Asthma

• RSI - Rapid Sequence Intubation

• Lots of medication needed for this process

• Sedation, Pain meds

Non Emergency Things:

• Note: Some larger ED’s have no time for non emergency things (Ex: Detroit)

• Teaching patients about medications, check their insurance, call them and their doctors office for follow ups

• ED orders

• WI Poison Center (in Milwaukee)

• Culture Review (If the bacteria in UTI will respond to the antibiotic they are given after they leave)

• Triage calls for Physicians about ED medication questions, can make changes (delegated authority from hospital)

• Answer questions from residents

• Boarding = admitted to hospital but no inpatient bed for you, hang out in ER for a day or so before you get a bed. Pharmacist must treat them like they are admitted

Teaching

• PGY1/2 Pharmacy Residency

• About 6 students (6 of 8 blocks)

• 9 first year pharmacists

• Internship program, pick rotations (2 every summer)

Staffing

• 24/7 dedicated coverage

• 1 AM, 1PM, 1Mid day shift, 1 overnight (7 on, 7 off) 9pm-7am

Why ED Pharmacists?

• Studies show there is value and benefit

• Reduce med errors, improve quality and safety

• Timely accurate drug info for patients and residents

• Cost effective

• Help get patients get in and out of ER

How did Joe get involved in ED?

• Grew up in Milwaukee, came to UW for undergrad

• 3 yrs undergrad

• Tech at group health for few years

• Pharmacy School with UW

• Rotations in Madison

• PGY1 Residency