Enhanced clinical pharmacy practice in the emergency department: what is it and what does it mean for patient care?

Exploring the role of pharmacists in A&E and their affect on patient care.

Daniel Greenwood, University of Manchester

This project is funded through the UKCPA-PRUK Clinical Pharmacy Grant.

As frequently reported in the news, UK emergency departments are struggling to meet demand which is partly due to a shortage of emergency department doctors and nurses. Due to staff shortages, the NHS has started to use pharmacists with enhanced clinical skills to care for emergency department patients. In addition to being medicines experts, this new type of pharmacist can diagnose some types of patient and write prescriptions like doctors. This research will help to better understand the role of these pharmacists and how they affect patient care.

Firstly, we will collect information about what these pharmacists do when they are working in the emergency department. This will include activities that pharmacists have always done, such as helping doctors to choose the best medicines for patients, as well as tasks that they do with their new extra training, such as examining patients. At this stage of the research, we will know what the role of these pharmacists is.

Next, we will develop a method to investigate how these pharmacists affect patient care. First we will need to decide what affect should be investigated. For example, we might investigate how these pharmacists affect patient waiting times or how they affect the types of medications used to treat patients. To help us with this decision we will ask past emergency department patients and emergency department healthcare professionals for their opinion. Once we have decided which specific affect to investigate, we will begin to develop a method to investigate this.

Method development will be a complex process because this pharmacist role is new and has never been investigated. Development will involve learning about how other researchers have developed similar methods to investigate the effect of healthcare professionals on emergency department patient care. In research beyond this project, we will use the method developed to investigate the effect of pharmacists with enhanced clinical skills on the care of emergency department patients.

The results of our research will be presented and distributed to many different healthcare professionals, hospitals, universities, and government organisations including Health Education England who are responsible for healthcare professional training in England. By informing these groups of this work, we hope that they will learn and understand more about what pharmacists with enhanced clinical skills training can do, and consequently, help more emergency departments to hire pharmacists.

This research is important because emergency departments often do not have enough staff which means that patients wait longer to be treated. We will produce evidence to show what these pharmacists can do to help care for emergency department patients and support the wider department. We will also develop a method to investigate how these pharmacists effect patient care, which, when used in future work, may demonstrate that patient care could be significantly improved by pharmacists and if so, ensure that more emergency department patients are cared for by pharmacists.

This project started in December 2016 and finished in April 2018.

See the detailed project description for more information.

The final report is available to view on this page. The appendicies are available in the links below:

Appendix 1: Pre-study participant questionnaire

Appendix 4: Clinical pharmacy care typology

Appendix 5: Systematic review search strategy

Appendix 6: PRISMA flow chart

Appendix 7: Systematic review inclusion and exclusion criteria

Appendix 8: Consensus calculations

Appendix 9: Patient interview schedule

Appendix 10: EDPP qualifications

Appendix 11: Role comparison

Appendix 12: Direct patient care activities

Appendix 13: Contribution to the wider ED

Appendix 14: Quality evaluations framework

Appendix 15: Priority outcome rankings

Appendix 16: EDPP service specification

Appendix 17: EDPP expert panel themes

Appendix 18: Patient interview quotes