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J Pharm Pract. 2019 Jan 13:897190018819412. doi: 10.1177/0897190018819412. [Epub ahead of print]

Implementation of an Advanced Pharmacy Practice Model in the Emergency Department.

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1 Mount Sinai Queens, Long Island City, NY, USA.
2 Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.
3 Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA.
4 Department of Clinical Affairs, Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA.



The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED).


Data from January 2015 to August 2017 extracted from the department of pharmacy's electronic documentation system and the hospital's electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution's administration as an acceptable reflection of the impact for activity.


The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist.


We created and implemented an advanced practice model tailored to our institution's needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.


emergency medicine; medication safety; pharmacy administration


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