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Pharmacist Improves Timely Administration of Medications to Boarded Patients in the Emergency Department

      Purpose

      Our purpose was to assess the variations in timely administration of medications based on differences in nursing staff (ED nurses who are responsible for emergency and boarded patients vs inpatient nurses who are responsible for only boarded patients) and to determine whether a pharmacist’s interventions can improve the timely administration of medications to boarded patients in the emergency department.

      Methods

      This was a prospective observational study. Patients were included in the study if they were aged 18 years or older, were physically located in the emergency department but had already been admitted to the medical center, and had medication orders. The pharmacist documented the medication orders and the allotted time for administration. Once the upper limit of the allotted time frame for administration had passed, the pharmacist determined whether the medications were given and interventions were then carried out for those medications that were not administered. Successful interventions were documented when the medication was given within 1 hour from the time of intervention.

      Results

      Seventy-nine patients were included in the study, resulting in 266 medication administration opportunities (emergency department, 146; inpatient, 120). Inpatient nurses administered medications in a timely manner at a significantly greater rate than ED nurses (83.3% vs 63.7%, P < .0001). The greatest difference was observed during the evening hours (95.2% vs 53.8% of medications administered for inpatient vs ED nurses, P = .002). The most common reason for medications not being administered by ED nurses was insufficient time (51.4%), and for inpatient nurses, it was that the medication order was not verified (77.8%). The pharmacist’s interventions were successful with both the ED and inpatient nurses (95.5% and 94.1%, respectively).

      Conclusion

      This study illustrates that assigning nurses with varying workloads as a means to manage overcrowding is likely to result in boarded patients in the emergency department not receiving their medications. ED pharmacists’ interventions may fill the gap, ensuring compliance with the administration of medication orders prescribed for boarded patients and ensuring more timely administration. A multidisciplinary team approach is needed to manage current overcrowding issues.

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      Biography

      Samantha P. Jellinek is Clinical Pharmacy Manager for Medication Reconciliation and Safety, Department of Pharmaceutical Services, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Victor Cohen is Assistant Professor of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, and Clinical Pharmacy Manager, Department of Emergency Medicine and Department of Pharmaceutical Services, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Lydia B. Fancher is PGY-2 Emergency Care Pharmacotherapy Resident, Department of Pharmaceutical Services, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Antonios Likourezos is Research Associate, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Mary Lyke is Nurse Manager, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Kathy Peterson is Director of Nursing, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Eustace Lashley is Director of Performance Improvement, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.

      Biography

      Steven J. Davidson is Chair, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, and Professor of Emergency Medicine, Mount Sinai School of Medicine, New York, NY.

      Linked Article

      • Timely Administration of Medication in China
        Journal of Emergency NursingVol. 36Issue 5
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          I was extremely interested in the article “Pharmacist Improves Timely Administration of Medications to Boarded Patients in the Emergency Department”1 in the March 2010 issue of the Journal. This is the first article I have ever read about timely administration of medications to boarded patients. The author illustrated that varying the workloads of nurses as a means of managing overcrowding is the major reason that patients boarded in the emergency department do not receive their medical service on time.
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