At Children’s Medical Center in Dallas you can see the future for some pharmacists

By Lauren Silverman, KERA NEWS

At Children’s Medical Center in Dallas you can see the future for some pharmacists – and it’s not working behind a counter or in a lab. As part of KERA’s Breakthroughs series, Lauren Silverman looks at why Children’s has put more pharmacists in the emergency room than any other pediatric hospital in the country.
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In the ER at children’s, there’s what looks like a vending machine, except instead of chips and cookies, it’s full of medicine.

 MORSE: “You can see we have oxygen supplies here, suction supplies…the IV fluids down here.”
Catch that? IV Solution. That clear liquid is a hot commodity.  For the past six months, hospitals across the country have had to work around a national shortage of the sodium chloride solution that hydrates and sterilizes. Dr. Rustin Morse, chief quality officer at Children’s, says er pharmacists have kept that from becoming a serious problem.
MORSE: “I put order into the computer and pharmacist would come over to me and and ask more questions about why I wanted IV fluids and then offer recommendations of either different IV fluids or different volumes such that we could manage the supply that we had.”

That may sound obvious, but Morse says ER doctors are used to jotting down a type and quantity of drugs, and moving on.  If there’s a problem, a pharmacist will hopefully catch it and call later on. At Children’s Medical Center, pharmacists review every single medication order in real time before its dispensed.
MORSE“So it wouldn’t be uncommon for me to decide I want to give a specific antibiotic that seems quite appropriate for me clinically … the pharmacist looks at that medication and the 25 other medications this patient is on and realizes that two of the medications I prescribed interfere with each other.”
Yes, that happens even at top hospitals. And yes, people die.  Every year more than 7,000 people die from preventable drug interactions.  Which is in part why hospitals including John Peter Smith, Baylor and Parkland have added pharmacists to their emergency departments.

BRENDA DARLING: “What do they look for? A myriad of things…The correct rate, the correct dose, the correct route, is it going to interact with vitamins or herbal supplements they’re taking…, food allergies, do we have to change routes…look at the cost, what insurance do you have, and are you self-pay all of those things go into what is the best and most efficient medication for the patient…and shortages.”
That’s Brenda Darling, the clinical pharmacy manager for Children’s – which has TEN full time ER pharamcistas – more than any one else in the country .

Medication errors are three times more likely to occur with kids.

BRENDA DARLING: “They’re not just little adults. They have a completely different metabolic rates, that you have to look at, different developmental states…so you have to know your patients.”

On any given week, pharmacists at Children’s review nearly twenty thousand prescriptions and medication orders. That’s IN ADDITION to automatic reviews by an electronic medical record system designed to essentially “spell check” orders to prevent errors. The thing is,

JAMES SVENSON:“The electronic medical record came out with the hope that it would catch all these things. But it hasn’t.”

James Svenson is associate professor of emergency medicine at the University of Wisconsin. He co-authored a study in the Annals of Emergency Medicine that showed prescription errors happened with one in ten adults and one in four of kids – that’s even WITH the electronic review.

So why doesn’t every hospital do this? Svenson says in large part, money.

JAMES SVENSON: “If you’re in a small ER it’s hard enough just to have adequate staffing for your patients in terms of nursing and techs let alone to have a pharmacist sitting down if the volume isn’t there it’s hard to justify.”
Hiring pharmacists is expensive, though Rustin Morse at Children’s points to research showing prescription review can reduce the number of hospital readmissions, saving money and lives.
Morse: “People do make mistakes, we’re all human and you want that extra level of benefit there so that a patient doesn’t get a drug that could potentially stop them breathing because it’s the wrong dose.”

As ERs search for ways to improve care and manage scarce supplies, pharmacists are stepping in to help juggle complex health care decisions.
Lauren Silverman, KERA News.