Editor’s Note: This series was created by third year medical student Gerhard Dashi and will highlight the important work that our interprofessional colleagues do. This week’s post was co-authored by Emily Wiener. Keep your eye open for more “Phone a Friend” articles and if you would like to be featured or know a colleague that should be highlighted follow this link to complete the questions on a google form.
Background on the “Phone a Friend” Series
As I progress through medical school, I notice a common thread drawing me to Emergency Medicine and events like the “National Health Care Team Challenge” or the “Simulation Olympiad”. That thread is that I love working with an array of talented and fascinating healthcare professionals. Just like doctors, these nurses, pharmacists, paramedics and other health experts belong to professions with intriguing histories, rich cultures, ambitious goals, and unique skills. These distinctive characteristics shine through as soon as you meet these experts, even during the stages of their training.
Their indispensable roles within the ED guide care from the minute patients walk in the door until they leave the department. Multiple decisions, including acuity determination, initial course of care, and long-term follow-up strongly involve input and expertise from these indispensable team members.
At every “Pearls of Wisdom” session (in which a clerk, resident, doctor, or program director gives advice to medical students) I hear “Be nice to the [non-MD specialists]. They know everything.” Interprofessional contributions are especially important in the Emergency Department, where we often work with partial information in a fast-paced, over-stimulating environment.
Therefore, we would like to give these health professionals an opportunity to tell BoringEM readers what they do, what they’ve been through, what you should know about them and, most importantly, how you can be a good colleague to them.
Although we have sent requests to some of our favorite professionals, we would love to hear from you or someone you know. Please send us the questions you would like answered or your own answers to the following questions. We hope to feature your responses on upcoming posts.
The Fantastic Pharmacist
Dr. Bryan Hayes (@PharmERToxGuy) completed his undergraduate degree in Chemistry. He conducted pharmaceutical research in lab for a number of years before heading back to school to obtain his PharmD. After completion of his PGY-1 pharmacy residency, he completed a 2-year clinical toxicology fellowship (not common for pharmacists) and started working in the ED at the University of Maryland, Baltimore. He currently holds dual Clinical Associate Professor appointments at the School of Pharmacy and the School of Medicine (also not common for pharmacists).
Profession/current job title: Clinical Pharmacy Specialist, Emergency Medicine & Toxicology
Years of practice: 7
Country of practice: US
Practice setting: Baltimore- academic medical center in the ED. 800 bed facility.
How does your work impact patient care?
I would say that optimizing antimicrobial therapy and medication oversight of all medical emergencies are my two biggest clinical roles as a pharmacist. Education (for patients, nurses, and providers) has to come in a close third, as this is what ultimately leads to practice change. Fourth, my involvement with Academic Life in EM has been an outstanding way to disseminate my practice pearls and experience worldwide.
What is the most common misperception about your role in the ED?
Probably that the pharmacist is there just to second-guess a provider’s order (although not within my department).
How can the ED utilize your skills more effectively?
My skills are best utilized in a prospective manner. In other words, involving the pharmacist while seeing patients and developing a plan together is more beneficial for patients than the pharmacist reviewing orders retrospectively.
What is your favourite part about working in an interprofessional environment?
I can’t really pinpoint one particular favorite. I love all aspects of my job, particularly working with an interdisciplinary team to improve patient safety. As much as we all hate committees, we have developed our own ED patient safety committee as well as an ED resuscitation committee to help optimize both of those areas. I also love how we all bring different perspectives to patient care. I’m always looking for potential adverse drug events, drug interactions, or possible unintentional overdose as a cause for a patient’s presentation while the physicians are usually focused on other parts of the differential diagnosis. As a team, we cover it all together.
What is the most difficult aspect of working in the ED?
For me, the most difficult thing is that even after education, the same mistakes happen over and over again. Part of that has to do with having to teach the same concept to new trainees each year and it is hard to target everyone all at once.
What can be done to improve interprofessional practice in the ED?
As much as computer order entry systems have positively impacted patient care, they certainly promote less verbal communication between ED team members. We really need to communicate better with other team members to let them know the ‘why’ behind what we do. This helps educate all involved team members at the bedside and prevents the silos from forming between the different professionals.
What is your biggest pet peeve when you are working in the ED?
Routinely seeing medication doses prescribed incorrectly (particularly antibiotics) even after intense education about what is correct.
What is the aspect of your job that you are most proud of?
I’ve been very blessed to work where I do as my first job out of fellowship. The U of Maryland EM faculty have provided me with numerous opportunities to teach (locally, regionally, and nationally) and perform research. The department of pharmacy I work for has provided me with flexibility to be able to pursue all of my passions (clinical, teaching, and research). What I’m most proud of are three things:
1. The education I’ve been able to provide through Academic Life in EM
2. The “To-Go Meds” program we created to reduce ED return visits
3- National speaking opportunities at SMACC, AAEM, ASHP, the Teaching Course, and the Crashing Patient Conference
Can you provide an example of an optimal patient interaction (e.g. one in which you used all of your training to positively impact the outcome for a patient)?
There are many, but the one that comes to mind is an incredibly sick DKA patient who was also hypokalemic (not common). Before I was involved, an insulin bolus was administered, without having a potassium value resulted yet. This patient required intense resuscitation, optimized insulin administration, and repletion of potassium.
I worked closely with the nurse and physician team to work outside of our institutional guidelines to resuscitate the patient. Educating the team about how to manage the patient outside standard treatment regimens while rapidly providing treatment is the reason I think I’m here and why a pharmacist is needed in the ED. I truly feel my role helps fill the gap between nurses and physicians.
A good resource for pharmacy students/residents interested in pursuing a career in EM pharmacy can be found by clicking here.