State pharmacies' staffing crisis

For the thousands of people who wait for hours to have their medication dispensed at public hospitals, it's a bitter pill to swallow, but there appears to be no short-term solution.

At many state hospitals, those on medication can wait up to four days for their medicine, while hospital authorities struggle desperately to fill vacant pharmaceutical posts, with applicants few and far between.

The head of Pharmaceutical Services in KwaZulu-Natal's Department of Health, Cyril Tshabalala, said there were 1 254 posts for pharmacists vacant in the province, but this should be seen in context.

He explained that whereas there had previously been 770 posts available to pharmacists, last year a decision was taken by the department to more than double this figure, to cope with the HIV crisis and general demand for their services.

'Some decide to leave the country before doing their year of community service'

This meant there were now 1 592 positions, of which only 338 had so far been filled.

As departments of health in each province are struggling to attract applicants, the Sunday Tribune attempted to establish if there had been a decline in those wanting to enter this sector of the medical field.

According to Andy Gray, senior lecturer at the Department of Therapeutics and Medicines Management at Nelson Mandela School of Medicine, Durban, some pharmaceutical schools had seen a reduction in the number of students, but this was not a countrywide phenomenon.

At the University of KwaZulu-Natal the number of applicants far exceeded the spaces available, said Grey.

At present they were taking about 80 new applicants into the four-year programme each year. Of these, about 60 would graduate.

'Free State is one of the hardest hit in this field'

About 350 to 400 pharmacists qualify in South Africa each year, but attrition of graduates had to be taken into account, said Gray.

"Some decide to leave the country before doing their year of community service and many students from neighbouring states go back there to do their internship and don't enter the profession in this country," said Gray.

He believes that of the 10 824 on the register of pharmaceutical practitioners, only about 9 000 are actually working here.

Of these, only 1 746 are employed in the public sector, although 80 percent of the country's population is dependent on their services.

"There's a maldistribution of pharmacists, with too few in the public sector for the number of patients they need to attend to.

"At the entry level some hospitals get no applicants. The Eastern Cape repeatedly advertises posts, but has few takers," said Gray.

Barbara Raftesath, President of the South African Association of Hospital and Institutional Pharmacists, said it had always been difficult to get health care professionals in the rural areas.

She believes the Free State is one of the hardest hit in this field.

Trying to get a precise breakdown of the salary differences between the private and the public sector had also proved almost impossible because these differed not only from province-to-province, but also at individual hospitals within a province.

"There is also no uniformity between private hospitals," said Raftesath.

She pointed out that at Level 8 (an entry grade post) the public sector received very few applicants.

At higher levels, where salaries were more on a par with the private sector, positions were easier to fill.

The department of public services is apparently restructuring health workers' salaries in the public sector to attract and retain more health workers.

No time frame had been given as to when this would come into effect, but action was not expected before mid-2007, said Gray.

The department of health's human resource plan had also not committed to specific staffing norms, so the number of pharmacists needed remained unknown at this stage, said Gray.

It has been suggested that locums could fill the void and Raftesath said in the Western ape many locums and retired pharmacists were being used effectively.

The official policy on locums also differed from province-to-province and hospital-to-hospital, with those in charge deciding what they could afford to pay them.

Gray said KwaZulu-Natal relied heavily on locums. Tshabalala said the department paid the going rate for locums - which varied from R90 to R120 an hour, depending on the area.

Obviously, a city hospital would pay more than one in a rural area.

He said pharmacists from the private sector often volunteered their services and believed that some young pharmacists also chose to act as locums, rather than take on full-time employment, finding this a more lucrative route.

The bulk of locums were, however, retired.

Durban's Vere Randles, a retired pharmacist, painted a different picture.

He said he would be happy to do locums and knew of other retired and semi-retired pharmacists willing to fill the void in the public sector, but felt the province's Department of Health was averse to using their services.

Randles did a stint of 17 months at KwaDabeka Community Health Centre, a very busy peri-urban facility.

He said he was due to fill in at a clinic in the Inchanga area, but, because there was no full-time pharmacist and policy dictated that locums may not work alone, this fell through.

"Locums are restricted to working six hours a day to ensure their earnings do not exceed those of a full-time worker," said Randles.

"Many young pharmacists also use the public health sector as a stepping stone, so do not stay long in a position."

Aisha Suleman, a research pharmacist attached to the Reproductive Health Research Unit (a Wits structure with a Durban office), cited salary discrepancies as the major reason.

"The newly qualified community service pharmacists are leaving the public sector for the private sector in droves," said Suleman.

"The public sector is offering them about R130 000 a year and the private sector about R200 000."

Another problem, she said, was the major shortage of pharmacists able to give adherence counselling to patients on anti-retrovirals.

As the struggle to fill posts continues, desperately short-staffed pharmacists in hospitals around the country try to cope with an ever-growing mountain of patients' prescriptions, often under the most trying circumstances as angry patients clamour for their medication.

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Pharmacists, schools feel a pinch

By Melissa Willett
Staff writer

Pharmacist John Calhoun, left, owner of Cape Fear Discount Drugs, and his intern

Fayetteville Observer Photo

After years of traveling across southern North Carolina filling prescriptions, John Calhoun was exhausted and fed up with his profession.

He had envisioned a career where, as a pharmacist, he had enough staff to conduct business in a relatively stress-free environment and provide proper customer service, things he said was missing in his days with chain stores.

So in 2003, Calhoun opened Cape Fear Discount Drugs as a solution to the problem.

Calhoun’s frustrations aren’t unusual. In fact, his concerns are echoed in pharmacies throughout the country about a profession that is experiencing a critical shortage of manpower.

By 2020, there will be a predicted shortfall of as many as 157,000 pharmacists, according to the American Association of Colleges of Pharmacy.

Today, pharmacists nationwide fill more than 3 billion drug orders a year, reports the National Association of Chain Drug Stores. And that number is expected to escalate as baby boomers age and more sophisticated drugs are developed. The problem, experts say, is that demand is exceeding supply.

Fewer druggists means higher salaries, multiple job offers for graduates and heavier workloads.

“The number of prescriptions and drug orders is increasing at a rate of approximately 68 percent per year, while the number of graduates is increasing by a rate of only 8 percent,” said Dr. William Stagner, professor of pharmaceutical sciences and director of the Pharmaceutical Sciences Institute at Campbell University.

To help meet the demand, some schools have increased class size. In 2002, the University of North Carolina partnered with Elizabeth City State University to create a joint pharmacy program. Students in Elizabeth City attend classes via video conferencing and a few days a month the instructor teaches in person. The program allowed UNC to increase its class size from 120 to 145.

In 2003, Wingate University opened its school of pharmacy with 61 students. Today, there are 70 students in the program.

The number of pharmacy schools nationwide swelled to 92 in 2005 and this year is expected to reach 100. Three of those schools are in North Carolina.

Help wanted

Some experts say that increasing class size isn’t going to ease the immediate burden pharmacists are feeling in their jobs.

Calhoun and Stagner say increasing pharmacy technician duties might be an option.

Last year, there were more than 140,000 certified technicians in the country, according to the Pharmacy Technician Certification Board. Of that, more than 5,000 work in North Carolina.

“When you don’t have enough technicians, that’s how you get into two, three, four hour waits,” Calhoun said.

They perform administrative duties, which reduces the pharmacist’s workload, which means he can spend more time counseling customers.

Cape Fear Discount Drugs has four technicians and four cashiers who help fill about 3,000 prescriptions under three pharmacists’ watch.

Stagner says the druggist shortage breeds other problems, such as a lack of scientists and professors.

About 20 percent of pharmacy professors leave their careers to pursue positions in retail, hospital or clinical pharmacy, which often pay better wages, or leave for jobs in the industry, Stagner said.

The average pharmacist in America earned $96,537 in 2004, according to a survey by Drug Topics magazine. Pharmacists who worked in discount/mass-merchandising stores brought in $93,442, and independent pharmacists made about $9,000 less.

Stagner doesn’t have a solution to retaining staff or enticing students to choose academia over retail pharmacy. But he does know that an aging faculty and shortage of community pharmacists doesn’t help.

“Education is key to solving these shortages. The U.S. faces a serious and long-term faculty shortage when 37 percent of the pharmacy school faculty is the age of 50 or older and 24 percent of the deans are 60 or over,” Stagner said. “Forty percent of the faculty vacancies go unfilled for six months to two years.”

If more schools followed UNC and Elizabeth City’s lead and share resources, that might help the schools grow and turn out more pharmacists.

Another answer may be hiring industrial professionals like Campbell did with Stagner. He worked in product development for more than 25 years and has taught at Campbell for the last two years.

Whatever the answer, Calhoun and Stagner say the problem isn’t disappearing anytime soon.

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Insurers Back Free Electronic Prescriptions

January 16, 2007 - Washington - A coalition of insurers, technology companies and health care organizations is working to provide free electronic prescribing to every physician in America.

The National ePrescribing Patient Safety Initiative (NEPSI) is the first nationwide effort to prevent medication errors that kill 7,000 and injure 1.5 million each year, according to the Institute of Medicine (IOM) of the National Academy of Sciences. IOM has called on all physicians to adopt electronic prescribing by 2010.

"Electronic prescribing is clearly a tool that can dramatically reduce errors and improve patient safety," says Nancy W. Dickey, president of the Health Science Center, vice chancellor for health affairs at the Texas A&M University System and former president of the American Medical Association.

"Yet despite the many benefits of electronic prescribing, physician adoption is still modest,” says Dickey. “The situation calls for a solution that will overcome the barriers many physicians face in adopting this life-saving technology."

The challenge is that fewer than 1 in 5 of the nation's physicians process prescriptions electronically, according to the eHealth Initiative, a Washing-based group uses information technology to improve health care. Studies indicate that many have been deterred by the costs or by fears that the technology requires too much time to learn and install, the organization says.

NEPSI plans to help eliminate those barriers by providing simple, safe and secure electronic prescribing at no cost, advocates say.

A key element of the NEPSI initiative is participation by two of the nation's largest health benefits companies, Aetna and WellPoint, as well as influential regional payers such as Horizon Blue Cross Blue Shield of New Jersey.

The coalition's health benefits sponsors will provide incentives to physicians in their networks to encourage use of electronic prescribing technology. Their view is that electronic prescribing adds quality and efficiency to the patient care process, backers say.

"WellPoint views electronic prescribing as an essential tool in providing high-quality, safe and cost-effective care to our members," says Charles Kennedy M.D., Wellpoint vice president of health information technology. "We are excited about the potential of the NEPSI program to improve care when executed by our network physicians."

NEPSI is led by Allscripts, the provider of clinical software, information and connectivity that physicians use to improve health care, and by national sponsor Dell Computers Inc.
Other technology companies sponsoring NEPSI are Cisco Systems Corp., Fujitsu Computers of America Inc., Google Inc., Microsoft Corp., Sprint Nextel Corp., SureScripts Inc. and Wolters Kluwer Health Inc.

"The National e-Prescribing Patient Safety Initiative brings together a diverse group of technology companies, payers and physicians who share a commitment to one remarkable idea -- that providing free electronic prescribing for every physician will ultimately reduce errors and improve care,” says Glen Tullman, chief executive officer of Allscripts.

Tullman also calls electronic prescriptions an “on-ramp to a complete electronic health record" that could help consumers manage their health care and would follow employees from one job to the next.
Kevin Rollins, president and chief executive officer of Dell, says “information technology holds great promise as a means to help upgrade our nation's healthcare system technology."

"We believe that consumers will be the biggest beneficiaries of this technology adoption by physicians, enabling real-time access to the most relevant patient information,” says Steve Shihadeh, general manager of sales, marketing and partners for Microsoft's Health Solutions Group.

Craig Barrett, Intel chairman, who recently announced an initiative with employers to provide a personal health record system for employees, says: "Paper prescriptions are a key cause of cost, errors and inefficiency in U.S. health care. Which other industry could tell their customers it was OK to have a 15% imagine the airlines landing at the wrong destination 15 percent of the time.”

Electronic prescribing should be the rule not the exception, says Barrett. Electronic prescriptions, he adds, could provide timely and accurate information to employees through direct feeds to the Dossia lifelong health record. Dossia was announced in December by five big employers backing the project--Applied Materials, BP America, Intel Corp., Pitney Bowes and Wal-Mart.

NEPSI also includes more than a dozen academic medical centers, groups representing thousands of physicians across the country and integrated delivery networks Those organizations will serve as regional supporters of NEPSI, leading the delivery and support of electronic prescribing to physicians in their states and regions by providing education, training, incentives and local physician support.

Healthcare providers serving as regional supporters of NEPSI include Advocate Health Partners, Mount Prospect, IL; Brown & Toland Medical Group, San Francisco; Delta Health Alliance of the University of Mississippi Medical Center at Stoneville; George Washington University Medical Faculty Associates, Washington; Healthcare Partners Medical Group, Torrance, Calif.; Holston Medical Group, Kingsport, Tenn.; Louisiana State University Health Network, New Orleans; MaineGeneral Health, Augusta, Maine; Novant Health, Winston-Salem, N.C.; Sierra Health Services and Southwest Medical Associates, Las Vegas; University of Massachusetts Memorial Healthcare, Worcester, Mass.; and University of South Florida/USF Physicians Group, Tampa, Fla.

The backbone of NEPSI eRx NOW, Web-based software from Allscripts powered by the same engine used by more than 20,000 physicians to write millions of electronic prescriptions each year. Designed to appeal to physicians in solo practice or small groups, eRx NOW is available free to any healthcare provider with legal authority to prescribe medications, and requires no download, no new hardware and minimal training.

The product generates secure electronic prescriptions that can be sent computer-to-computer or via electronic fax to 55,000 retail pharmacies--more than 95% of all U.S. pharmacies. All prescriptions are checked for potentially harmful interactions with a patient's other medications, using a real-time complete medication database provided by Wolters Kluwer Health, as well as real-time notification of insurance formulary status from payers, plans and pharmacy benefit managers.

The product also allows physicians use a custom search engine from Google to search for health-related information. The NEPSI Custom Search Engine was created for medical professionals and when used with eRx NOW can obtain search results tailored for the medical community.
eRx NOW offers physicians and patients the highest security available, with redundant layers of firewall, deep-packet inspection, SSL encryption, database encryption, intrusion detection, and virus, spyware and malware protection for the program's remote servers.

To ensure privacy, all patient information is stored on remote servers in a secure location, so information cannot be compromised even if a physician's computer or phone is stolen.
Similar programs have succeeded regionally, proponents say. Blue Cross Blue Shield of Michigan, for example, has worked since early 2005 with General Motors Corp., The Ford Motor Co. and DaimlerChrysler Corp. on the Southeast Michigan e-Prescribing Initiative (SEMI).

Detroit-based Blue Cross, which provides or administers health care benefits to more than 4.7 million members , also worked on the plan with Detroit-based Henry Ford Medical Group, Health Alliance Plan (HAP) and pharmacy benefit manager Medco Health Solutions Inc.

BCBS of Michigan reported last year that more than 1,400 physicians had joined SEMI. Preliminary results showed improvements in generic drug prescribing rates and formulary compliance, as well as reductions in adverse drug events due to prescribing errors.

After writing a million e-prescriptions, more than 98,000 prescriptions were changed or cancelled because of drug-to-drug interaction alerts, and more than 63,000 prescriptions were changed or canceled because of formulary alerts, which increased the use of generic drugs.

Source: National ePrescribing Patient Safety Initiative

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Is your pharmacy providing 24/7 coverage?

Nov 20, 2006

By: Anthony Vecchione

Health-System Edition

At most large tertiary care hospitals and academic medical centers, around-the-clock pharmacy service is relatively common. But in some small and rural hospitals, 24-hour, seven-day-a-week pharmacy coverage is not economically feasible or practical. How are pharmacy services provided in those facilities? And how do health-system pharmacists feel about a Joint Commission on Accreditation of Healthcare Organizations proposal that would require all hospital pharmacies to provide 24/7 service?

Drug Topics commissioned a survey to understand how hospitals provide comprehensive pharmacy services off-hours and on weekends.

Here's a summary of the findings.

In response to the question, Does your hospital provide 24/7 pharmacy service? 64.3% of respondents answered in the affirmative.

Of those respondents who said their hospital has 24/7 pharmacy service, an overwhelming 87.9% indicated that their hospital had its own pharmacists on site 24 hours per day, while 6.4% reported that they used a pharmacist in a remote location to review drug orders during off hours. Only 5.7% of the respondents said that pharmacy services are provided by "other" means, but they did not elaborate.

According to pharmacists who do not have 24-hour pharmacy service, 93.8% stated that they use automated dispensing cabinets in the off hours, while 6.3% said that their hospital uses a locked cabinet with medications.

Of those respondents who do not have 24/7 pharmacy service, 88.4% said that their hospital has no plans to implement a 24/7 service next year, but 11.6% said that they intend to initiate such a plan.

When asked to rate their satisfaction with their pharmacy department's current 24/7 service, 27.7% of the respondents who have such pharmacy coverage said that they were extremely satisfied, 39.8% were very satisfied, and 29.5% were satisfied. Only 2.7% said that they are not satisfied with their current service and a mere .3% said that were not at all satisfied.

Some respondents explained why they are dissatisfied with their department's current 24/7 status. Here's what one had to say: "Only one pharmacist is on duty, what happens if he or she gets really busy or stuck in the ER? There's no one to call to cover." Another R.Ph. said, "We don't adequately staff the graveyard shifts. We don't have a plan in place for when demands exceed resources."

Thirty-two percent of the respondents said that their pharmacy operated on day and evening shifts but was closed overnight, while 10.5% reported that the pharmacy operated only from Monday through Friday but was closed on weekends.

Of the respondents who said that their hospital does not offer 24/7 pharmacy coverage, 35.6% reported that hospital staff members are allowed to access medications when the pharmacy is closed. However, 64.4% said that the practice was prohibited.

Of those hospital staff members who are allowed to access medications after-hours, 73% are nurses, 4.9% physicians, 1.6% paramedics, and 19.7% fell into the "other" category. Forty-two percent of respondents who reported that hospital staff members are allowed to access medications after-hours said that they can do so by using an automated dispensing machine outside of the pharmacy. Only 4.8% said that no arrangement has been set up for nonpharmacist personnel to access meds when the pharmacy is closed.

JCAHO oversight

When asked the question, Should JCAHO require all hospital pharmacies to provide 24/7 service? only 39% of respondents believe that JCAHO should require all hospital pharmacies to provide such service. Sixty-one percent disagreed with that premise.

The top two reasons why respondents believe that JCAHO should require hospital pharmacies to provide 24/7 coverage are the following: it will improve patient safety (33%) and patients will receive better care if a pharmacist reviews their drug regimen (26.7%).

Twenty-five percent of the respondents said that JCAHO-mandated 24/7 pharmacy coverage would improve the quality of the clinical care and operational aspects of the pharmacy service, while 12.2% said pharmacists would help reduce drug costs. About 2.5% of the respondents cited "other" reasons why JCAHO should require all hospital pharmacies to provide 24/7 coverage.

One respondent said that requiring all hospital pharmacies to provide 24/7 service would "make for better rapport between physicians, nurses, and pharmacists." Another pharmacist commented: "Pharmacists are the clinical medical experts and should be utilized 24/7. That's the business we are in."

How does your pharmacy allow other hospital staff to access medications after-hours?

Of the respondents who do not believe JCAHO should require all hospitals to provide 24/7 service, 44% said they feel this way because many small and rural hospitals cannot afford to provide that level of service. Thirty-one percent cited the pharmacist shortage and the difficulty in securing adequate pharmacy staffing. "I do not believe that there is enough work to demand that the pharmacy remain open 24/7," said one respondent. "If it's a small operation, very few orders are written during the night; a pharmacist should be on call," stated another respondent.

State regulations

Respondents were asked whether their state currently had established rules related to telepharmacy. Only 17.7% of respondents reported that their state had such rules, 20.8% said that their state did not, while 61.5% didn't know.

Almost 74% of participants who reported that their state had rules related to telepharmacy believe that those rules are a benefit because they establish parameters for telepharmacy to occur. In contrast, 10% said that those rules create a risk of displacing on-site pharmacists, while 4.3% said that the rules are too restrictive. Just over 11% expressed "other" opinions.

Respondents' satisfaction with their pharmacy department's current 24/7 service

Of the 20.8% of pharmacists who stated that no rules are established in their state regarding telepharmacy, 67.1% feel that their state board of pharmacy should enact rules that would allow for telepharmacy to take place.

In our survey, 40.6% of respondents think that telepharmacy services across state lines are an acceptable solution for extending night coverage. Here's what a few of these respondents had to say:

• "As long as the orders are being reviewed by a licensed pharmacist, I don't think it matters what state they are being reviewed in."
• "As long as the out-of-state pharmacist is aware of the different laws and able to make clinical decisions in providing patient care," telepharmacy across state lines is acceptable.
• "Health care is health care. What does an imaginary line on a map have to do with it?"

Those opposed to telepharmacy made these comments:

• "A physical presence of a pharmacist within the facility is needed to provide continuity of care to all patients no matter what the time of day or night. Different state laws may be a factor that can hinder care, as could a lack of knowledge of the particular patients and his or her treatment."
• "An on-site pharmacist is needed to dispense medication and respond to codes."

"An off-site pharmacist, especially in another state, cannot possibly handle pharmacy issues in another hospital, except to answer general questions."

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Viewpoint: Pharmacy and telehealth: Perfect together

Dec 11, 2006

By: Sheldon Prial, R.Ph.

Drug Topics

Every day we read about the many pressures retail pharmacists face: Medicare Parts A, B, D—all affect the industry. Major discounters offering lowball drug prices as "loss leaders" to build their sales are truly frightening.

In the midst of these dark clouds, I have found an exciting opportunity for pharmacists to bring a new service to their patients with chronic illnesses. It is called home telehealth.

To understand what this is, one has to refer back to the first successful launching of astronauts into outer space. NASA needed a means of checking the vital signs of the astronauts as they traveled around the earth. What was developed has blossomed into home telehealth.

Sheldon Prial, R.Ph.

This gives physicians, healthcare professionals, and family caregivers the capability to monitor patients without having to make a call in person or bringing them to an office. They can obtain all the vital signs they need almost instantly via home telehealth. Weight, blood pressure, glucose level, pulse rate, and cardiac monitoring are some of the vitals the practitioners need to maintain their patients' health.

How simple this is can best be described as follows: The patient steps onto a scale and then utilizes a pulse oximeter, spirometer, blood pressure cuff, glucose meter, or any other equipment required. All these vital signs are immediately reported to the nurse or physician. The recipient can then make a hard copy or transfer the information to the patient's record via his computer.

If there are any significant changes, the physician or nurse can follow up to determine what's happening with the patient. If the patient's weight has jumped, the clinician might find that the patient went out for dinner the previous night and there is no problem. If the patient's blood sugar or pressure rises, the health professional can ask and determine whether a personal call must be made. It's been reported that emergency room visits have been reduced by as much as 80% when a home telehealth unit monitors the patient. The need for a patient to be hospitalized has been reduced dramatically via this technique.

So how does the local pharmacy fit into this program? Right in the middle; that's how! Active community pharmacies have staff with the necessary knowledge to make this a success. They must prove to manufacturers of home telehealth equipment what they know, whom they know, and how they will be able to become local distributors.

Pharmacies should begin by identifying all of their bedridden or house-bound clients and then listing those with congestive heart failure, asthma, the ostomates, chronic obstructive pulmonary disease, and other debilitating illnesses.

Now the names of the physicians and therapists these patients use and the Visiting Nurse Association or home health agency taking care of them should be added to the list. Be sure it includes the name of the family caregiver. As an old pharmacist, I can look back to my days behind the counter. My partner and I knew all of our patients by their first name; we were a friend of the family caregiver and the practitioner. Yes, retail pharmacists are in the center of the activity, and in that position, they will be able to best provide this service.

Armed with this information, pharmacies should contact companies that provide telehealth equipment. Show them how many people the pharmacy services. Introduce them to the staff. Your pharmacy is a valuable asset to these companies.

Communicate with all of the resources identified, from the patient to the therapists, and miss none. One member of your team should be trained to be the "outside" salesperson, carrying the message to the potential referral sources. The manufacturer you arrange with to become its distributor will provide your team with the necessary knowledge to successfully market its equipment.

Nothing will happen unless you roll up your sleeves and work to get a piece of what is predicted to be a $2 billion-plus market. I believe that pharmacists can be very effective in building this new discipline.

For the pharmacist, this will be a cash business, since you will either be selling the equipment or leasing it. I prefer leasing and providing a maintenance contract. Of course, these are all cash sales.

So what have you got to lose—seize this opportunity before it slips away from you!

THE AUTHOR is a healthcare consultant based in Melbourne, Fla. He can be reached at shelly.prial@att.net


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Pharmacists fill new role in ERs

By Elise Kleeman, Staff Writer Whittier Daily News

PASADENA - To say that practicing emergency medicine is challenging is an understatement. Patients arrive with an endless range of ailments and often without a known medical history. With every moment counting, doctors must distribute medications quickly and accurately, regardless of the stressful atmosphere, lack of written prescriptions or pharmacist oversight. It's no wonder, then, that emergency departments see the highest number of preventable medication errors in hospitals, according to the National Center of Health Statistics. Around the country, though, emphasis on emergency patient safety is growing. Toward that end, some hospitals are beginning to hire specialized pharmacists to assist the doctors and nurses in the ER. "It's now, in my opinion, really going to become the next frontier for practicing pharmacy medicine," said Daniel Hays, a clinical pharmacy specialist in emergency medicine at the University of Rochester Medical Center. Among the small but growing handful of trauma centers to adopt this approach in recent years is Huntington Hospital in Pasadena. There, Jill Hara, a 28-year-old pharmacist and Monterey Park native, has been working in the emergency department for a year and a half, after petitioning to create the position. "I can add that extra element, that extra health care mind," she said. Hara's job is a mix of treating patients, educating the doctors and nurses she works with and reorganizing the way drugs are distributed to make the process safer and more efficient. Some changes have been as simple as requiring pharmacists to sign off on the use of any high-alert medications - ones that are more likely to cause harm if misused. But the impact has been notable, statistics indicate. Among the hospital's pediatric emergency department patients, there was a 50 percent reduction in miscalculation or misdosing - from 22 errors during the six months before Hara's arrival to nine during a corresponding period afterward. Though medication errors actually harm patients only 5 percent of the time, according to a study by U.S. Pharmacopeia, the standards-setting authority for all medicines, they can keep treatment from being its most effective. "There is a lot of evidence in the literature to support (the idea) that with a pharmacist involved in patient care, the safety is improved and the effectiveness of the medication is also improved," said Jean Pallares, Huntington's director of pharmacy. "I'm sure the time to medication is shorter," Hara said. "We've made many medications more accessible so they can be started quicker - that may mean shorter stays in the hospital." But despite the potential benefits of having a dedicated emergency-room pharmacist, they only exist in between 1 and 3 percent of hospitals nationwide, Hays said. "The problem that we're facing, particularly in California because of limited financing, is that it's hard to do all (suggested safety improvements) at the same time," said Kent Martyn, the director of pharmacy for Citrus Valley Medical Center, which has branches in Covina and West Covina. "You've got to kind of pick your battles." At Citrus Valley, funding has been directed not toward an additional pharmacist but toward a computerized system that can double-check a physician's prescriptions for drug interactions and allergies. "Everybody's out there trying to approach this safety issue and best-outcome issue the best that they can, and everybody's sort of picking at it from different angles," Martyn said. Aside from funding problems, another major hurdle is a severe shortage of the specially trained pharmacists. An emergency department pharmacist position at Los Angeles County Hospital has been open for a year and a half, Hara said, because of a lack of the specially trained applicants. There are only two accredited residency programs for emergency department pharmacists, in Rochester and Detroit, and one more unaccredited program at Rutgers, Hays said. Each program usually trains one pharmacist a year. Slowly, other programs are emerging. Huntington is among them, planning its own residency program for next year. Soon Hara, only recently out of school herself, will be passing on her knowledge. elise.kleeman@sgvn.com (626) 578-6300, Ext. 4451

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