The application of explicit criteria to identify accident and emergency patients suitable for management solely by a pharmacist

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The Pharmaceutical Journal
Vol 279 No 7461 p73-76
21 July 2007

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Original papers

The application of explicit criteria to identify accident and emergency patients suitable for management solely by a pharmacist

By Sana Ahmed, Ursula Collignon and C. Alice Oborne

Sana Ahmed was a fourth year undergraduate at the School of Pharmacy University of London.

Ursula Collignon, BPharm, MRPharmS, is senior pharmacist, emergency medicine, and C. Alice Oborne, PhD, MRPharmS, is principal pharmacist, medicines use research, at Guy’s and St Thomas’ NHS Foundation Trust.

Correspondence to:
Ms Collignon at Pharmacy Department, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH
e-mail ursula.collignon@gstt.nhs.uk

Abstract

Aim
To determine the proportion of patients attending an accident and emergency (A&E) department who are suitable for management by a pharmacist.

Design
A cross-sectional, retrospective review of patient notes, testing criteria defined from the literature.

Subjects and setting
Adult patients attending an inner London teaching hospital A&E department during a two-week period between March and April 2006.

Outcome measures
The proportion of adult patients attending A&E who can be assessed and treated by a pharmacist.

Results
4,503 patient notes were reviewed. Of these 218 patients (5%) were identified as suitable to be seen by pharmacists based on information documented in the initial nursing assessment. Final assessment of the full case notes identified 87 patients (2%) as suitable for management by a pharmacist.

The most common patient group identified by initial assessment was sore throat (44/218, 20%). However final assessment showed requests for medicines were the largest patient group (24/87, 28%). A specificity test result of 97% shows high levels of agreement between patients considered not appropriate for management by a pharmacist and those not identified by the tool.

However the positive predictive value of 40% indicates that screening based on initial assessment was less effective at picking up suitable patients.

Conclusion
A pharmacist could treat at least 2% of adults presenting at the study hospital A&E department. This excludes 3% of patients with minor ailments currently well managed by nurses in the study hospital.

A pharmacist working in this A&E department could treat an estimated 5,854 patients annually.

Incorporating a pharmacist within the team may alleviate the workload of emergency staff and could potentially reduce waiting times.