Joe Halfpap, PharmD, always knew he wanted to work directly with patients. He pursued a residency in emergency pharmacy immediately after pharmacy school and is now clinical pharmacist in emergency medicine at University of Wisconsin Hospitals and Clinics in Madison.
But it was an experience during his emergency department rotation in the second year of his pharmacy residency that proved his career choice was right. He saw a cardiac patient’s response to a half-milligram of epinephrine, an inappropriate dose for the patient.
“I walked into that room and saw what looked like a person strapped to a rocket ship going into outer space. He was literally yelling ‘Whoa!’ and his eyes were about the size of saucers,” says Halfpap. The patient’s blood pressure had gone from 80 systolic to 190 systolic in a couple seconds, he adds.
“This was a very sick cardiology patient, one who had overdosed on a beta blocker,” says Halfpap. A nurse had administered the medication under the direct instruction of a cardiology fellow who was at the bedside, he recalls. The patient experienced significantly elevated blood pressure and heart rate for approximately an hour, but ultimately recovered, and Halfpap believes he experienced no long-term ill effects.
Looking back, he says, “I should have been in the room. I could have potentially prevented that.”
Value in Emergency Pharmacy
Emergency departments (EDs) have become a primary-care destination for patients, and they are ordering more medications regularly. “Emergency departments are becoming much, much larger, and we’re providing a lot more care in them than we ever have before,” Halfpap says. Because of this change, it’s essential to have a pharmacist in the ED to consult on the appropriate care of patients, and for medication review and recommendations. The response among physicians and nurses is typically favorable, as they tend to feel more at ease with a pharmacist present, he says.
“They feel more comfortable having a pharmacist in the emergency department because we’re there to answer a lot of their questions,” he says. “If you’re the physician, you can cognitively kind of offload a lot of the medication decisions because you know you can have the pharmacist [involved] in these more complicated, more complex decision-making processes.”
Halfpap has worked in the ED at University of Wisconsin Hospitals and Clinics, which has 24-hour pharmacist coverage, for 12 years.
Effective communication among team members is essential because members of the care team might be focusing on a variety of tasks at once or in different locations. For example, the attending physician might be calling in by phone from home, while the nurse might be managing multiple patients.
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