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tation of the Institute for decrease in medication errors and adverse events.1,2
Healthcare Improve- As part of this evolution, pharmacists are also being
ment’s 5 Million Lives included in rapid response teams.
Campaign interventions
depends on a multidisci- Emerging model
plinary approach and Composition of the rapid response team varies based
support from hospital on available resources in the hospital. This team typi-
leadership. Each suggest- cally has some combination of a critical care nurse, res-
ed intervention for pro- piratory therapist, hospitalist, physician assistant, and
tecting patients from incidents of medical harm resident or fellow. Some teams may consist of only a
shouldn’t be considered in isolation; components of single critical care nurse.
each intervention may be improved by work in anoth- An emerging model includes pharmacists. Research
er area. demonstrates a reduction in mortality when pharma-
Medication reconciliation is one of the most com- cists are involved on code teams.3 In this role, pharma-
mon healthcare interventions to prevent adverse drug cists determine appropriate and safe medication dos-
events and harm, and to some extent medications play ing and prepare medications for administration. An
a role in almost all of the Campaign’s interventions. extension of this program is the participation of phar-
For example, the protocols developed for administra- macists in rapid response teams.
tion of insulin, a high-alert medication, should be The goal of the team is to bring critical care exper-
linked to the work of the team that’s focused on tise to the patient bedside (or wherever it’s needed),
glycemic control—likewise protocols for anticoagula- particularly for patients at risk for cardiac or respirato-
tion management should be linked to deep vein ry arrest—two high-mortality conditions. There are
thrombosis prophylaxis, opioid therapy, and under- often observable signs of patient deterioration, and
standing patient deterioration. early recognition and prompt treatment can reduce
Pharmacists can play a key role in ensuring reliable death rates in hospitalized patients. The team can be
medication management processes. Their role contin- called on to respond at the first sign of trouble. Data
ues to evolve. Responsibilities have traditionally from several studies indicate an improvement in mor-
included review of medication orders and drug distri- bidity and mortality when rapid response teams are
bution. Over time, pharmacists have become an inte- implemented.4-6
gral part of the healthcare team by being available to As team members, pharmacists contribute by deter-
answer staff questions while in patient care units, par- mining appropriate medication dosing, making needed
ticipating in treatment decisions as part of multidisci- medications available, and helping to determine if
plinary rounds, and leading medication safety initia- medications contributed to patient deterioration. While
6 Pharmacy Solutions, November 2008 www.nursingmanagement.com
the team focuses on stabilizing the patient, the pharma- may leave the team to continue stabilizing the patient
cist reviews the medication administration record to unless the problem is medication related.
identify any potential medication-related causes. As with many improvement programs, implement-
To expedite medication administration during a ing a rapid response team uncovers other systems
team response, pharmacists can rapidly review orders defects. The evaluation of a deteriorating patient’s
and ensure appropriate preparation. In some situa- medication treatment regimen may reveal instances
tions, needed medications aren’t found in the unit. In where inappropriate medication use or dosing may be
these instances, the pharmacist can quickly acquisition contributing to the patient’s condition. For example,
these medications from pharmacy supplies. Robert Wood Johnson University Hospital Hamilton in
New Jersey added a clinical pharmacist (PharmD) to
Cases in point the rapid response team after the hospital identified a
At Long Beach Memorial and Children’s Hospital in repeated use of naloxone with team calls. After review-
California, pharmacists are an integral part of the rapid ing its opioid administration policy, the hospital staff
response team. The team relies on the pharmacist’s determined a need to develop a dosing and monitor-
familiarity with dosing and medications, especially for ing protocol.
patients with conditions such as hypertension and In pediatric situations, pharmacists are particularly
arrhythmias. Pharmacists identify and recommend important in ensuring appropriate medication dosing
doses of reversal agents for patients experiencing res- and preparation. Many of the commercially available
piratory depression due to oversedation. After the medications used aren’t available in pediatric dosage
patient’s medication needs are met, the pharmacist forms and concentrations. A pharmacist on the team can