oa Implementation of on-call clinical pharmacy service in an emergency department during COVID 19: New initiative in Hamad General Hospital, Qatar

Background: Throughout COVID-19, complex therapeutics and medication protocols left clinicians overwhelmed by contradicting information leading to drug-related problems (DRPs) potentially leading to ineffective pharmacotherapy and drug-related morbidity and mortality^1,2. DRPs queries are time consuming, utilize numerous resources, and require skills and experience to provide accurate answers³. Quick answers are paramount in the Emergency Department (ED) especially during a pandemic period. Clinical pharmacists (CP) can identify and resolve DRPs but are only available in the ED during daytime hours. We set up an out-of-office CP service for ED DRPs. This study aimed to assess the capacity of the service to capture 100% of calls received and to measure the time taken to resolve DRP queries compared to the international standard³. Methods: A dedicated ED CP on-call phone line and rota until 10 pm daily was arranged by the Hamad General Hospital Pharmacy (Doha, Qatar). Data was documented in a logbook and within the Electronic Medical Records (EMR) and analysed using predefined parameters. Results: Between March-September 2020, 133 DRPs calls were received and resolved by a CP. 38% were related to drug interaction/safety (often about medications used in COVID-19 treatment protocols), adverse drug reactions, dose-adjustments, drug allergies and drug in pregnancy. 30% were about medication administration, such as infusion rates, titration, and intravenous compatibility. Those questions were mostly from nurses (Figure 1). Appropriate dose selection and appropriate indication represented 21% and 11% respectively (Figure 2). Caller's acceptance rate to responses provided by CP was 100%. Responses were documented in the patients’ EMR. The call-history-log showed an average duration of 4.66 minutes per call which is below the average standard of 15-30 minutes³. Conclusion: The availability of clinical pharmacists to provide quick, acceptable, responses to DRPs queries is crucial given the complexity and diversity of ED patients. During COVID-19, an on-call clinical pharmacy service has proven its capability to resolve DRPs and support the clinical decision-making process in a relatively short time.