The Role of the Clinical Pharmacist in Caring for Trauma Patients
Creators: name: Gessner, Brooke
name: Gorman, Sean
name: Kelly, Jarred
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Medicine and Health Sciences
subject: #trauma #pharmacist #clinicalpharmacist #traumatology #resuscitation

description: The role of a clinical pharmacist embraces the philosophy of pharmaceutical care, which is a patient-centred practice in which the practitioner assumes responsibility for a patient’s drug therapy needs. The practitioner is also committed and held accountable for identifying, resolving, and preventing drug therapy problems (DTPs). Drug therapy problems are actual or potential undesirable event(s) experienced by a patient which involve or are suspected to involve drug therapy and that interfere with achieving the desired goals of therapy. There are seven categories of DTPs which include: unnecessary drug, new drug required, suboptimal/ineffective drug/route, drug dose too high, drug dose too low, adverse drug event, and adherence concerns. Pharmacists must categorize these DTPs as actual or potential and resolve them on a priority basis. Clinical pharmacy is defined as “that area of pharmacy concerned with the science and practice of rational medication use”. Clinical pharmacists ensure rational medication for hospitalized patients by performing several daily activities. In general, the daily activities of the clinical pharmacist include doing best possible medication histories, medication reconciliation, bedside patient visits, attending patient care rounds, therapeutic drug monitoring, providing discharge medication counselling and acting as a direct resource to physicians, nurses, and other healthcare providers. More specifically, clinical pharmacists should perform high value actions proven to be associated with improved processes and outcomes of care. These high-value actions are reflected in a set of national clinical pharmacy key performance indicator (cpKPI) activities. A cpKPI is a quantifiable process measure of clinical pharmacist activities that are evidence-based and associated with improved patient and health-system outcomes. The measurement and reporting of cpKPIs can support pharmacists to target and prioritize the delivery of clinical pharmacy services in a resource limited setting. The eight Canadian consensus cpKPIs include medication reconciliation on admission, pharmaceutical care plan, resolution of drug therapy problems, active participation on interprofessional patient care rounds, patient education during hospital stay, patient education at discharge, medication reconciliation at discharge, and bundled patient care interventions. Numerous studies of differing methodologies and endpoints have been conducted to investigate the benefit of clinical pharmacists as essential members of the interdisciplinary team. For example, Bond et al., investigated the link between hospital-based clinical pharmacy services and hospital mortality rates and determined that the presence of clinical pharmacy services was associated with reduced mortality rates. Other studies have demonstrated that clinical pharmacists also reduce morbidity, re-admission rates and have a positive return of investment. The pharmacist’s recommendations regarding therapeutic decisions reduces the time it takes to get the appropriate medication to the patient, ultimately, improving patient care. The role of the clinical pharmacist is an essential one. Due to robust evidence supporting the benefit of clinical pharmacists they have become integral team members in many areas, including the emergency department (ED). The roles and responsibilities of the ED and ICU clinical pharmacist are well defined and serve as the standard of care in these areas. In contrast, there are no publications that comprehensively describe the role of clinical pharmacists integrated into trauma teams who provide care for trauma patients; referred to as trauma pharmacists. The American Society of Health System Pharmacists Guidelines for Emergency Medicine and the Society of Critical Care Medicine offer miniscule recommendations regarding the role of the clinical pharmacist. The American Society of Health System Pharmacists Guidelines for Emergency Medicine provide some reference to the pharmacist’s role in trauma resuscitation, pain control and advanced trauma life support training (ATLS); however, this is insufficient to characterize the optimal value of the holistic trauma clinical pharmacist who provides care along the continuum of acute care for patients who have experienced physical trauma. This lack of inclusivity leaves a perceptible gap in the literature and clinical care. The paucity of literature regarding the defined roles and responsibilities of clinical pharmacists who provide care to trauma patients may in part be due to the diverse and varying locations where they work. A pharmacist that is integrated into a trauma team or that provides care for trauma patients may work in the ED, ICU, or in more specific ward-based care settings such as orthopedic surgery, a burn unit, neurosurgery, or a rehabilitation unit, etc. Trauma pharmacists in these settings have many important, evidence-based interventions and activities to consider completing for a variety of problems including but not limited to ATLS, resuscitation, rapid sequence intubation (RSI), pain/analgesia, opioid stewardship, sedation/agitation, traumatic brain injury, seizure treatment/prophylaxis, tetanus prophylaxis, antibiotic prophylaxis, venous thromboembolism prophylaxis, splenectomy vaccinations, and massive hemorrhage, and hemorrhagic shock. We hypothesize that comprehensively describing the role and impact of trauma pharmacists, similar to work that has already been done for ED or ICU pharmacists, will improve pharmacy practice and patient outcomes. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted. The results suggest that promoting the professional development of the clinical pharmacist in caring for trauma patients has strengthened key steps in the trauma pathway and that a pharmacist’s presence on the trauma ward promotes confidence and evidence-based decision making among other members of the trauma team. This search also confirmed that no other review articles or guidelines exists for this topic. Of the fourteen established evidence review types we determined that a scoping review, following the Arksey and O’Malley’s, JBI, and PRISMA-ScR framework, is the most appropriate methodology for this work. According to the Canadian Institutes of Health Research, scoping reviews are “exploratory projects that systematically map the literature available on a topic, identifying key concepts, theories, sources of evidence, and gaps in research.” Scoping reviews can be particularly useful when the body of literature is complex and heterogenous – as anticipated with this work. Thus, completion of a scoping review would be the starting point for comprehensively describing the roles and responsibilities of the clinical pharmacists that provide care for trauma patients, here referred to as trauma pharmacists. This scoping review aims to identify, catalogue, and describe published research investigating the roles, responsibilities, and activities of a clinical pharmacist in the care of trauma patients along the continuum of acute care.