Pharmacology in Emergency MedicineImpact of Clinical Pharmacists on Initiation of Postintubation Analgesia in the Emergency Department

BackgroundPain and anxiety are common in mechanically ventilated patients, and frequently undertreated in the emergency department (ED) setting.ObjectiveWe sought to compare the rate of initiation of postintubation analgesia in the ED before and after intervention by pharmacists specialized in emergency medicine.MethodsThis was a retrospective cohort study of patients who underwent rapid sequence intubation (RSI) in the ED. The primary endpoint was overall frequency of analgesia initiation, with subset analysis of RSI during the ED pharmacist (EDP) duty hours. Secondary endpoints included frequency of sedative or anxiolytic use without analgesia, time to initiation of postintubation analgesia, and adverse drug events (ADEs) resulting in analgesia discontinuation.ResultsForty-one patients were included in each group. The overall rate of postintubation analgesia increased after pharmacist intervention, from 20% to 49% (p = 0.005). Analgesia initiation during EDP hours was 50% and 85% in the pre- and postintervention groups, respectively. In the preintervention group, more patients received sedation without analgesia (73% vs. 51%; p = 0.04), and a small percentage (7%) received neither sedation nor analgesia. Time to initiation of postintubation analgesia decreased from 98 min to 45 min. ADEs were rare: there were no discontinuations of analgesic therapy in the preintervention group and one temporary discontinuation because of hypotension in the postintervention group.ConclusionAnalgesic use after RSI in the ED significantly increased after the implementation of ED pharmacy services. The large proportion of patients receiving analgesia during the EDP duty hours suggest the increase may be related to direct pharmacist involvement in postintubation management.