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Profile of a Pharmacy Innovator: Matt Hubble

Describe your current pharmacy position at Mercy West Lakes and what led you to pursue this career path.
I am the Clinical Pharmacy Specialist/Emergency Room Pharmacist for the Mercy West Lakes Medical Center in West Des Moines. I have been in this role since November of 2009. My roles include rounding in the ICU, managing pharmacy consults for the entire hospital, and training and assisting pharmacy staff in all clinical roles covered by pharmacists throughout the hospital. When taking on this position, I was asked to establish a pharmacy presence in the Emergency Room (ER).

The potential to start an ER practice was very exciting to me. I had researched this position several times and found that it provides a very unique environment for pharmacists. This is one of the few roles in our profession that provides a complete hands-on experience. If done right, a pharmacist can be a huge asset to patient care in this arena.

As an ER pharmacist I have been involved in many aspects of care. Activities I have been involved in include the following:

  • Medication administration including IV push, IV fluids and medications, oral medications, IM injections, and topical applications.
  • Assist with antibiotic culture follow-ups for patients discharged from the emergency department (ED).
  • Patient education related to discharge medications or currently administered medications.
  • Provide drug information as requested including dosing, administration, IV compatibility, and other recommendations.
  • Assist with all codes and rapid response situations; in this case, pharmacy tries to manage the drug cart and administer or provide medications as needed.
  • Monitor patients to make sure antibiotics are administered within guidelines for sepsis and pneumonia.

Overall, the pharmacist’s role is to be an extra pair of hands where needed and be a part of the ER team.

What obstacles have you had to overcome to establish yourself as a pharmacist in the emergency department?
The biggest challenge to this position was the extensive learning curve. In this environment, you are exposed to aspects of practice most pharmacists have never encountered. The largest obstacle was learning how to administer medications via intravenous (IV) and intramuscular (IM) routes. The IM route was easier for me, based on past experience with flu shots; however the IV route posed a need for me to learn a new skill. The ER nurses were very good about training me on the various IV lines and pumps used, priming of IV fluids, and use of needle-less systems. Being able to perform these tasks makes it possible for the nursing staff to do what they need to, especially in acute situations.

The other major challenge was trying to integrate myself into the ED. The ER staff had never included a pharmacist before, so nurses and physicians had to adjust to my presence as well. This took a few weeks, but quickly I was accepted as a member of the ER team. Over the past several months I have been utilized in all situations. It has proven to be a very rewarding career change for me.

What ongoing challenges do you continue to face?
The biggest challenge we face now is the ability to staff the ER for more hours and provide longer coverage. At my location we currently provide pharmacist coverage Monday through Friday from 8 am to 4:30pm. Staff has asked for more coverage, especially in the evening and on weekends. Unfortunately at this time we don’t have enough pharmacist staff to provide this. The success we have had at our location did allow us to get two pharmacists hired to cover evenings 7 days a week at the Mercy Main Medical Center, downtown. There seems to be a desire to expand this role so we have hopes of getting more staff to accommodate these requests.

How are you promoting change in the pharmacy profession?
Currently there are only about 42 institutions nationwide that have a pharmacist staffed in their ER department. By creating this presence we are hoping to continue to support this effort nationally. Literature has shown that pharmacist involvement in EDs has been very significant in preventing adverse events associated with medication errors. Also pharmacists have an ability to help meet core measures associated with sepsis and pneumonia. I think we will continue to see this role change more and more.

What is your professional goal?
I would like to continue to develop my skills in emergency medicine to be able to offer more and more as this role expands. I am currently working with hospital staff to become more a part of our CODE BLUE response teams as well as rapid response for respiratory cases. I am working with others to encourage this practice at our main hospital as well. It is an exciting and rewarding opportunity for pharmacists who are interested in this type of hands on practice.

What advice do you have for others who would like to create a similar position at their institution?
I would encourage anyone with an interest in this area to shadow others who currently are in such positions. This is how I got started as well. From that you gain ideas and processes that can easily be implemented at your own site. I would also suggest pursuing training in ACLS, PALS, and other emergency based practices to gain the skills necessary to work in this environment. For those that start in the ER environment, I encourage you to “be in the way” as much as possible. Injecting yourself into every situation forces interaction with staff and greatly facilitates the learning process associated with IV’s, pumps, and medication administration. Hands on training with ER staff helps build a relationship and trust with the staff as well, making the transition into this position even easier.