This series highlights members of the GEDC community who are clinical champions for older adults in the emergency department.
Throughout her career as a pharmacist, Jennifer Esch, PharmD, MBA, BCPS, has worked in a variety of hospital settings from the ICU to the emergency department. Esch currently serves as a clinical pharmacist specialist at Aurora BayCare Medical Center Emergency Department in Green Bay, Wis.
Though many emergency departments do not have an in-house pharmacist, Esch’s ED has discovered how to effectively utilize her role to save time and money while improving patient outcomes.
Esch started in the emergency department during the COVID-19 pandemic when her hospital’s ED was overwhelmed with patients. She was placed in the ED for a two-week pilot period to determine whether or not having a full-time pharmacist there would be worth the financial investment.
“The longer I’ve been there, the more things they find that they can have me help with,” Esch said. “So I’ve now presented at staff meetings on topics like time-saving medication administration techniques we can do that have better outcomes for our patients.”
To make a case for her position, Esch had to record every task she did each day, including all the patient charts she reviewed. The ED team used this information to create a proposal that demonstrated the cost savings of Esch’s role, accounting for things like preventing hospital admissions.
“One of our pharmacy residents helped me put dollar figures on everything, and we submitted it to our board of directors,” Esch said. “They approved for us to have one pharmacist full-time down there.”
When Esch started in the ED full-time, one of the first projects she was asked to contribute to was the ED’s pursuit of Geriatric Emergency Department Accreditation. She served on the accreditation committee, and the ED achieved Level 3 and then Level 2 Accreditation. As part of the pursuit of Level 2 Accreditation, Esch was asked to write policies around medication management for older adult patients.
One of the most successful initiatives that Esch has contributed to is a medication review for every patient 65 and older who presents to the ED after a fall.
“We look at their medications and compare them against the Beers Criteria list of medications that are potentially inappropriate for older adults,” Esch said. “If we find anything, we write a note. We tell them what our findings are, and we send it to their primary care doctor as a follow-up to their emergency department visit.”
After completing these reviews for about a year-and-a-half, Esch and her pharmacy resident evaluated the data to determine whether or not Esch’s feedback was utilized by primary care physicians. They found that those physicians were adjusting patient medications approximately 30-percent of the time.
“That was a whole lot better than I expected,” Esch said.
In the ED, Esch also works with both pharmacy and medical residents and has helped write EMS policies. She said that being in the ED makes her more accessible to doctors and nurses who have medication questions or need her advice about patients.
Other facets of Esch’s role include writing information sheets on medications that might be unfamiliar for patients and talking to patients about their medications. For example, she speaks with all patients who start a new anticoagulant to review the risks and answer questions. She is also certified to administer medications to patients, which helps with workflow.
“I’ve trained a few other people on it now, so that we can do everything we can to try and help our patients and get people in and out faster,” Esch said.
When it comes to treating older adult patients, Esch enjoys the opportunity to sit with patients and answer questions like she does for members of her own family.
“Since I started pharmacy school, everyone in my family calls me up with questions,“ Esch said. “I don’t always stop and think that not everybody has someone like that. I really like being able to help people understand their medications.”
