Engstrom, Kellyn

ABSTRACT Clinical pharmacists are increasingly recognized as vital contributors to acute stroke care, yet their role remains inconsistently defined and underutilized across health care systems. This consensus statement explores the expanding presence of clinical pharmacists within interdisciplinary stroke teams, particularly in the management of both acute ischemic stroke ( AIS ) and hemorrhagic stroke. This consensus statement panel was composed of clinical pharmacists, emergency medicine physicians, and a vascular neurologist. The Grading of Recommendations, Assessment, Development, and Evaluation ( GRADE ) approach was used to assess the level of certainty and strength of recommendations. We focused on two questions regarding the clinical pharmacist's role in caring for adult patients presenting to the emergency department ( ED ) with AIS or hemorrhagic stroke. Despite the very low level of evidence, a consensus was reached for the following recommendations: (1) clinical pharmacist involvement in AIS care for adult patients presenting to the ED and (2) clinical pharmacist involvement in hemorrhagic stroke care for adult patients presenting to the ED . Based on the available literature, we believe optimizing the clinical pharmacist role is a critical factor in improving time‐sensitive treatment and equity in care delivery.

ABSTRACT As emergency department (ED) crowding and patient boarding reach critical levels nationwide, the role of the emergency medicine pharmacist (EMP) must be both defined and safeguarded. While EMPs are increasingly valued for their contributions to acute care, their responsibilities often unintentionally expand during periods of operational strain, particularly when admitted patients remain in the ED for prolonged durations. EMPs should ideally be resourced to remain focused on time‐sensitive, high‐risk medication management where their expertise is most impactful and not be used as default providers for all pharmacotherapy needs during ED boarding. This perspective outlines our position on the ideal scope of EMP practice during times of congestion, advocating for clearly defined role boundaries, strategic collaboration with other pharmacy team members, and system‐level support to prevent dilution of emergency care. EMPs must be empowered to prioritize critical ED workflows, support resuscitations, and lead initiatives in education, protocol development, and patient safety, without being overextended by responsibilities that can be absorbed by other team members.

ABSTRACT Background Intracranial and extracranial hemorrhages are significant causes of morbidity and mortality. Emergency medicine pharmacists (EMPs) can play a crucial role in anticoagulation reversal by identifying patients on anticoagulation, selecting the optimal anticoagulation reversal agent, and ensuring adequate dosing and prompt administration. The goal of this systematic review and meta‐analysis was to determine the impact EMPs have on time to anticoagulation reversal and patient outcomes in anticoagulation‐associated hemorrhages. Methods A medical librarian performed a literature search in EBSCO CINAHL, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection from inception to January 2025 for all types of oral anticoagulants and for life‐threatening bleeding that required emergent reversal. Newcastle‐Ottawa was used to assess the risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the level of certainty of the evidence. Random effects models estimating mean differences and 95% confidence intervals are reported. Results There were 2445 titles and abstracts screened, with 44 undergoing full‐text evaluation. Six observational studies including 219 patients who received an anticoagulation reversal agent with the presence of an EMP and 198 patients who received a reversal agent without an EMP were included. Time from emergency department (ED) presentation to anticoagulation reversal agent administration (75.60 min, 95% confidence interval [CI]: −101.7 to −49.5) and time from medication order to administration were faster with an EMP (−18.7 min, 95% CI: −23.5 to −14.0). There was no difference in short‐term mortality. The included studies had a high risk of bias and were deemed very low quality of evidence. Conclusion EMP involvement in patient care during anticoagulation reversal of acute hemorrhages improved time to anticoagulation reversal agent administration. Larger scale, higher‐quality studies are necessary to assess the value of EMPs in improving patient‐centered outcomes.

ABSTRACT Transgender and gender diverse (TGD) individuals face minority stress and often avoid the emergency department (ED) due to previous negative experiences. The goal of this review is to prepare the emergency medicine pharmacist to care for TGD patients, with the ultimate goal of improving the care TGD patients receive. This review summarizes interactions with TGD patients, trauma‐informed considerations, physical exam and organ inventory sensitivities, and gender‐affirming hormone therapy and complications that may arise and be seen in the ED. Additionally, this review discusses common complaints and considerations that may commonly arise when caring for TGD patients.

AbstractBackgroundTransgender and gender‐diverse (TGD) patients experience challenges and disparities when seeking health care across a multitude of settings. Studies have demonstrated that TGD individuals experience bias when interacting with health care providers, including pharmacists in the community and hospital settings. Without proper training, pharmacists are less likely to be prepared to provide equitable and optimal patient care to TGD patients. This quality improvement initiative aimed to identify gaps in pharmacist knowledge and comfort with regard to TGD health care.MethodsA 29‐item reflective questionnaire was designed to collect information on pharmacist training and experiences in caring for TGD patients. The survey was distributed via email to all 490 pharmacists within a single health system and responses were collected from October 23, 2023 to November 3, 2023.ResultsA total of 116 pharmacists completed the survey, for a response rate of 24%. Although 77% of respondents reported caring for a TGD patient, only 21% reported receiving any formal education or training on TGD health care. While 83% of respondents agreed that formal education on TGD health care is important, and 90% indicated that education on gender‐affirming therapy is important, a majority of pharmacists disagreed that they were comfortable with making recommendations and providing counseling on gender‐affirming therapy. A majority of pharmacists were interested in formal education and engaging in departmental initiatives to improve TGD care.ConclusionsThere was a gap in confidence and education in caring for TGD patients among pharmacists practicing in a single academic institution. Pharmacists reported that more education is warranted to bridge current gaps in pharmacist comfort and TGD health care.

AbstractObjectiveTransgender and gender‐diverse (TGD) individuals have a gender identity or expression that differs from the sex assigned to them at birth. They are an underserved population who experience health care inequities. Our primary objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bisexual/queer (LGBQ) or heterosexual individuals presenting with abdominal pain to the emergency department (ED).MethodsRetrospective observational cohort study of patients ≥12 years of age presenting to 21 EDs within a health care system with a chief complaint of abdominal pain between 2018 and 2022. TGD patients were matched 1:1:1:1 to cisgender LGBQ women and men and cisgender heterosexual women and men, respectively. Propensity score matching covariates included age, ED site, mental health history, and gastrointestinal history. The primary outcome was pain assessment within 60 min of arrival. The secondary outcome was analgesics administered in the ED.ResultsWe identified 300 TGD patients, of whom 300 TGD patients were successfully matched for a total cohort of 1300 patients. The median (IQR) age was 25 (20–32) years and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 min of arrival (59.0% TGD vs. 63.2% non TGD, p = 0.19). There were no differences in the number of times pain was assessed (median [IQR] 2 [1–3] vs. 2 [1–4], p = 0.31) or the severity of pain between groups (5.5 [4–7] vs. 6 [4–7], p = 0.11). TGD patients were more likely to receive nonsteroidal anti‐inflammatory drugs (32.0% vs. 24.9%, p = 0.015) and less likely to receive opioids than non‐TGD patients (24.7% vs. 36.9%, p = <0.001). TGD and nonbinary patients, along with LGBQ cisgender women (24.7%) and heterosexual cisgender women (34%), were less likely to receive opioids than LGBQ cisgender men (54%) and heterosexual cisgender men (42.3%, p < 0.01).ConclusionThere was no difference in frequency of pain assessment, regardless of gender identity or sexual orientation. More cisgender men, compared to TGD and cisgender women, received opioids for their pain.