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Pharmacist Presence Reduces Time to Emergency 4F-PCC Administration

August 28, 2019

A pharmacist at the bedside significantly shortened the time to administration of four-factor prothrombin complex concentrate (4F-PCC) for life-threatening bleeding or urgent procedures in the emergency department, according to a study published online in The Journal of Emergency Medicine. 

“Reversal of anticoagulation with 4F-PCC is critical, yet the optimal timing to 4F-PCC administration and whether quicker administration improves hemostasis remains unknown,” wrote researchers, who conducted their retrospective cohort study to determine how the presence of a pharmacist affected 4F-PCC administration time. 

The study included 116 patients who received emergency 4F-PCC between 2014 and 2018. Fifty patients had a pharmacist present, and 66 patients had physicians alone. Some 68.1% of patients presented on warfarin. Intracranial hemorrhage was the most common life-threatening bleed.

“A pharmacist at the bedside of patients who present to the emergency department with life-threatening bleeding or need for emergent procedure decreased time to 4F-PCC administration by 140 minutes,” researchers reported, “even after accounting for confounders.”

Specifically, the median time to 4F-PCC administration among patients with physician-only teams was 206.5 minutes. Patients with a pharmacist at the bedside, however, had a median 4F-PCC administration time of just 66.5 minutes.

Pharmacist presence in the emergency department also significantly shortened length of stay in both the hospital and intensive care unit among patients in the study, researchers reported.  

Compared with 5 days in intensive care for patients seen by physicians alone in the emergency department, patients with a pharmacist in the emergency department averaged 2 days in intensive care. Overall hospital length of stay was 8 days for patients who received physician-only emergency care compared with 5.5 days for patients who had a pharmacist present. 

Jolynn Tumolo


Masic D, Hidalgo DC, Kuhrau S, Chaney W, Rech MA. Pharmacist presence decreases time to prothrombin complex concentrate in emergency department patients with life-threatening bleeding and urgent procedures [published online ahead of print August 22, 2019]. J Emerg Med. doi: 10.1016/j.jemermed.2019.06.027

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