Pharmacists as members of an interdisciplinary pulmonary embolism response team

Introduction Pulmonary embolism response teams (PERTs) were developed to assist with diagnosis, risk stratification, and management of intermediate and high‐risk pulmonary embolism (PE) and have been shown to reduce 90‐day mortality. The pharmacist's role on the PERT is not well defined. Objectives Describe the pharmacist's role as a PERT member and determine if pharmacists can improve time to anticoagulation and promote use of low molecular weight heparin (LMWH) instead of unfractionated heparin (UFH). Methods A retrospective, observational study of adult patients with massive or submassive PE between January 2014 and May 2020. Patient demographics, clinical variables, anticoagulation treatment/timing, and pharmacist activities during PERT response were evaluated. Patients were divided into three groups for comparisons (pre‐PERT vs post‐PERT with a pharmacist vs post‐PERT without a pharmacist). Wilcoxon rank‐sum or Kruskal‐Wallis test and chi‐squared analysis were used for continuous and categorical data, respectively. Results A total of 573 patients were included (mean age 63.2 ± 15.6 years, 54% male, 78% submassive PE); 137 in the pre‐PERT and 436 in the post‐PERT groups. Within the post‐PERT group, 305 patients (70%) had a pharmacist as a member of the PERT, of which 222 (73%) had a documented pharmacotherapy‐related intervention/activity. Most (n = 178, 58%) involved a pharmacist facilitating ordering/administration of an anticoagulant/thrombolytic. Median time from diagnosis to anticoagulation was significantly reduced in the post‐PERT groups (pre‐PERT: 104 minutes [IQR 124.5], post‐PERT with a pharmacist: 63 minutes [IQR 84], post‐PERT without a pharmacist: 75.5 minutes [IQR 113], P = .0001). More patients in the post‐PERT groups received LMWH compared to UFH when a pharmacist was involved vs without a pharmacist (69.5% vs 53.3%, P = .0019) and major bleeding events were reduced (pre‐PERT: 14.6%, post‐PERT with a pharmacist: 4.6%, and post‐PERT without a pharmacist: 9.9%, P = .0013) Conclusion Pharmacists have an active role on the PERT and their involvement was associated with a shorter diagnosis to anticoagulation time, increased LMWH use, and fewer major bleeding events.