The presence of pharmacists in an emergency department (ED) is no longer a theoretical benefit; it’s rapidly becoming a clinical imperative. Clinical pharmacist Charlotte D’haene and Dr Robert Leach, head of the ED at the Centre Hospitalier de Wallonie Picarde in Tournai, Belgium, explain to Saša Janković how pharmacy integration in the ED is being put into practice at their hospital, and the positive difference it’s making on the ground.
A growing body of research and expert opinion is supporting the permanent integration of pharmacy professionals within emergency department (ED) teams, where they play a vital role in optimising medicines use, preventing harm and improving patient outcomes.
A comprehensive review published in August 2023 underscored the transformative impact of ED pharmacy services, highlighting their contributions to medication reconciliation, timely medicines administration and antimicrobial stewardship.
More recently, in April 2025, the Royal College of Emergency Medicine (RCEM) championed the pharmacist’s role in managing time-critical medication, particularly in the high-pressure environment of emergency care where seconds matter and missteps can be life-threatening.
Physician support for the permanent integration of pharmacists into EDs has also been gaining traction. In March this year, a study in Norway showed that senior doctors overwhelmingly back their continued presence, citing enhanced interprofessional collaboration and reduced medication errors.
Dr Robert Leach, president of the European Society for Emergency Medicine and head of the ED at the Centre Hospitalier de Wallonie Picarde in Tournai, Belgium, echoes these sentiments. He firmly believes that having a clinical pharmacist embedded in the ED from the earliest stages of patient care improves both efficiency and safety.
‘Pharmacists are essential for tasks such as medication review, dose adaptation, checking for interactions and facilitating communication between departments,’ he explains. ‘And while some may assume doctors should know everything about medications, the pharmacist provides valuable real-time support and an opportunity for collaborative exchange, especially in time-critical or complex cases.’
First in class
Charlotte D’haene is the first clinical pharmacist to be permanently embedded within Centre Hospitalier de Wallonie Picarde’s ED.
After completing five years of pharmacy training followed by a three-year specialisation in hospital pharmacy, she dedicated her final year and thesis to exploring the value a pharmacist could bring to emergency care – and it was that work, supported by Dr Leach, which led directly to the creation of her current role in 2021.
Bringing a collaborative, patient-focused approach to her work, Charlotte works closely with emergency physicians to carry out medication reviews, optimise prescribing, manage substitutions and ensure continuity of care. She also provides direct counselling to patients and liaises with both community pharmacists and inpatient wards.
Uncommon service in the ED
The Centre Hospitalier de Wallonie Picarde is one of very few hospitals in the country to have a clinical pharmacist permanently working in the ED. ‘Most clinical pharmacists in the country still work primarily in geriatrics, where polypharmacy is a major concern. It’s certainly something that is not systematic,’ says Dr Leach.
Indeed, this level of service provision is much less common and less established across many European countries, with the exception of the UK where pharmacists working in EDs is considered the norm in many areas.
In fact, in March 2024, David Webb, chief pharmaceutical officer for England, told members of parliament that approximately 45% of hospital EDs in the UK have a clinical pharmacy service – based on responses from NHS Trusts to a national benchmarking exercise.
Dr Leach believes there are a number of challenges such as cost and staffing issues that limit wider adoption of this model across Europe. ‘The role of the clinical pharmacist is not one that can be billed for,’ he explains, ‘so it is really a cost for the hospital and for the ED.’
Wider challenges of pharmacists in the ED
Dr Leach also notes a shortage of hospital pharmacists and insufficient incentives, which puts pressure on the system and limits the number of pharmacists able to transition to work in EDs. ‘There’s a very limited number of training places to become a hospital pharmacist,’ he says. ‘You have to be accepted into the programme and it’s a long and hard route – and then a pharmacist within a city pharmacy will usually make more money than one in a hospital.’
For those who choose to take on such a role, there are regular challenges to be managed once in post, which demand a careful balancing act to deliver optimum care for patients.
‘One of the challenges is to ensure that every hospitalised patient has a medication review, as this impacts the quality of care,’ Charlotte says. ‘This includes verifying chronic treatments, identifying discrepancies and ensuring that dosages are appropriate and that no medicines are omitted or duplicated during transitions of care.’
The second major challenge she faces is the management of hospital-wide medication shortages because, in addition to her ED responsibilities, Charlotte leads the identification and sourcing of alternative medications when standard supplies are unavailable. ‘I am the person in charge of all of the hospital medication shortages,’ she explains, ‘so I’m the one who searches for replacement and substitute drugs for the whole hospital.’
A multidisciplinary perspective
This hospital-wide visibility puts Charlotte in the ideal position to work closely with physician colleagues to optimise prescribing, offer clinical advice, propose dose adjustments and suggest alternative treatments when needed.
‘Sometimes I’ll suggest an adaptation of substances or dosages based on the patient’s clinical condition,’ she says. ‘The doctors will also come to me with questions about what they’ve prescribed, or they might ask me to explain a medication directly to the patient.’
Her role bridges multiple points in the patient care journey. ‘I contact the hospital ward to inform the receiving doctor of any treatment modifications,’ she continues, ‘and I often reach out to patients’ community pharmacists to clarify which medicines they’re actually taking, because what’s on a prescription isn’t always what the patient is using, and this is particularly important in the ED, where patients may arrive without accurate records and may not initially disclose complete medication histories.’
Benefits for patients and staff
Charlotte’s presence during medicines reconciliation conversations also brings a more patient-centred dimension to medication management. ‘When patients speak to a pharmacist, they often feel more comfortable,’ she says. ‘They’ll say things like, “Actually, I stopped taking that one because it made me feel sick”, or “I only take this every other day”, and that honesty is so important as it helps us catch issues that might otherwise be missed.’
Both Robert and Charlotte believe their model of embedding a clinical pharmacist in the ED offers a valuable example that other hospitals could learn from, not just in terms of patient safety but also in efficiency and collaboration.
Emphasising the ease of communication and improved teamwork that come with having a pharmacist permanently in the ED, Dr Leach says: ‘The key point is accessibility. It’s not a question of going through emails or phones; you just walk across the corridor and say, “I’ve got a question” and you get a live answer. It’s quick, efficient and collaborative.’
He also champions the direct patient benefit of this close integration: ‘When patients have questions, Charlotte can go and speak to them, explain what has changed and why, and that’s part of their right to understand their treatment.’
For Charlotte, it’s not just the ED that can benefit from recognising the pharmacist as an active clinical team member, rather than someone who works behind the scenes, it extends to other departments around the hospital, too. ‘What we’ve shown is that the pharmacist doesn’t just stay in the pharmacy,’ she says. ‘We’re part of the patient care team, we’re visible, we collaborate, and that helps build trust with both patients and doctors.’
