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Every year, more than 7,000 Americans die because of preventable medication errors. These aren’t rare mistakes or freak accidents. They’re miscalculations, missed allergies, wrong dosages and other potentially deadly mistakes that happen in chaotic emergency rooms where seconds matter. The cost isn’t just human. Adverse drug events are the No. 1 cause of unplanned hospital admissions and cost the United States billions of dollars each year.
Dr. Karina Rudenberg, PharmD, BCEMP, BCPS has made it her life’s work to fix it. As one of the first pharmacists in the country to earn Board Certification in Emergency Medicine Pharmacy, she’s part of a new wave of specialists who are reshaping how we think about emergency care. And she’s proving that pharmacists don’t just fill prescriptions behind a counter, they can save lives on the frontlines.
“When I first started pharmacy school, I wasn’t yet equipped with the knowledge or experience to know what would be a good fit,” Dr. Rudenberg said. That changed after a stint at the Center for Poison Control, where she worked with overdoses and exposures. The experience lit a fire. She later pursued a hospital residency that demanded overnight on-call coverage in the ER. “Emergency medicine is an exciting field,” she explained. “One of the biggest draws is the ability to problem solve with limited information in a fast-paced, high-pressure, interdisciplinary environment.”
That environment is exactly where she thrives. In emergencies like strokes, cardiac arrests, seizures or severe infections, Dr. Rudenberg and her peers make rapid-fire decisions about which drugs to use, at what dose, and when. Doctors and nurses rely on their expertise in the moment, but also in the aftermath, minimizing complications, preventing readmissions, and catching costly mistakes before they happen. It’s the difference between a patient walking out of the hospital and one who doesn’t.
The recognition of emergency medicine pharmacists is relatively new. In fact, the first Board Certified Emergency Medicine Pharmacy exam wasn’t even offered until 2023. Dr. Rudenberg was part of that inaugural cohort, helping validate the role and solidify its place in the ER. “Emergency medicine pharmacists haven’t always been widely recognized as an asset,” she said, “but after ongoing publications documenting cost savings, reduction in medication errors, and improvement in patient care, there has been a significant push to make emergency medicine pharmacy standard of care.”
The data backs her up. A 2023 BMJ systematic review found that adding an emergency medicine pharmacist to an ER team led to a 73 percent reduction in patients experiencing at least one medication error, a 58 percent increase in appropriate prescribing, and faster delivery of critical drugs. Another national study showed that pharmacists like Dr. Rudenberg generated more than $7.5 million in cost avoidance across hospitals, simply by preventing errors and improving treatment efficiency.
And yet, many Americans still don’t realize these professionals are working behind the scenes during their scariest hospital visits. Rudenberg calls them the “medication gatekeepers,” a phrase that sums up both the responsibility and the stakes. “We’re ensuring that a patient surviving an overdose gets the appropriate antidote before it’s too late or that a patient experiencing a stroke doesn’t have any contraindications to receiving a strong clot busting medication within a very delicate timeframe,” she said. “We’re catching potentially deadly drug interactions when no one else has the time to look.”
That vigilance extends beyond single patient encounters. Emergency medicine pharmacists also help manage drug shortages, develop hospital policies, train the next generation of pharmacists, and even guide responses to national health crises. During mass casualty events or pandemics, their expertise helps coordinate protocols, prevent shortages, and make sure medications get to the right hands at the right time.
It’s not glamorous work. Sometimes the success story isn’t a dramatic save, but a near-miss such as a medication error that never reached the patient, the wrong dosage quietly corrected before it became dangerous. Other times it’s as simple as sitting down with a family in the ER to explain why a drug matters and how to take it safely. In a system where so many people feel powerless, those moments restore trust.
The reality is America’s healthcare system is stretched thin, from soaring costs to chronic staff shortages. Emergency medicine pharmacists aren’t a silver bullet. But they’re part of a solution that saves lives, avoids billions in unnecessary costs, and makes hospitals safer. And the more hospitals embrace them, the more impact they can have.
Medication errors will never make headlines the way breakthrough cures or hospital mergers do. But they’re one of the most fixable problems in healthcare and the fix is already here. If Dr. Rudenberg and her colleagues get their way, every ER in the country will have a pharmacist at the bedside, double checking, advocating, and preventing mistakes before they happen. That’s the kind of quiet reform that can ripple across the nation, improving outcomes for millions of patients while cutting waste from a system that can’t afford it.
In an emergency room, seconds count. And sometimes, the difference between life and death isn’t the doctor with the stethoscope. It’s the pharmacist standing right beside them, making sure the medicine doesn’t hurt more than it helps.
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This content is brought to you by Melissa Moraes.
Photo provided by the author.
