Good read.
So what does a pharmacist do? This was a question that I probably should have had straight in my head before I entered Uni, but all that I had really seen them doing was standing behind the counter in a shop, getting stock and labelling it up, which I am sure a lot of people still think that is what pharmacy is: a supply business no different to any other shop. However, what a pharmacist does is extremely varied, as I will hopefully illustrate.
Depending on who is reading this, you may already have an idea of what pharmacists do. If you are a doctor for example, you may think that we are the annoying people who thrust drug charts into your face, wildly blathering about renal function (How well someone’s kidneys are working) and why a dose of a medication needs to be changed. Or trying to explain why we cannot give a patient two medications because they could interact in a dangerous way with each other. The amount of times that I have heard ‘What did I do now?’ come out of a doctors mouth! (All in good fun of course)
So here is a bit of an explanation of what a hospital pharmacist may do. Firstly, the most well-known job of a pharmacist is supply of medications. Like what occurs when you drop a script from the doctor into a community pharmacy (a shop), a pharmacist at the hospital is responsible for making sure that a medication prescribed for the patient is safe for the patient and delivered in a timely fashion.
To be able to do this, a pharmacist must be able to review a patient’s medication chart and check for interactions between the medications. If you have ever tried to buy a medication from a pharmacy, then hopefully the question “do you currently take any medications?” was asked by the pharmacist before they prescribed you any medication. In addition to these ‘drug-drug interactions’, there are also drug-patient interactions, where the medication may not be appropriate for someone with certain conditions. For example, someone with kidney problems (again with the kidneys!) may not be able to use anti-inflammatory medications which can further damage the kidneys.
Next, we need to check the dose. To be able to do this properly, quite often the pharmacist will need to view blood test results to help determine this. However, as the senior clinical pharmacist at Frankston continually reminds us, another important part is that we see the patient. A fit 20 year old man will handle medication very differently to a 90 year old lady!
The pharmacist should also be asking other questions such as is this the best medication to treat this condition? Is this cost effective? (Ask any nurse- they all know the pharmacy department is notorious for trying to save money by using generic medication- the cheaper the better!) All this adds up to a quick chart review by the pharmacist once we are satisfied that the medication is in fact safe (remember the motto ‘First, do no harm’), the pharmacy technicians deliver the medications to the patient’s bedside. Without the techs, the department would fall apart! Your pharmacists, and the patients, are all extremely grateful!
Pharmacists also complete medication reconciliation whereby they determine what a patient was taking before coming to hospital, and if it should be continued whilst in hospital. Usually, the pharmacist will interview the patient to determine how they took their medications, or question the person who gives medications at home. We then double check this against a list from a community pharmacy, local doctor or the patient’s own drugs.
On discharge, a pharmacist is presented with a script in order to provide the patient with any medications they need at home, which is a very similar process to what your local GP/community pharmacy do. This requires the age old pharmacist skills of reading a doctors handwriting
There are other things in a hospital that a pharmacist does. At Frankston, we are in a quite unique situation where we have PETS (Pharmacist Initiated E-Transcription Service) pharmacists, who go around the hospital and at the request of the doctor (Or more often the pharmacist!) write the script for the doctor, who if they are happy can sign off on the script after checking it for themselves. The ward pharmacist then checks this script after the doctor has. This incorporates the ‘Swiss cheese model’ of medication safety, whereby the more checks we have, the less chance there is of the patient coming to harm and something being missed. As I was taught early at Frankston, trust no-one!! In the end, to err is human which incidentally was the title of a patient safety report by the US Institute of Medicine some years ago.
Pharmacists also help to write protocols on how medications should be used within the hospital, to ensure that medications are used at the right dose in the right patient for the right reason Pharmacists are also involved in medication safety, which probably seems obvious given what I have said above. However, there is a medication safety pharmacist who is continually working on ways to make the health system safer for patients, for example how IV bags are labelled, how drugs are stored or how the pumps that nurses use are programmed.
Pharmacists also partake in education programs such as ELVIS (a program designed to help educate doctors about how to prevent blood clots in patients), drug usage evaluations (such as how antibiotics are used in hospitals) and many other activities which I have no room for!
If you have made it this far, think of this the next time you are wondering why the pharmacist is taking so long to stick a label on the bottle. Remember, we are paid to know lethal combinations of drugs!!
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Apr 22 2013, 07:49 PM
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