Pharmacists are the most visible and accessible health professionals. We see them every day in community pharmacies filling prescriptions, counseling patients about prescription and over the counter medications, administering immunizations, conferring with providers, and working with insurance companies on the patient’s behalf. They are approachable when questions need to be answered and all this without an appointment. However, pharmacists are involved in health care in ways not as visible as in community pharmacies.
Pharmacists are an integral part of hospital care. Did you know that every order a provider writes for an inpatient must be verified by a pharmacist as appropriate? This involves checking allergies, drug-drug interactions, routes of administration, and appropriateness per guidelines for therapy. The pharmacist sometimes must make arrangements for the delivery of unique medications in special situations. For instance, if a patient has a rare blood disorder and a particular medication needs to be obtained the pharmacist will make the arrangements for shipping and delivery. In addition to these activities, pharmacists also monitor storage conditions for all the medications in the hospital, especially the refrigerated medications or the ones that need to remain frozen. When temperatures are out of range the pharmacist is responsible for relocating the medications to proper storage conditions.
Another important function of the pharmacist is the monitoring of controlled drug usage. The pharmacist must be involved in resolving discrepancies when they occur, in the number of doses of a controlled drug that are supposed to be on the unit, and what is actually on the unit. All discrepancies must be resolved to make sure that controlled substances are not being diverted. When discrepancies are not resolved the pharmacist must report these occurrences to the hospital administration for further investigation.
Hospital pharmacists are involved in a process called medication reconciliation. When a patient is admitted to a hospital the patient’s current medication list needs to be clarified and double-checked to make sure the list is appropriate and accurate. This same procedure is done when a patient is discharged from a hospital. Patients are given a list of their medication regimen and told of any changes that have been made. They are made aware of any new medications added to their regimen and any changes in dosage. The patient is told to take this list to their primary care provider. May I add here that this list should be shown to the community pharmacist, so they know of the changes that have been made.
Monitoring laboratory results of patients taking medications that affect their blood coagulation or blood sugars is another important function of the pharmacist. They ensure the results are acted on if the laboratory results are out of range. Another of the more important functions of pharmacists in hospitals in the monitoring of antibiotic usage, called antibiotic stewardship. In fact, some large hospitals have pharmacists dedicated to monitoring antibiotic usage and conferring with providers on the most appropriate antibiotic therapy. The pharmacist, called an infectious disease pharmacist, reviews laboratory results of antibiotic levels and recommends dosage adjustments.
Also, large hospitals have pharmacists dedicated to the oncology unit, who are responsible for the correct ordering and preparation of the oncology regimen medications and scheduling. In addition, the pharmacist monitors the oncology patient’s laboratory values because oncology therapy can affect a patient’s blood values and alerts the provider when values are out of range.
Many emergency departments have pharmacists dedicated to their service to assist in the management of patients. These pharmacists participate in cardio-pulmonary resuscitation and assist in complicated medication management issues that present to emergency departments.
In addition to the role’s pharmacists play in hospital care, there are a few more that need mentioning. They are very much involved with patients who need parenteral nutrition, which is given to patients who cannot use their gastrointestinal tract for a period of time and must be feed intravenously. Another area that is emerging is the appropriate management of pain in hospital patients, so pain is addressed, and the risk of addiction is lowered. Of course, the pharmacist is still responsible for the medication distribution system that involves correct charging for medications, timely delivery to nursing units, and the compounding of sterile products for intravenous administration.
I trust this column has given the reader a deeper appreciation of the role a pharmacist plays in health care that may not be as visible to the public as the community pharmacist, but is vitally important and adds to improved outcomes. Be alert for a column in the future detailing how pharmacists assist patient care in nursing homes and other places where medications are administered.
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William Garst is a consultant pharmacist who resides in Alachua, Florida. He received his B.S. in Pharmacy from Auburn University in 1975. He earned a master’s degree in Pharmacy from UF in 2001. In 2007 he received his Doctor of Pharmacy from the University of Colorado. He is a member of many national professional associations as well as the local Alachua County Association of Pharmacists, and he serves on the Alachua County Health Care Advisory Board. He works part time at the UF Health Psychiatric Hospital. He retired from the VA in 2016. Dr. Garst enjoys golf, reading (especially history), and family. He writes a blog called The Pharmacy Newsletter (https://thepharmacynewsletter.com/). He can be contacted at firstname.lastname@example.org
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