First of all, thank you so much to everyone who reached out with the positive feedback to my last post. It meant a lot to hear from so many people who I look up to! It’s day 3 with my student, and I feel like she might be learning a couple of things 🙂
As promised, I am here, on the first day of Pharmacist Awareness Month (PAM) 2017 to elaborate a little on what I do as a hospital pharmacist. Why you ask? Well, to be honest, I’ve been hatching this one for a while. I couldn’t resist the timing!
As you know, I love PAM, and as you may or may not know, a pharmacist’s role in hospital still seems to be shrouded in mystery. Every time one of my fantastically supportive family members would ask what exactly I do, I would think “Guys, you’ve been in this with me for five years, how is this a question!” But, you know what, it’s a fair enough question! Most of the times we interact with a pharmacist, it’s in community. And my response is often “I help the doctors pick out drugs” or “I optimize medications”. Well, we can clearly see that that’s a vague enough answer to not really help describe the role beyond a community pharmacy.
The answer tends to go like that because my role varies depending on what area of the hospital I’m practicing in, and the team I am with. Different teams have different needs, just like different patient populations have different needs. As an allied health member, I adapt my role to the needs of my team. That’s right-pharmacists play on the team, right there, next to the doctors and nurses.
Over this month, I’m hoping to highlight my roles with my CCU team, my nephrology team, from the dispensary and from a research perspective.
Let’s talk about CCU first: A day in the life!
Background: CCU is the Coronary Intensive Care Unit. It’s where the sickest heart patients come after their heart attacks, when they have infections in their hearts, when their hearts aren’t pumping right, or their hearts are beating out of whack.
My day starts by reviewing my patients from my desk. I am seeing who is new, what drugs everyone has on board and their labs. Are they on the right drug, the best drug for them? Do they need more drugs, less drugs? Do these drugs interact? I want to know how their kidneys are functioning (because the kidneys clear a lot of drugs), how their electrolytes are (because maybe some of the drugs they’re on effect this, or maybe they need more drugs to correct it). I want to see if they have any signs of infection, and if we sent any samples to grow in the lab. Did they grow anything? What can we kill it with?
Next I head up to the floor, and I check charts. If someone else on the team has not gotten to it, I interview the patient about their home medications. It’s important we get it right, so we give them the right things that aren’t related to their heart, and we know what drugs they’ve already tried for their heart. Did their legs hurt when they were on a higher dose of a cholesterol med before? Were they dizzy on a higher dose of blood pressure pill? What kind of insurance do they have? Can they afford their drugs? Do they understand why their medications are important?
Up to now, this is the gathering information phase. I’m getting the facts, and finding the problems. Then I figure out the solutions. Sometimes I know off the top of my head, but more times I need to look it up. I try to have a plan before rounds start, and often a plan B and C in case the variables change. This often means changing doses based on labs, vitals, targets and how the kidneys are working, but it also means things like picking out the best drug to kill a bug.
During rounds, my whole team (Attending, Med Residents, Med Students, Charge Nurse, Pharmacist, Pharmacy Resident, Pharmacy Student) discusses each patient, and the ongoing problems we are trying to solve. We usually do this at the bedside. Here I make suggestions to solve the issues I’ve identified, or that come up as we discuss. It’s where we fit all the puzzle pieces together!
The rest of my day is spent looking things up, as I don’t want us using drugs that don’t have good scientific evidence saying we should if we don’t have to. I counsel my patients as to why we’ve just added five new meds, how they help, how long they’ll be on them. I fill out forms to make sure my patient can afford their medications. I help the team reconcile all the changes we’ve made in hospital, with the pre-hospital regimen, so the patient is clear on the plan and the community pharmacy is clear on the plan and things don’t get missed.
Someone said to me today “So if you’re the pharmacist, does that mean you help decide what drugs they’re putting me on?”. Exactly my friend, that is what I am here for. I am here to provide pharmaceutical care.
And that’s closing bell folks.
Talk to you soon,