You’re ready to discharge a patient, but you don’t know whether the medication you’ve ordered will be available in the outpatient setting. Who do you ask? Your pharmacy service will have the answers, and if you’ve established a collegial relationship with the pharmacists there, most likely you can get a quick answer via page, text, or phone call. But if you don’t have personal contact with your pharmacists, chances are the interchange will impersonal—and that could mean missing ou
t on an extra layer of information that could be valuable to your patient.
“Pharmacists may be underutilized, especially if the range of clinical services they offer are not recognized,” notes Kristine Gleason, RPh, clinical quality leader at Northwestern Memorial Hospital in Chicago. “We can be an excellent resource for young hospitalists and clinicians, offering information on clinical dosing and monitoring of complex, high-risk medications.”
Pharmacists also can be valuable resources for medication reconciliation and patient counseling, Gleason says, adding that “our goal is to work collaboratively with our clinicians to help ensure patients receive evidence-based medication regimens that are safe and without error and that are tailored to each patient’s individualized characteristics.”
Benefits of Rounding
Interactions between hospital pharmacies and HM services vary by institution size and organization. Roberta Barber, PharmD, MPH, is assistant vice president of pharmacy for Virtua Health’s four hospital campuses in New Jersey. At Memorial Hospital, where Erik DeLue, MD, MBA, SFHM, first established a hospitalist program, pharmacists are present in the ICU units and participate in care-coordination rounds.
Barber is crafting policies to extend the decentralized pharmacist model to all of Virtua’s hospitals. Equipped with cordless phones and tablet computers, pharmacists will be able to round with the HM team without sacrificing availability to other physicians and hospital staff. In this way, she says, “physicians will be able to consult with pharmacists as they’re creating their treatment plans, and the pharmacist can intervene regarding potential problem orders right then and there.”
At the University of California at San Francisco Medical Center, clinical pharmacists in the general medicine division work closely with the nine medicine teams run by hospitalists. That means 24/7 availability by pager, participating in multidisciplinary rounds, and furnishing new physicians with a “contacts” card and an orientation guide to help hospitalists write better orders, says Vicki Ising Jue, PharmD.
The personal touch is appreciated. “If I am in the pharmacy making a call and not on the unit, it just makes the phone call so much easier if the caller happens to be someone I’ve worked with before,” says UCSF’s Alan Tan, PharmD.
The degree of communication with pharmacy services may depend on whether you’re working in a teaching hospital with a structured orientation program or starting out in a community hospital. No matter the setting, though, Gleason says the pharmacist’s mission stays the same.
“We’re all striving to get to the same goal: safe, effective and patient-centered care to achieve positive outcomes for our patients,” she says. “Partnering with pharmacists can really move all of us closer to that goal.”
Gretchen Henkel is a freelance writer based in California.
One excellent way to foster collaboration with your hospital pharmacists and gain a better understanding of the medication management services they can provide, Gleason says, is to visit the department. “Spend an hour with us, shadow us, come to a meeting, and understand what we do professionally,” she explains.
Barber agrees: “If your hospital doesn’t offer training on the range of pharmacy services, solicit that yourself. Orient yourself to pharmacy rules and regulations; familiarize yourself with your hospital’s formulary and the role of the P&T committee in placing drugs on the formulary.”—GH