TWO PATHS, ONE HOSPITAL

PHARMACY CAN TAKE MANY different directions at Methodist Healthcare, a health care delivery system which operates over 20 facilities throughout the San Antonio, Tex area.

For Brigit Caciola, a staff pharmacist at Metropolitan Methodist Hospital, hospital pharmacy allows her to be an integral part of the health care team. ?I love hospital pharmacy,? said Caciola. ?It is a dynamic atmosphere, and I am constantly learning or educating others.? Caciola, who worked as a retail pharmacist for 3 years prior to moving to a hospital practice, said the transition was not difficult. ?I had to get used to being up on the floor,? she said. ?You realize that your job is so very important to a patient?s health. You have to always give the appropriate response and always be prepared.?

She is certainly up to the challenge. In a hospital environment, said Caciola, pharmacists really feel as though they are an important part of a health care team, rather than a part of the process. ?A hospital is quite a different atmosphere because you have a greater impact on prescribing,? she said. ?You are right there when the physician is prescribing, so it is much more of a team approach.?

Caciola said she is proud of the relationship she has built with staff nurses and physicians. ?You are really an integral part of the team, so physicians will page you with questions even if it is not about a patient who is in the hospital. When we are responding to code blue emergencies, you can see how important the pharmacist?s role is. Physicians depend on the pharmacist to set up drips, and we play an important part in the patient?s outcome.?

One of the most rewarding parts of her job is seeing patients go home. ?It is so exciting when you see a patient who has been in the hospital?especially the ICU [intensive care unit]?for a while, finally get better,? she said. ?We once had a patient in the ICU for nearly a year. When the patient leaves in a wheelchair or is walking with a walker, they are laughing and talking and are so excited to go home, it is really a miracle, and you feel so happy that you have contributed to their well being.?

Caciola said she continues to have the patient interaction she enjoyed in retail pharmacy, but she experiences it in a different way. ?In retail, you build a relationship with patients, and I thought I would really miss that because you have day-to-day interaction, but many patients we see more than once, and you become familiar with their case,? she said.

A big part of Caciola?s job is overseeing the renal dosing of antibiotics, helping physicians write parenteral nutritional orders, and helping with aminoglycoside dosing.

When it comes to career growth, Caciola said the path is limited only by a pharmacist?s own desires. ?There?s always career growth,? she said. ?You can specialize in infectious diseases, pediatrics, neonatal intensive care, or oncology, or you can move to an educational role in a program that develops educational programs for nursing staff,? she said. ?You could also take an administrative route that allows you to set up protocols.?

That is the path that Donna Burgess, an antibiotic surveillance pharmacist at Methodist Hospital, followed. ?I?m in charge of reviewing antibiotics in adult patients,? said Burgess. ?We make sure that patients are using the right antibiotic in the right dosage. In the area of renal dosing, we often start a patient out on a broad-spectrum antibiotic and stream down to a narrow-spectrum antibiotic that addresses resistance issues.?

As a specialist, Burgess is responsible for reviewing patients? charts and sharing information with physicians. She also works as part of a team on quality improvement issues. ?We can really impact a lot of patients by working with interdisciplinary teams. Working together, we can really make a difference in patients? lives,? she said.

Burgess had considered medical school, but after a stint as a pharmacy technician, she fell in ?love with pharmacy.? Her specialization allows her to delve deeply into her practice. It also allows her flexibility.

?There are so many different opportunities in hospital pharmacy,? she said. ?I?ve been a clinical coordinator and a hospital pharmacist. This position allows me to do exactly what I like and affords me a flexible schedule of 32 hours a week,? she said. ?There are many areas of advancement open for me.?

Ms. Sax is a freelance writer based in Chevy Chase, Md.