HOW PHARMACISTS INFLUENCE PATIENT CARE IN A CLINICAL SETTING

PHARMACISTS HAVE PLAYED Amajor role in patient care for centuries.The general public has createda stereotypical pharmacist's pictureas being a person who stands behinda counter, dispenses medicine, andanswers questions. Today's pharmacistis not necessarily a person whofits this picture very well.

Most people on the outside of thehealth care profession are not familiarwith this new role of the pharmacist.We as pharmacists are thankfulto have the opportunity to expandour professional horizons and addmore levels to patient care in a clinicalsetting. I firmly believe that it isour responsibility to make everybodyaware of what we as clinical pharmacistsdo, which can be accomplishedby hard work and by making ourplace in a clinical setting. Numerousopportunities exist for pharmaciststo greatly and efficiently influencepatient therapy on a daily basis.

Clinical pharmacists have beeninvolved in therapy selection, adjustment,and monitoring of medicationregimen. Some of the ways that pharmacistsare able to provide clinicalwork is by adjustment of total parenteralnutrition (TPN), dosing ofnephrotoxic drugs, intravenous (IV)to po conversions, offering vaccinations,or as a part of a medical teamduring rounds. All of these interventionsare ways to significantly impactpatient care and often its outcome.Among many, this is a very gratifyingaspect of a pharmacist's job, which isappreciated by various members of amedical staff. Besides the clinicalbenefit, a monetary benefit also isassociated with this type of work,usually saving the hospital or othermedical facilities unnecessary expensesassociated with impropermedical care.

As a clinical pharmacist, I was ableto learn and acknowledge how toappreciate a pharmacist's direct influenceon patient care in a clinical setting.The most effective way to monitorand adjust patient therapy is tobe part of a medical team duringpatient rounds. That is the placewhere drug treatment gets initiatedand discontinued. A pharmacist inthis setting has an opportunity toprevent inappropriate use of medicationright at its source.

Pharmacists participating duringpatient rounds are able to provideeducation to physicians and othermembers of the medical team as wellas give highly appreciated advice onvarious treatment approaches. This isa very rewarding and fulfilling aspectof pharmacy as a profession. It also isan incredibly efficient way of broadeninga pharmacist's own knowledgebase and building confidence in one'sskills and abilities. I believe that allpharmacists should be embraced andencouraged to participate in multidisciplinarypatient rounds andbecome proficient with this aspect ofour profession.

Many pharmacists, depending onthe hospital institution by which theyare employed, have the opportunityto participate in parenteral nutritionsupport. In this setting, we are able tolearn how to meet a patient's nutritionalgoals and help improve treatmentoutcomes. Such exposure couldbe arranged in a multidisciplinarysetting, where pharmacists are collaboratingwith registered dietitians whoare able to provide us with very specificand valuable knowledge on howto approach various types of patientswith very specific nutritional needs.

This is one of many valuable experiencesthat a pharmacist can acquireduring clinical work. It is a way tolearn how a patient's body respondsto small electrolyte adjustments andhow different disease states can alterone's physiological response to suchadjustments. Observing a patient'sresponse within a very short periodof time to changes made in a TPNbag is quite an exciting experience.

Another way pharmacists make adifference in a clinical setting is byfollowing patient treatments with IVvancomycin and aminoglycosides.These nephrotoxic drugs are verycommonly prescribed in a hospitalsetting. A pharmacist's roleis to make sure that patientsare getting therapeutic dosesof such drugs but also notto exceed safe drug levels inthe blood. Patients veryoften have supra-or subtherapeuticlevels of either orboth vancomycin and/oraminoglycosides. The mostcommon reasons for this aredue to not allowing the necessarytime for a drug toreach a steady state at thetime the level was drawn,inappropriate dose or dosinginterval that a patient hasbeen given, or inappropriatelydrawn drug levels. It is apharmacist's job to ensurethat levels are being drawncorrectly and that the drugsare being given in a sufficientdose and at the right time. Both physiciansand nurses can benefit frompharmacists' valuable drug knowledgein situations like this, and they are usuallythankful for that.

Pharmacists not only play a majorrole when it comes to correct dosing ofmedication but also by reducing largeexpenses spent on health care on a dailybasis. Appropriate IV to po conversionsand renal dosing are small tasks,but they are very significant changesthat pharmacists are able to do in aclinical setting. Not only do such interventionssave money, but they also preventunnecessary adverse drug reactions.The same is valid for pharmacistswho ensure that patients are properlyvaccinated and offer such vaccinationsto their patient population. This is asimple and very effective way of diseaseprevention and another way of decreasinghealth care-associated costs.Most patients are aware of the benefitsassociated with proper vaccination andare willing to accept such offers.

Various kinds of clinical work havechanged the face of the pharmacyprofession in recent decades. Notonly have pharmacists made a big differencein patient care through theirclinical interventions, but also havecontributed to a greater job satisfactionand a more hands-on health careapproach. Physicians and otherhealth care professionals commonlywelcome pharmacy's input and recommendations.This is an opportunityfor pharmacists to use andbroaden their knowledge base, whichgets to be somewhat underused in aretail pharmacy setting. I believe thatwe should embrace clinical work performedby pharmacists and make itpart of the "standard of care." In thegrowing world of automation androbotics, dispensing activities shouldbecome a secondary job for manypharmacists. Today's pharmacistsshould better focus on becoming amore effective and respected part ofthe medical team and help medicalcommunities advance to higher standardsof care.

Dr. Kohler is a clinical coordinator atEdward White Hospital in St. Petersburg, Fla.