JANUARY 01, 2007
Alma Kohler, PharmD

PHARMACISTS HAVE PLAYED A major role in patient care for centuries. The general public has created a stereotypical pharmacist's picture as being a person who stands behind a counter, dispenses medicine, and answers questions. Today's pharmacist is not necessarily a person who fits this picture very well.

Most people on the outside of the health care profession are not familiar with this new role of the pharmacist. We as pharmacists are thankful to have the opportunity to expand our professional horizons and add more levels to patient care in a clinical setting. I firmly believe that it is our responsibility to make everybody aware of what we as clinical pharmacists do, which can be accomplished by hard work and by making our place in a clinical setting. Numerous opportunities exist for pharmacists to greatly and efficiently influence patient therapy on a daily basis.

Clinical pharmacists have been involved in therapy selection, adjustment, and monitoring of medication regimen. Some of the ways that pharmacists are able to provide clinical work is by adjustment of total parenteral nutrition (TPN), dosing of nephrotoxic drugs, intravenous (IV) to po conversions, offering vaccinations, or as a part of a medical team during rounds. All of these interventions are ways to significantly impact patient care and often its outcome. Among many, this is a very gratifying aspect of a pharmacist's job, which is appreciated by various members of a medical staff. Besides the clinical benefit, a monetary benefit also is associated with this type of work, usually saving the hospital or other medical facilities unnecessary expenses associated with improper medical care.

As a clinical pharmacist, I was able to learn and acknowledge how to appreciate a pharmacist's direct influence on patient care in a clinical setting. The most effective way to monitor and adjust patient therapy is to be part of a medical team during patient rounds. That is the place where drug treatment gets initiated and discontinued. A pharmacist in this setting has an opportunity to prevent inappropriate use of medication right at its source.

Pharmacists participating during patient rounds are able to provide education to physicians and other members of the medical team as well as give highly appreciated advice on various treatment approaches. This is a very rewarding and fulfilling aspect of pharmacy as a profession. It also is an incredibly efficient way of broadening a pharmacist's own knowledge base and building confidence in one's skills and abilities. I believe that all pharmacists should be embraced and encouraged to participate in multidisciplinary patient rounds and become proficient with this aspect of our profession.

Many pharmacists, depending on the hospital institution by which they are employed, have the opportunity to participate in parenteral nutrition support. In this setting, we are able to learn how to meet a patient's nutritional goals and help improve treatment outcomes. Such exposure could be arranged in a multidisciplinary setting, where pharmacists are collaborating with registered dietitians who are able to provide us with very specific and valuable knowledge on how to approach various types of patients with very specific nutritional needs.

This is one of many valuable experiences that a pharmacist can acquire during clinical work. It is a way to learn how a patient's body responds to small electrolyte adjustments and how different disease states can alter one's physiological response to such adjustments. Observing a patient's response within a very short period of time to changes made in a TPN bag is quite an exciting experience.

Another way pharmacists make a difference in a clinical setting is by following patient treatments with IV vancomycin and aminoglycosides. These nephrotoxic drugs are very commonly prescribed in a hospital setting. A pharmacist's role is to make sure that patients are getting therapeutic doses of such drugs but also not to exceed safe drug levels in the blood. Patients very often have supra-or subtherapeutic levels of either or both vancomycin and/or aminoglycosides. The most common reasons for this are due to not allowing the necessary time for a drug to reach a steady state at the time the level was drawn, inappropriate dose or dosing interval that a patient has been given, or inappropriately drawn drug levels. It is a pharmacist's job to ensure that levels are being drawn correctly and that the drugs are being given in a sufficient dose and at the right time. Both physicians and nurses can benefit from pharmacists' valuable drug knowledge in situations like this, and they are usually thankful for that.

Pharmacists not only play a major role when it comes to correct dosing of medication but also by reducing large expenses spent on health care on a daily basis. Appropriate IV to po conversions and renal dosing are small tasks, but they are very significant changes that pharmacists are able to do in a clinical setting. Not only do such interventions save money, but they also prevent unnecessary adverse drug reactions. The same is valid for pharmacists who ensure that patients are properly vaccinated and offer such vaccinations to their patient population. This is a simple and very effective way of disease prevention and another way of decreasing health care-associated costs. Most patients are aware of the benefits associated with proper vaccination and are willing to accept such offers.

Various kinds of clinical work have changed the face of the pharmacy profession in recent decades. Not only have pharmacists made a big difference in patient care through their clinical interventions, but also have contributed to a greater job satisfaction and a more hands-on health care approach. Physicians and other health care professionals commonly welcome pharmacy's input and recommendations. This is an opportunity for pharmacists to use and broaden their knowledge base, which gets to be somewhat underused in a retail pharmacy setting. I believe that we should embrace clinical work performed by pharmacists and make it part of the "standard of care." In the growing world of automation and robotics, dispensing activities should become a secondary job for many pharmacists. Today's pharmacists should better focus on becoming a more effective and respected part of the medical team and help medical communities advance to higher standards of care.

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

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