In this episode, I’ll discuss three reasons why 1 clinical pharmacist on the unit = 2 in the office.
If you are a clinical pharmacist working in a hospital, the chances are that you have an office or desk to call home in the central pharmacy. Certain aspects of the job require a quiet space to work, such as creating an in-service or presentation, or drafting a policy or procedure. But for the majority of the day, it is far more effective to be present on the nursing unit, elbow-to-elbow with patients and the care team. Here are three reasons why:
1. Observing / interacting with the patient
Many aspects of pre-rounding or optimizing medication regimens become more efficient when done on the nursing unit.
If I’m trying to determine whether venous thromboembolism prophylaxis is appropriate, it is much faster and accurate to see the sequential compression stockings (SCDs) on the patient’s legs than it is to search the medical record for documentation that SCDs were applied.
When assessing whether medications can be changed from the IV to enteral route, the medical record can only reveal if a patient is taking other medications already by an enteral route. But when I am on the nursing unit, I can see the NG tube hooked up to the tube feeding, or the patient eating their breakfast.
When evaluating cross-allergenicity of a medication order, being able to step in a patient’s room and ask them questions about their allergy history is far more effective than scouring old progress notes or reading in the record that the patient has “hives to penicillin.”
It is very easy to determine if a patient is inadequately sedated, or has inadequate pain management by briefly observing them while you are on the nursing unit.
2. Interacting with team
Being present as much as possible on the nursing unit allows for greater interactions with other members of the care team such as nurses, physicians, and respiratory therapists. When the care team knows they can count on you being on the unit, they are more likely to seek out your assistance. Your consistent presence turns into more IV compatibility questions, more pain consults, more drug fever or thrombocytopenia evaluations, more antibiotic stewardship opportunities, etc…
Being available in-person for spontaneous questions provides an invaluable service to members of the care team. You’ll find many questions you can answer off the top of your head without further research – this saves you and the nurse or physician a significant amount of time.
When you interact face-to-face with the care team you begin to learn how each discipline thinks and what their priorities are – this will allow you to more effectively communicate recommendations/interventions to those team members in the future.
3. Learning opportunities
The number of learning opportunities you’ll be exposed to by maximizing your time on the nursing unit is tremendous. No one is going to hold off starting a procedure for the pharmacist to walk up from the basement to the nursing unit. But if you are already there, you’ll get to see bronchoscopies, endoscopies, echocardiograms, central lines, joint reductions, intubations, tracheotomies, autopsies and countless other procedures. By viewing procedures, you will gain a better understanding of how medications are used to facilitate them.
There is no shortage of experts readily available to learn from when you spend most of your day on the nursing unit. Want to know the best way to calculate the QTc when the rate is irregular? Find a cardiologist and ask them. Want to know why the infectious disease physician didn’t double-cover legionella? Be on the unit to ask them before they see the patient for the day. Want to know exactly how phentolamine is used in extravasation? Ask the IV therapy nurse next time you see him or her.
Occasionally you’ll find someone who is too busy or stressed at the moment to share their expertise with you – but I’ve found this to be the exception to the rule. Nearly always, people are happy to take a moment to share their expertise or answer questions.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Well said! You learn more and do more this way.
Any suggestions on how to change your presence on the unit from being a person who is sought out only as a resource (by nurses) for meds they are requesting from central pharmacy. Currently we at my hospital we are finding that the vast majority of the time the nurses are only seeking us out when they are having difficulty obtaining their meds from the pharmacy.
Melissa,
I think you’re glossing over a major point. If nursing is constantly seeking for missing meds, the pharmacy team need to evaluate why meds are missing. Is there inadequate storage? Are nurses not properly trained during orientation? Are techs not stocking meds as they should? If you have fixed the problem on your end, nursing should call less for missing meds. On average, regardless of how well your team does, nursing may call but it’s seldom (2 to 3 calls per day is probably fair).
I am not sure if this is feasible, but at my hospital budgets got shifted around from nursing to pharmacy for the creation of “decentralized pharmacy technicians (DTech)” whose job it is to make sure the nurses have the meds in their hand when they need them. Each floor has a number posted by their PYXIS of their assigned Dtech as well as the central pharmacist responsible for their floor. The program has been in place long enough now that the nurses know, if the med is missing call the DTech, if there is a problem with the order call the central pharmacist, etc…
Other than that, you may have to proactively demonstrate how you can help nurses a few times. Checking for adequate pain management and proactively intervening would be the best way to do this I think.