Contemporary Pharmacy: Part 4/4

Today concludes Sarah’s four-part series on contemporary pharmacy. I’ve certainly enjoyed having her back and can’t wait for her return. Today she focuses on the hospital pharmacist.

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may need to introduce a pharmacist character or understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.
Today’s article discusses practice in the hospital setting. Previous articles discussed an overview of the profession, pharmacy education and training, and practice in the community pharmacy setting.
Hospital Pharmacy
About 22% of pharmacists work in America’s 5800 hospitals. These can range from the small community hospital with a few dozen beds, to large teaching hospitals with thousands of beds.

Setting

The traditional hospital pharmacy is “in the basement,” away from the main hospital area. As pharmacists have become more involved in patient care, some larger hospitals have opened satellite pharmacies on the floors. To deliver medications, hospitals use employees, vacuum tube systems, dumbwaiters, or even robots.
Access to the hospital pharmacy is restricted to pharmacists and pharmacy technicians, and briefly to nurses, administration, housekeeping staff, and delivery personnel under pharmacist supervision.
The typical hospital pharmacy is divided into work areas. One area contains computers and reference materials for pharmacists entering medication orders. A narcotics room contains all the controlled substances, usually in a secure cabinet accessible only by password or biometric scan. A “cart-filling” area contains medications as well as the large carts that will be filled with a daily supply for each patient. The IV room contains laminar flow hoods for sterile preparation of intravenous medications. There is also room for bulk storage and tables for breaks and meetings. Offices are provided for the director of pharmacy and others.
Work Conditions
In the inpatient setting, medications must be available twenty-four hours a day, every day of the year. Therefore, the largest hospitals are always open. Smaller hospitals may have off-site pharmacists enter orders electronically after hours, while nurses obtain the medications from automated systems.
On average, a hospital pharmacy employs ten pharmacists and about twice as many pharmacy technicians. Directors of pharmacy must be pharmacists by law, but they usually perform administrative duties only.
Opportunities for part-time or on-call work abound. Most employees work odd hours, including evenings, weekends, holidays, and graveyard shifts. Those in administrative or purely clinical jobs may work traditional hours.
Dress codes vary, but most pharmacists dress professionally—men wearing nice pants and shirt, with or without a tie, and women wearing a nice top with dress pants or a skirt. Technicians tend to more casual clothes, often jeans or scrubs. Lab coats may or may not be worn within the pharmacy, but are preferred when the personnel go to the floors. In the hospital setting, the long-sleeved knee-length lab coat is most common.
Work Flow
Physicians’ medication orders are transmitted to the pharmacy electronically or by fax. Many hospitals have the physicians enter the orders themselves to prevent errors due to illegibility. A pharmacist checks if the drug and dose are appropriate for the patient’s condition, age, and weight, and checks for potential problems due to allergies, drug-drug interactions, or drug-disease interactions. Many hospitals have protocols that allow pharmacists to adjust doses for certain drugs.
Technicians then pull a day’s supply of the new medications to send to the floors. Most medications in hospitals are “unit-dosed,” with each dose individually packaged in blister packs and labeled with drug name, strength, manufacturer, lot number, expiration date, and bar code.
Most hospitals supply medication on a 24-hour basis. Large carts contain drawers for each patient, which are filled with a 24-hr supply of medications and delivered once a day. Intravenous medications are batched, with a 24-hr supply sent up once a day. Exceptions are made for drugs with low stability or high cost. As medications are changed, only the new medications need to be sent up. Automated dispensing machines on the floors provide nurses access to emergency medications, stat doses, or after-hours doses. These machines are also used to dispense controlled medications, as they require passwords or biometric scans.
IVs and TPNs
One special function of the hospital pharmacy is mixture of intravenous (IV) solutions and total parenteral nutrition (TPN). These require calculations, training in sterile technique, and the use of a laminar flow hood.
Clinical Pharmacy
A growing and cherished role in hospital work is clinical pharmacy, the direct interaction with physicians, nurses, and patients to optimize pharmaceutical care. Pharmacists in a clinical role monitor lab values, read patient charts, analyze the patient’s condition and current care, and make recommendations individualized for the patient. Clinical pharmacists can improve patient care, reduce length of stay, decrease side effects, and even reduce costs.
The Hospital Pharmacy Experience
Hospital pharmacy personnel work behind-the-scenes in a fast-paced, often-interrupted, and frequently stressful environment. However, they take pride in working with complex medications for critically ill patients, knowing they do their best to improve patient care and reduce medication errors.
Sources:
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Pharmacists, on the Internet at http://www.bls.gov/oco/ocos079.htm (visited October 17, 2011).
American Pharmacists Association http://www.pharmacist.com/
American Society of Health-System Pharmacists http://www.ashp.org/
American Association of Colleges of Pharmacy http://www.aacp.org/
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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

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