Hospital pharmacists are not unlike pharmacists in other practice settings. Their primary objective is to ensure that patients experience safe medication use.
Beyond that purpose, however, the role of hospital pharmacists (also known as health-system or clinical pharmacists) encompasses a broad range of duties with the ultimate goal of providing quality care during an inpatient stay, ensuring a seamless transition of care, and reducing the number of medication errors.
Hospital pharmacists consult on diagnosis, examine patient charts, conduct patient evaluations to recommend a course of treatment, and choose the appropriate dosing of medications and evaluate their effectiveness.
“In health systems, pharmacists are more involved with direct patient care than ever before,” says Norman Tomaka, CRPh, a clinical consultant pharmacist in Melbourne, Florida. “There’s an incredible opportunity for pharmacists to improve patient outcomes. I see that happening more and more.”
With the continued trend toward value-based payment models, hospital pharmacists are taking an active part in efforts to reduce readmission rates.
“The role of pharmacists in the hospital is shifting from a distribution-centric model to more of a service delivery focus,” says Eric Maroyka, PharmD, BCPS, director of the Center on Pharmacy Practice Advancement section for the American Society of Health-System Pharmacists (ASHP). “They’re part of an interprofessional team that may cut across different settings of care. Some of this is driven by a move to value-based care, such as CMS’ quality measures and readmission targets.”
The suggested pharmacist-to-patient ratio for optimal care is about 1-to-30 (1-to-20 in the intensive care unit), notes Kimberly A. Boothe, PharmD, MHA, system director, pharmacy services for St. Elizabeth Healthcare in Fort Thomas, Kentucky. (The traditional pharmacist-to-patient ratio is in the 1-to-50 to 1-to-100 range).
With fewer patients to treat, hospital pharmacists can examine patients more holistically for both acute and chronic conditions.
Acutely, a patient is admitted with signs and symptoms of emerging sepsis, although the lab work initially seems fine. Hospital pharmacists are knowledgeable about those signs and symptoms. They can identify a drug that may be harmful if not adjusted to compensate for acute changes in kidney function because of emerging sepsis.
“A hospital pharmacist can take steps to communicate with the nursing and physician team about a dose adjustment or preemptively recommend discontinuing a medication,” Maroyka stresses. “They can make proactive changes based on evidence instead of reactive changes later that will unnecessarily extend a patient’s hospital stay.”
Related article: How Health Systems Use Pharmacists to Reduce Readmissions
For patients with chronic conditions, hospital pharmacists can collaborate with physicians to manage disease states such as hypertension and chronic obstructive pulmonary disease, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific risk factors, and outcomes.
These examples of interactions show the value of the hospital pharmacist participating in rounds as part of the care team.
“Many times, the body stresses when someone is in the hospital,” says Brook DesRivieres, PharmD, MS, a member-spokeswoman for the American Pharmacists Association (APhA). “What works at home may not work in the hospital. Hospital pharmacists can make sure prescriptions and doses are clinically appropriate.”
DesRivieres describes the hospital pharmacist as a watchdog. “We’re the safety net,” she points out. “A provider may order a drug therapy, but it may not be administered until the pharmacist does a safety check. That’s the biggest contribution pharmacists make in the inpatient setting.”
Transition of care
Medication management has many gaps that, if not closed, could result in an adverse event for patients. Those gaps become more noticeable—and potentially more life threatening—during a transition of care from the hospital to home, a rehab or skilled nursing facility, or other care setting. Hospital pharmacists coordinate post-discharge care to prevent adverse events.
At discharge, pharmacists ensure there is an accurate and updated medication list communicated with patients and their providers. In certain cases, pharmacists will check to see whether patients have access to the pharmacy and a way to pay for the medications. Care coordination may be done with the servicing outpatient pharmacy.
“The pharmacist can determine whether there is a reason that a medication is no longer indicated and be discontinued,” notes Erika Thomas, MBA, BS Pharm, director of the Inpatient Care Practitioners section for ASHP. “If the patient is elderly and at risk for falls, the risk and benefits of certain medications must be evaluated.”