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October 24, 2007 > Striving for Win-Win Outcomes

Striving for Win-Win Outcomes

When patients come to the hospital for care they often are in need of more intensive care than the person running down the street to pick up a prescription at the local pharmacy. That's why patients at Washington Hospital not only receive close care from doctors and nurses, but they also are under the watchful eye of the hospital's Pharmacy Department.
To recognize the vital role played by pharmacies and their professionals, October is recognized as American Pharmacists Month. National Hospital & Health-System Pharmacy Week is observed this year beginning Oct. 21.
So what makes pharmacies in the hospital setting any different than commercial pharmacies? A number of factors, according to Washington Hospital's Director of Pharmacy Minh-Thu Dennen, Pharm.D.
"Our patients tend to be sicker since they are in the hospital and require more intensive assessment by a pharmacist," Dennen says. "We are also dealing with more critical medications. Hospital-based clinical pharmacists are involved with the monitoring of patients on a daily basis. When patients are sicker, the way the body works may also change and we have to adjust drug therapies based on individual's changing needs."
Working on patient safety 24/7
The Pharmacy Department at Washington Hospital is staffed 24 hours a day, seven days a week, by 24 pharmacists, 15 pharmacy technicians and various administrative staff. On a daily basis, pharmacy staff at the hospital performs complex tasks where attention to detail is paramount.
"Our pharmacy operations consist of procurement and dispensing pharmaceuticals, unit dose sterile compounding of oral products, sterile compounding of intravenous admixtures and quality assurance audits," Dennen lists. "In addition, we provide clinical pharmacy services, which include monitoring of drug therapy, providing drug information and ensuring that we provide individualized drug therapy for high-risk drugs with narrow therapeutic window by monitoring them through our progressive clinical pharmacy protocols."
It all breaks down to making sure the sickest patients receive the appropriate medication, in the correct dose and frequency at the right time. For patients that need numerous medications simultaneously, accurate dosing and timing are of the utmost importance. For this reason, the Pharmacy Department employs strict protocols to ensure accuracy, Dennen says.
"The department's order entry system has a built-in alerts that will notify pharmacists to investigate potential problems such as drug-drug interactions, high drug levels, changing renal function requiring dose adjustment, and many others," Dennen says. "These alerts are built-in safeguards for medication use in hospital. Although we do rely on technology, critical thinking is still an essential for pharmacy. Our clinical pharmacists are highly trained and the majority of our staff have a Doctorate degree in Pharmacy."
In addition to clinical pharmacists, the department's pharmacy technicians play many vital roles in the department, Dennen notes, calling these staff members the Pharmacy Department's "strong support." The technicians' roles include: preparation of first doses, restocking/refilling the pharmacy's automated dispensing cabinets, IV sterile compounding, unit dose compounding, answering and triaging telephone calls, delivery of medications to patients, charging and crediting patients and preparing and distributing reports for pharmacists.
Patients play a role in medication safety
Medication safety is not only important inside the hospital, but is also essential for patients to monitor when they go home. In fact, proper use of prescribed medications can have a tremendous impact on patients' health and safety, Dennen says. Complying with doctor and/or pharmacist recommended instructions helps ensure that patients get the optimum benefits from their medications.
But the opposite is also true. By misusing or not taking prescribed medications, patients may jeopardize their health.
"Medications need to be used appropriately with a watchful eye of physician and a pharmacist because every medication has side effects," according to Dennen. "These side effects can sometimes be harmful and land you in the hospital. It is important to know that medications are not a 'magic bullet' and to realize that pharmacists have received specialized training in monitoring medications."
For patients being prescribed several different medications, Dennen says it's especially important that they communicate with their physician and pharmacist if they have any questions or concerns.
"For some types of drugs, it's important to know how to take them, for they may have drug-drug interactions," Dennen notes. "We want patients to maximize the effect of the drugs they are taking.
Particularly for older patients, it's important for them to be mindful of the medications they are taking. The senior population often takes more medications than their younger counterparts and they may be more prone to medication side effects, which makes appropriate dosing, appropriate medication use and compliance even more important for them, according to Dennen.
But no matter what the patient's age, Dennen stresses it's always important to pay close attention to the instructions that come with a prescription or over-the-counter medication. If there's any doubt about how often, how much or whether it's all right to stop taking a particular medication, it's always best to ask a physician or pharmacist before taking action.

Key Points to Remember About Your Medication
* Know Your Medications: What and why you are taking them
* Always carry an updated list of your medications with you including drug dose, how often you take it, and for what indication
* Take them as prescribed by your physician
* When unsure, ask your physician or pharmacist about your medication

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