My Health Career is pleased to present a guest blog post from Matt, a hospital pharmacist at the Frankston Hospital, which is part of the Peninsula Health organisation. Peninsula Health has expanded the Mornington Centre, and are taking applications for 60 new jobs in health care.

“Monday. Most people’s most hated day of the week. It sure is for me. Not because I had to get out of bed early, or because I partied like a member of led zeppelin over the weekend, but because of the how my ward will be after a weekend of no pharmacist on the ward to help out. I bring this up because at a grand round recently, the topic of medication safety was discussed.

It was suggested that because of the new e-prescribing system, that maybe we no longer need pharmacists on the ward. I can assure you that after just two days, sometimes even after just one night during the week, that there will be patients with medications charted for them (or not charted for them) that need to be chased up or clarified.

How can I be so sure? Well, as part of the new prescribing system, there is a program that the pharmacists open up each day, called pharmnet. This is a part of the new electronic prescribing system. The electronic prescribing system has inbuilt order sentences for each medication. For example, with paracetamol, when the doctor chooses to order this they can pick a sentence that says ‘two tablets four times a day.’ If the doctor does not modify this pre-set order sentence, then there isn’t a problem and the pharmacist is not notified. But the minute the doctor alters this, the pharmacist is notified, as this is deemed an unusual dose or route of administration and requires further investigation. There are times a medication is always sent through to pharmnet, such as when a patient is prescribed powerful antibiotics, when drug interactions come up on a drug chart, or some high risk medications (such as blood thinners or insulin).

As a result, the pharmacist can then direct their attention to the patients that need it most. For example, if a patient who is allergic to penicillin is prescribed penicillin, the pharmacist can make this their highest priority in the morning, and ensure that the patient does not come to harm. Thus, pharmnet is helping to make the hospital safer for the patients, and ensuring that the pharmacist is directed to the areas that they are most needed. This has made our life so much easier! The pharmacists now are across more of the big medication issues in their ward much faster than previously.

Now, the electronic system has been very helpful in reducing the amount of errors that occur and ensuring effective use of resources. But it does not replace a brain. It will not pick up that two drugs of the same class have been ordered for a patient, that a patient’s blood pressure or heart rate are too low for certain medications, and there is not a hope that it can pick up that a patient is not charted for medications that they regularly take at home. This is where a pharmacist comes in, to perform a clinical review and ensure the patient has the best therapy for their condition, with all regular home medications continued. If we were not needed, then the pharmnet program mentioned above would not have 30 to 60 new things a day for us to clarify. Yep, 30 to 60, and that is even before I begin to look at charts for the other types of problems I mentioned above! And while the system pops up with quite a few drug interactions, there are more that do not come through immediately to the pharmacist’s attention. So yes, pharmacists are needed, and to ensure even better treatment for our patients. A computer cannot see the patient or interpret blood test results yet.

Part of being a ward pharmacist involves entering clinical interventions, with the top 10 each month from the pharmacy department being presented at a monthly meeting and sent to all the medical staff. These range from wrong doses to drugs omitted from drug charts to drug interactions and everything in between. These represent what we consider to be our most important intervention, or the intervention that can be used to teach people important lessons. The pharmnet program above has helped with these, and has improved patient safety a great deal.

On a lighter note, here are a few things that after a few months out, this pharmacist is already weary of hearing:

• “I take so many pills I rattle”- I have yet to hear anyone rattle due to medication!!! Please people, this was funny the first time. But remember, you aren’t the first to say this, so if and when I don’t laugh, don’t be offended.
• “I take the little white pill”- Oh that one, I remember that one, along with the other 300 or so tablets that are small and white!!
• “I dont want any genetics”- (Supposed to be generics, the equivalent but less expensive brand of medication). Bad luck! We all have genetics
• “I’m allergic to penicillins, it gave me diarrhoea”- No. No you are not. Antibiotics give you diarrhoea. This is normal. Please don’t say this, as penicillins are a life-saving medication, and if possible are the drug of choice for many infections. Unless you come out in a rash or cannot breath, you can have the penicillin
• “I don’t like taking drugs, I only take natural products”- I would like to use the examples that a lecturer from university used. Snake venom and dog droppings are natural, but do you really want to take these? I think not. Natural does not always equal safe, but that’s another topic…”

More articles on My Health Career:

• Hospital pharmacists – what do they do?
• The best and worst of a career in pharmacy
• Become a pharmacist – pathway infographic