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Hospital pharmacists have moved from behind the counter

By Brendon Mitchell 
Winnipeg Regional Health Authority
Published Monday, March 29, 2021

Many of us tend to think of pharmacists as the people in white lab coats who fulfill our prescriptions from behind a counter. While that is still largely true for the pharmacists we depend on in our local drug stores, the role of a hospital pharmacist is broader, more collaborative, and plays an important part in overall patient safety and care.

Within settings both urban and rural, a pharmacist working in hospital and related health-system settings such as primary or ambulatory care clinics is an integral part of an interdisciplinary care team, working in close collaboration - and often making the rounds with - physicians, nurses and other health care professionals to ensure medication use is safe and effective. According to figures shared by the Canadian Society of Hospital Pharmacists, they save the hospital system $4 for every dollar they earn by preventing hospital readmissions, reducing the length-of-stay, preventing medication errors and reducing the harmful effects of medications.

Hospital pharmacists have also had an important, behind-the-scenes role in helping the health-care system better cope with the COVID-19 pandemic. They have kept a close watch on inventory levels of COVID-supportive medications, developing models that better predict supply needs. By identifying opportunities to safely simplify patients' medication regimens and associated monitoring of therapy, they have helped reduce the workload of nurses whose time is often in short supply.

There are nearly 350 hospital pharmacists currently working in Manitoba hospitals, primary care clinics, and hospital-affiliated ambulatory care clinics. In a hospital setting, their work begins as soon as a patient is admitted, by identifying a patient's current medication use. The investigation includes a review of the patient's online medication record (which tracks prescriptions filled at community pharmacies), but can also include speaking directly to the patient, members of their family, or their community pharmacist.

In their role as trusted medication experts, pharmacists use their specialized knowledge in consultation with prescribers and patients to help identify treatment options, and to monitor those treatments to ensure they are meeting anticipated goals and outcomes.

A pharmacist's skills are also required when medications are unavailable or in short supply. Such shortages are commonplace, with Manitoba hospital pharmacies managing an average of 500 new shortages each year, about 50 of these being considered critical. Where shortages occur, pharmacists take the lead in monitoring supply, directing medications to high-priority patients and, where necessary, working with physicians on alternative therapeutic plans.

There are often cases where a patient's response to medication doesn't match expectations, or where adverse effects or unknown allergies can necessitate a change in regime. It's a question of matching the right medications to the right patients, but there are also instances where medications are deprescribed, when they are no longer necessary.

In some cases, it is the pharmacists themselves who prescribe medication, an added capability that resulted from a change in legislation in 2014.  Approximately two per cent of Manitoba's pharmacists are registered as "Extended Practice Pharmacists," having completed additional training and licensure requirements that permits them to prescribe and manage patient medication therapy in collaborative practice with a physician or nurse practitioner. 

The number of extended practice pharmacists is still relatively small, but is expected to double over the next few years. Currently, 90 per cent of these pharmacists work in a hospital setting.

Patient-centred care is critical. As pharmacists, we know that that medications, when used effectively, have a role in curing, preventing or limiting the progression of illness, and we frequently work with patients to help them better understand the reasons why adhering to their treatment plans and medication regimen is in their best interests. This is not always as easy as it sounds, especially where patients and caregivers feel the medication tastes bad, has unpleasant side effects, or interferes with their lifestyle. In other instances, medication affordability may be a barrier.

In these cases, a pharmacist will work with a patient to develop plans to counteract or alleviate negative side effects or other impacts. Such conversations are often key to preventing hospital readmissions.

In fact, if I had to use a word to describe the changing role of hospital pharmacists, it would be "proactive." There are times when you will find us behind the counter, but you are more likely than ever to see us on health care's front lines, putting our medication expertise to use for you and the health-care professionals spearheading your care.

For more information about hospital pharmacists, visit the Manitoba Branch of the Canadian Society of Hospital Pharmacists at www.cshp-mb.ca.

Brendon Mitchell is Regional Pharmacy Director for the Winnipeg Regional Health Authority.

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