Pharmacy - Interview Interview Analyses

Pharmacy - Interview

INTERVIEW ANALYSES and SYNTHESIS

This project is a synthesis and analysis of the product of three interviews conducted with two practicing pharmacists and a retired pharmacist who work as a an industry advocate and contributes his time to patient advocacy groups as well. The range of professional experiences includes nearly five decades, with one of the subjects having entered the profession in 1960; he continues to practice at the age of 72. The other practicing pharmacist is relatively new to the profession, having just started his career a few years ago.

Several themes emerged throughout the series of interviews, including the dual role of the practicing pharmacist as a dispenser of drugs and an educator of patients; the role of technology in modern pharmacy; and the changes resulting from the evolution of the profession in the age of 21st century medicine, pharmacology, and technology. The purpose of this project is to acquire greater insight into the profession from information provided by knowledgeable individuals with different perspectives.

The Role of Pharmacists:

Pharmacists work in several different types of professional environments; predictably, their individual perspectives are substantially attributable to their specific responsibilities and to the realities of the vocational settings in which they work. The hospital pharmacist views his most essential roles primarily as defined by the need to dispense medications accurately and by the need to ensure that physician errors are identified and corrected before they result in dispensation errors.

The sheer volume of work faced by hospital physicians and the weakened condition of hospital patients (as compared to outpatients) raises the potential for the "perfect storm" of devastating medical harm that could result from pharmacy errors, regardless of whether the source of error was the prescribing physician or the pharmacist.

The hospital pharmacist must implement proactive measures to safeguard patients from errors, such as by maintaining lists of ambiguous terms and abbreviations known to be associated with potential misinterpretation or mistake. In order to be effective, those measures must be communicated to physicians; ultimately, optimal patient protection in this regard would require a standardized approach within the entire industry.

The secondary major role of pharmacists is that of provider of patient education, although setting also determines many aspects of that responsibility. The hospital pharmacist, for example, may have less opportunity for direct patient interaction compared with the outpatient pharmacist who ordinarily encounters patients under less exigent circumstances in which the patients are functioning more independently and in a frame of mind that is more conducive to their education. Even in the outpatient setting, heavy workloads and the need to provide fast service may preclude more extensive interactions between pharmacists and patients. One suggestion is that increased reliance of pharmaceutical technicians within the dispensation process would enable outpatient pharmacists to devote more time to direct patient interaction for the purpose of educating them.

In the hospital setting, the face-to-face education of the patient is more likely to come from physicians, supplemented by the pharmacist's notes and warnings. For that reason, efficient communication channels between physicians and pharmacists are essential in the hospital environment. Likewise, the realities of the hospital setting often limit the nature of patient education to the specific pharmacological issues associated with acute treatments.

The outpatient setting provides much greater opportunity for the pharmacist to dispense general information beyond the scope of acute illness and its treatment. Again, that opportunity is necessarily limited by the time demands of the pharmacist's primary responsibility of filling orders and ensuring patient safety by identifying potential mistakes, confirming information, and noting contraindications and administration instructions. However, in principle, where the outpatient setting permits, the pharmacist may take a much more comprehensive role in patient education in several ways.

For example, many drugs such as Coumadin require the patient to monitor blood pressure at home to determine daily administration issues or dosages; similarly, diabetes patients (and others) must perform diagnostic procedures in conjunction with their self- administered drugs. By monitoring patients in that process, the pharmacist has the opportunity to identify mistakes and other difficulties that could result in errors in drug administration. In a more general sense, pharmacists represent a valuable source of medical information for patients that could help prevent or identify problems before they manifest themselves in presentations that, in the most serious cases, result in unnecessary emergencies and hospitalizations. Technology and Communications:

The evolution of modern technology has had a profound effect on the pharmacy profession, just as it has on medicine in general. Computerization of internal systems, mobile communication, instantaneous access to published research, advisories, and warnings enables the professional pharmacist to provide comprehensive care that far exceeds mere drug dispensation and distribution.

The age of Internet connectivity means that all communications devices and data storage systems are now interconnected. Beyond the logistical and patient safety considerations with which interconnectivity in pharmacy facilitates direct communication of timely information, these technological tools also allow a qualitative difference in the manner in which physicians and pharmacists collaborate to provide quality patient care.

Specifically, pharmacists now have immediate access to physicians' notes and vice-versa, by virtue of the capability of modern system technologies to record entries directly into patient charts. In addition to the general benefit of saving valuable time (on both ends) required to confirm problematic information, the mutual access to the entire patient history and to all professional notes dramatically decreases the relative likelihood of mistake by increasing the ability of pharmacists to identify them before they result in harm to patients.

The Evolution of Modern Pharmacy:

The pharmacy profession has evolved profoundly since the days when pharmacists worked in a little room within a drug store when their main responsibility was to count pills and fill orders. Certainly, drug dispensation is still the primary service, but various elements of modern medicine have completely revolutionized even that task.

First, the sheer number of new drugs and drug classifications is incomparable to what was available when the most experienced interview participant began practicing. Second, the evolution of modern medicine, health science, and drug therapy necessarily involves more responsibility on the part of the patient. That, in turn, requires greater patient education, which in many instances, comes from the pharmacist.