A message from Rita Shane, Pharm.D., FASHP, FCSHP Chief Pharmacy Officer

A message from Rita Shane, Pharm.D., FASHP, FCSHP Chief Pharmacy Officer

A message from Rita Shane, Pharm.D., FASHP, FCSHP Chief Pharmacy Officer

By Bryan Wright 0 Comment August 18, 2019


When when we look at the transformation
of healthcare in the U.S. today the opportunities that are available for
pharmacists are really remarkable. You know given the number of patients with
chronic diseases, the complexity of medications that are being released,
years ago traditionally patients were treated with with with oral pills and
yet today we’re seeing the advent of biologics sometimes infusion therapies
that are treating debilitating chronic diseases that in the past we couldn’t
even treat. All of these really represent opportunities for pharmacists to make a
huge difference and when we think about what our role is, it’s fundamentally
ensuring the safe and effective use of medications. I like to think about
pharmacists as part of the three-legged stool in the care of the patient.
Physicians prescribe and diagnose and have their intentions of what they feel
is best for the patients and oftentimes patients see multiple physicians and so
we have this phenomenon poly doc which results in polypharmacy and that’s
essential given the complexity of chronic diseases patients have but that
also helps us define where we can make a difference
given our knowledge and skills in medication therapies we really are the
the guardian angels of the medication use process, if we think about it. So if
if we look at how what that really means it starts with the the order being
written and we as pharmacists oversee the procurement of the medications that
we have to make sure that the right medications are ordered and and stored
appropriately. Oftentimes really severe errors occur due to storage of
medications incorrectly. For medications that need to be compounded there are now
national standards to ensure the safety of that sterile compounding process and
actually this area is being examined as an area of specialization for
pharmacists historically that wasn’t the case and so that represents a new
opportunity for individuals to really advance in that area who have expertise
and ensuring safety of sterile products. Once the medication
has been prepared, the pharmacists who’ve been evaluating those orders play a key
role in ensuring the safe administration of those medications and that’s where we
work very closely with the nursing staff: to ensure the right rate of medication,
to ensure that any monitoring that needs to occur concurrently is occurring,
especially for medications require monitoring right around the time the
dose is being given. And if we really think about how this whole process
begins we have the knowledge and training to look at that patient and the
orders are in the context of that patient so current diseases, other
concurrent medications those are the things that we bring to the table our
understanding of those facets of the patient’s care are essential to ensure
that that that drug therapy is carried out with the intent that the physician
had in mind and are administered safely. So that’s what we’re I think of us as
the guardian angels if you will of the medication use process. So let’s now
think about a patient as they enter our systems and what and what our role
really is. If we think about it a patient’s only within our walls for
about five days, that’s the average length of stay in hospital settings. So
let’s walk through that process. Patients shows up the emergency department. We
have pharmacists who are trained a specialist in the emergency department
medicine and whether the patient’s admitted for a stroke or a trauma or a
pediatric patient or a dosing is really critical, we’re there at the
bedside to make sure that that process is is safe. Once the patients admitted if
they end up in a critical care unit are critically trained.. critical care trained
pharmacists are really intensive and much like the medical model we make
sure that any critical issues around that episode of care are managed to
ensure safe and effective drug use. As patients transition to the next level of
care, our pharmacists who work in areas like med surg really are like hospitals
so if we think about the medical model it’s it’s very analogous and at that
juncture we’re trying to look at any other acute issues that we need to
manage but we still need to start thinking about why is the patient here
and what are they going to need when they go home. So this is where I really
look at the the patient as a whole and our role to
ensure that not only are the Q care needs taken care of, we start to think
about what’s that patient going to be needing a discharge we need to engage
our outpatient pharmacy in evaluating whether or not that the the patient’s
medications of discharge makes sense, was anything omitted. Up to 20% of the time
we might actually find an error, which is what our data shows and so our
outpatient pharmacists play a critical role in evaluating those discharged meds
again in the context of what the patient was here for during their inpatient
hospitalization. We oftentimes identify problems with antibiotics, anti
coagulants sometimes anti platelets, I call it the the Triple A of Pharmacy, our
triple aim is to ensure safe use at discharge. We’ve also identified that
this transitions of care that patients undergo as they leave the hospital is a
very vulnerable time for patients and research studies that we have done with
our residents who have been instrumental in helping us develop this program
demonstrate that when we call patients post discharge we actually make a
difference in terms of a reduction in readmissions and our residents have
developed algorithms to help us risk stratify the highest risk patients those
who don’t understand their meds and therefore aren’t adherent and those are
the ones we target for post discharge follow-up. So what we’ve seen at
Cedars-Sinai is that the opportunities to really make a difference occur across
the organization and the demand has grown as a result of the relationships
that pharmacists with training and knowledge bring to the table and
regardless of where the patient is we have been able to develop collaborative
relationships that enable us to really make a difference in the care of the
patient. I’ve spent my whole career at Cedars-Sinai, I started here as an intern
and the reason I stayed is I looked at the remarkable opportunities to make a
difference in patient care. Establishing relationships with physician and nurses
has really been the best part of my career. Being able to hire pharmacists
who are really committed to patient care has created a demand for pharmacy
services. When I began as director we had 44 pharmacists so we are now up to 180
and that isn’t due to anything I did, it was about identifying individuals who
were trained and really committed to patient care. I always say that I’m
passionate about this profession and about patients, one of the residents a
number of years ago created a button for for pharmacy week that says must love
pharmacy and it was based on conversations I’d had with with staff
about you know every patient, every medication, every dose that we evaluate,
dispense, and administer to patients counts because any one of those can
cause harm or can cause good which is the the ultimate goal is to treat the
patient’s underlying condition. So over the years it’s been really really
important as we recruit and hire people to help them continue to advance and
develop their knowledge and skills and let them utilize and leverage their
passion on for the behalf of our patients and I think that’s probably why
we’ve grown so much is that as physicians and nurses interact with
pharmacists they see what a vital role we play because medications are the
mainstay of treating underlying conditions. So when I think about
what’s important to individuals who are looking at and how they want to spend
their career it’s really finding a place that really cares not only about
patients because that’s our first and foremost responsibility but an
environment that’s going to help individuals grow and develop and nurture
them and and really that is that is our primary mission here I always say to the
pharmacist “My first responsibility is to our patients, my second responsibilities
to each of you to help you figure out what your passion is and to help you
leverage your knowledge and your background to achieve your your personal
goals” because if if if we’re able to do that then the
beneficiary of that is our patients and what’s more important than that?

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