The Department of Pharmacy Services initiates and participates in interdisciplinary efforts to provide favorable outcomes from drug therapy. The services benefit our patients and other members of the health care team through:
• Assessment of and active participation in the medication use process • Efficient procurement, preparation, and distribution of drug products • Provision of education and clinical information to patients, caregivers, and health care professionals
Assessment of and Active Participation in the Medication Use Process
Pharmacists at Meriter Hospital provide clinical consultation and patient monitoring in various areas throughout the hospital, especially in the critical care, medical, surgical, cardiology, and neonatal intensive care units. The extent of clinical consultative and monitoring services includes, but is not limited to, the following:
• Drug information for physicians, nurses and patients. • Drug therapy and dosage adjustments for patients with renal compromise or liver disease. • Drug interaction and adverse drug reaction screening and reporting. • Pharmacokinetic consultations • Fluid and electrolyte consultation and monitoring. • Consultation for monitoring patients with acute coronary • Code Blue response • Warfarin teaching program for patients • Medication reconciliation
Additionally, the pharmacy department provides specialty pharmacy services in the following areas:
Drug Information Center
Drug information services are provided to patients and health professionals associated with Meriter Health Services. The center is staffed on weekdays by the pharmacy drug information specialist. The services provided through the drug information center include:
• Answering patient-specific drug information questions in a complete, timely and unbiased manner. • Supporting educational and teaching activities for professional staff through provision of drug information. • Preparing informative, unbiased, comparative evaluations of medications for the Pharmacy and Therapeutics Committee • Maintaining the Meriter Hospital Drug Formulary and Therapeutic Interchange program. • Supporting the medication use evaluation program, adverse drug reaction reporting system, and medication incident reporting program. • Actively participate in and promote hospital-wide patient safety initiatives
Infectious Disease Service
Clinical pharmacy services that ensure optimal antimicrobial therapy are provided to all adult inpatient areas of the hospital via the pharmacy specialist in infectious diseases. These activities serve to complement the responsibilities of the infectious disease physicians and infection control practitioners. Activities of the specialist include:
• Screening antimicrobial therapy profiles to detect inappropriate drug combinations and/or dosing regimens. • Reviewing culture and susceptibility reports to initiate or modify antimicrobial therapy. • Consulting with physicians to modify drug choice, dose, route, and duration of antimicrobial therapy. • Supervision of pharmacist-managed dosing of aminoglycosides and vancomycin. • Assisting in the design of treatment guidelines for various infections and for specific antimicrobial agents. • Surveillance of antimicrobial susceptibility results to detect trends in resistance and to recommend changes in reporting strategies. • Assessing new antimicrobial agents for formulary status. • Educating health professionals about emerging issues in antimicrobial therapy. • Ensuring pneumococcal and/or influenza vaccination in eligible patients.
Nutrition Support Team
A multidisciplinary nutrition support team provides nutrition support services for inpatients at Meriter Hospital. Pharmacists who staff the nutrition support team have primary responsibility for the management of parenteral nutrition regimens. This responsibility includes:
• Screening patients to determine appropriate candidates for parenteral nutrition. • Assessing the nutritional status of patients in conjunction with the clinical dietitian. • Formulating the composition of and ordering patient specific total nutrient admixtures. • Daily evaluation of each patient’s clinical status and documentation in the medical record. • Participate in developing nutritional care plans for patients who require parenteral nutrition. • Formulate patient-specific total nutrient admixtures to meet each patient’s assessed nutritional needs, fluid & electrolyte requirements and targeted glucose control. • Reassess each patient’s clinical status on a daily basis and document changes made in the in the medical record.
Pharmacists also monitor patients who are receiving enteral nutrition. They focus on optimizing drug product selection specifically related to route of drug administration, fluid and electrolyte considerations, and drug-nutrient interactions.
A specialist in perinatal pharmacotherapy provides clinical pharmacy services to the Neonatal Intensive Care Unit (NICU), Obstetrics and Pediatrics units of the hospital. Primary responsibilities of the specialist are to the NICU with consultative services to the other areas. Responsibilities of the specialist include:
• Attending daily work rounds with the medical team and providing consultation regarding appropriate drug therapy in neonatal patients. • Assessing nutritional requirements and implementing and modifying parenteral nutrition regimens for neonatal patients. • Providing pharmacokinetic evaluation of medications with drug selection and dosing recommendations. • Providing medication teaching for families of patients discharged from the unit. • Teaching medical residents and students on rotation in the NICU. • Providing drug information and expertise to other health care providers in any of these patient care areas.
Critical Care Service
A critical care specialist, along with clinical pharmacists, provides a variety of services to the Adult Intensive Care Unit of the hospital. They work together with the critical care physicians, nurses and other health care professionals on a daily basis to ensure the best care for the patients that they serve. Services that are provided to these patients include:
• Daily monitoring of patient charts to identify potential medication related problems. • Evaluate, provide dosing recommendations and monitor patients on a variety of pharmacy dosing protocols. • Provide consultative services to physicians and other health care professionals relating to pharmacotherapy issues. • Respond to Code Blue alerts and other emergencies throughout the hospital, including the emergency room. • Provide teaching to students and residents in the ICU
Clinical pharmacy services are provided to peri-operative patients who require intensive glucose management and/or anticoagulation initiation and monitoring. Clinical pharmacists provide services that include:
• Pre-operative screening to determine possible candidates for glucose management. • Initiate insulin therapy in patients who do not meet target blood glucose levels. • Transition glucose management patients to inpatient protocols within 24-48 hours after surgery. • Provide daily monitoring of post-operative orthopedic patients on the anticoagulation consult service. • Assess daily labs and modify warfarin treatment regimens as needed. • Evaluate potential drug and nutrient interactions. &bu
Efficient Procurement, Preparation, and Distribution of Drug Products
The pharmacy department includes a staff of 50 FTEs (30 professional staff and 20 support staff). Comprehensive pharmacy services are provided 24 hours a day, 7 days a week. These services to the hospital are facilitated by:
• Computerized patient profiles and order entry utilizing an integrated hospital-wide computer system. • Computerized medication administration records. • Distribution of pharmaceuticals from the central pharmacy. • Automated dispensing of oral solids • Complete IV admixture service including small and large volume parenterals, and total parenteral nutrition solutions. • Unit dose dispensing of medications with multiple daily medication exchanges. • Utilization of automated dispensing machines on the patient care units.
Provision of Education and Clinical Information to Patients, Caregivers, and Health Care Professionals
The pharmacy department is committed to teaching and advancing the level of pharmacy practice as evidenced by:
• The Pharmacy Practice Residency Program • Co-sponsorship (with the University of Wisconsin) of the Teaching Certificate Program for Pharmacy Residents. • Preceptorship of Doctor of Pharmacy students from the University of Wisconsin by our clinical specialists and pharmacists. • Weekly Pharmacy Journal Club. • Presentations at monthly Surgical and Medical Teaching conferences. • Presentations at Medical Grand Rounds and Perinatal Conference. • Pharmacists’ involvement in many local, state, and national professional organizations – including The Pharmacy Society of Wisconsin, ACCP, ASHP, ASM, and ASPEN. • The ACPE-accredited Pharmacy staff development program that includes monthly inservices on pertinent topics and issues in pharmacy practice.
Professional and support staffs are offered many opportunities for career and professional growth. The department nurtures this growth in many ways. Some of these include:
• Pharmacists’ active participation in and/or leadership of hospital interdisciplinary committees. • Support for attendance at state and national meetings. • Opportunities to explore new pharmacy practice models and develop new practice sites. • Networking with other practitioners. • Promoting advanced certification.