The many hats pharmacists wear

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Lee Choy Ee
B.Pharm, R.Ph

Gan Pou Wee
M.Pharm, MBBS, BCPS, R.Ph

John Tiong
M.Pharm, Ph.D, R.Ph

 

Recently, a student’s lament on not being able to secure a place in the pharmacy course in a public university went viral overnight. While we sincerely sympathize with his frustration, we also hope to dispel the misunderstandings some may have towards the Pharmacy course and also the Pharmacy profession. Contrary to common belief, the course itself is not easy. We would not like to make any comparisons to other courses as it would be unfair and baseless in addition to going beyond the scope of this article.

In this article we would like to share the many facets of the Pharmacy profession apart from the narrow “dispensing medications only” job description. Moreover, dispensing medicine is also not a walk in the park as most may think. What we present here is just a snippet for the many roles that a pharmacist can play and certainly is not exhaustive.

 

Here are some examples

 

Hospital-Based Pharmacist

Hospital-based pharmacists play many roles in the hospital from dispensing medications, to ward rounds and even compounding injections for patients. Moreover, they have to be on-call or work shifts to provide round-the-clock dispensing services and therapeutic drug monitoring services.

 

Outpatient pharmacist

This is the pharmacist that does dispensing of medications most of the time.

They are also the “face” of pharmacy as they have the most patient contact. Although seemingly easy, dispensing medications isn’t just slapping a label on the medication. Pharmacists are the last line of defence in making sure the right medication is given to the right person at the right dose with the right instructions. Once a prescription arrives, a complex system of checks and counterchecks are made before dispensing the medications along with advice to the patient on the medications they are about to take. To read more on the complexity of dispensing medications, click here.

 

Inpatient pharmacist

These are pharmacists who take care of medications for patients who are currently staying in the ward.

Similar to outpatient pharmacists, they are also guardians against medication errors. After checking and counter-checking that the medications are correct, the medications are sent to the ward for nurses and doctors to administer to patients.

 

Clinical Pharmacist

Clinical pharmacists provide direct patient care in wards.

Daily routine includes wards rounds with doctors, recommending the appropriate medications for patients and even identify untreated health issues that might improve with medications. Moreover, clinical pharmacists provide information about potential side effects and monitor the effects of treatment to ensure that it is safe and effective. This is especially challenging as they need to work closely with doctors, nurses and other members of multidisciplinary teams as well as to stay up to date with all aspects of medicines, their usage and new developments.

 

Therapeutic Drug Monitoring (TDM) Pharmacist

TDM pharmacists would run the patient’s blood sample through specialised machines to determine the concentration of medication in the blood.

They would then calculate whether the concentration is too low, too high, toxic or just right and make relevant recommendations on the appropriate dose of the medication to be administered thereafter .  They work hand-in-hand with doctors and clinical pharmacists to provide optimal care in patients. As mentioned previously, they are required to be on-call in case there are medication poisoning cases where blood samples need to be run immediately.

 

Cytotoxic Drug Reconstitution (CDR) Pharmacist

Cytotoxic drugs are mostly anti-cancer medications and can be very harmful to humans.

These medications usually come in small vials of high concentrations, too high to be injected directly into humans without dilution.  CDR pharmacists take on this dangerous role, wearing “space-suits” like protections suits, they work in a clean room to dilute these drugs and prepare them for patient administration. They also triple check the doses of cytotoxic drugs to make sure they are right for the patient.

 

Total Parenteral Nutrition (TPN) Pharmacist

In patients who are unable to take food via the oral route for any reason, clinical pharmacists may recommend or doctors may order for TPN.

TPN is giving food through a continuous injection directly into the patient’s blood. This requires the skills of a TPN pharmacist who will calculate the number of calories, protein, fat and carbohydrate contents according to the patient’s body weight, current medical condition, etc. They will then choose a suitable ready-made formula, or if no ready-made formula is suitable, then compound a special formula just for the patient from different ingredients.

 

Drug Information Pharmacist

Who does a doctor or a nurse call when they have a question on medications?

The drug information pharmacist! They handle enquiries from healthcare professionals. More than often, these questions may be  complex, where the drug information pharmacist would have to look through numerous research papers to give a complete answer. They also compile the hospital drug formulary and are in charge of many drug related committees.

 

Medications Therapeutics Adherence Clinic (MTAC) Pharmacist

MTAC are clinics run by pharmacists to ensure medication compliance and to provide extra counselling.

Numerous disciplines are covered by MTAC such as diabetes, asthma, heart failure, warfarin, etc. The pharmacist may run blood tests and also change doses of drugs accordingly in these clinics.

 

Store Pharmacist

Store pharmacists have shed most of their clinical roles and went on to assume a more administrative role.

They meet suppliers, run the medication store to ensure that there is enough medication to run the hospital . They are in-charge of the budget and work very hard to ensure that the hospital does not overspend while keeping wastage (such as expired drugs) to the minimum.

 

Research Pharmacist

These pharmacist, unlike those in the academia, are focused on clinical research instead.

Clinical research is running studies on real patients rather than laboratory work. Research Pharmacists play a role in explaining the purpose of the study, the medications, side-effects, risks, benefits, etc to the participants of the study. They also take charge of collecting data, ensuring the drug supply chain is maintained.

 

Community Pharmacists

Community pharmacists are the pharmacists we see manning pharmacies outside of hospital settings.

Although their role appears to be similar to that of an outpatient pharmacist in hospitals, they are much more than that. Some are business owners or partners of the pharmacies they run. Hence they are also the store’s manager, and are in-charge of stock supplies, human resource, marketing, etc. Furthermore, not only do they have to dispense medications, they have to diagnose minor ailments such as a cold or an allergy and dispense appropriate medications. They also need to be vigilant and identify situations where the patients should see a doctor and refer them accordingly.

 

Academia and research

Pharmacists with postgraduate degrees may enter into the world of academia to train future pharmacists and to conduct cutting edge research in medical/pharmaceutical sciences.

Pharmacy educators are involved in teaching, supervision, research, grant applications, research paper publications and review as well as attending conferences to speak on their research findings. The job scope may be wide and the hours might be long but nothing beats the satisfaction of nurturing the future healthcare professionals which makes a huge difference to the society.

 

Pharmaceutical industry

Pharmacists are employed by pharmaceutical companies to deal with regulatory matters pertaining to the registration and quality control of medicines, medical devices and cosmetics in compliance with both national and international regulations.

They are also involved in drug safety monitoring (pharmacovigilance) by collecting and reporting data on adverse effects of medications and other pharmaceutical products. Others are engaged as medical affairs or medical scientific officers who would serve as scientific experts to their colleagues as well as establishing a good rapport with the medical fraternity.

The purview of industrial production pharmacists on the other hand, encompasses the quality control of manufacturing processes in compliance with good manufacturing practice as well monitoring of company supply chain (distribution, import and export).

 

National health and drug policy as well as enforcement.

Pharmacists attached to pharmaceutical affairs under government agencies are involved in formulating health and drug policies including their enforcement.

Likewise, they are also tasked with regulating the pharmacy profession. Furthermore, they work closely with professional pharmacy bodies and universities in devising and improvement of pharmacy curricula. In in all, the successful implementation of national laws and policies governing health and drugs is important to ensure an orderly and efficient health care system in the country.

 

The authors of this article have tried to keep this article as brief as possible, but the hats that pharmacists wear are just too many. This barely offers a glimpse into who pharmacists are and what roles they play other than just “dispensing medications”.

 

Image credit: https://www.sig-is.org/images/branding2_six_pharmacists.jpg

 

 

 

 

 

 

 

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