Not many people know what a clinical pharmacist is or what we do. It is best to explain by describing a typical day at my workplace.
I start off by visiting my allocated wards. Currently I am the clinical pharmacist in the medical ward. In the morning, I review new patients’ medication histories and assess the medicines they have brought with them. Then, I check their compliance to the medications.
Active participation in the ward rounds is crucial to my routine. During ward rounds, I review patients’ drug charts, observation charts and investigation results. When a doctor prescribes a medication, I check the prescription to ensure rational use of drugs. I look at the indication(s) and make sure it is the right drug, dose, and duration. I also ensure it is served at the appropriate time. This is important especially for patients with renal or hepatic impairment as dosing adjustments may be necessary. I make the appropriate interventions by informing the doctor and documenting the required action. This is to ensure that all patients receive the correct medications and achieve the optimal therapeutic effect.
My role is also to identify, prevent and reduce the incidence of adverse drug reactions (ADR) and allergic reactions. Once ADR is detected, it needs to be reported. When an allergic reaction is identified, the patient affected needs to be issued an allergy card.
In addition to the above, I play an important part in Therapeutic Drug Monitoring (TDM) services. TDM is the clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patient’s bloodstream, therefore optimising individual dosage regimes. At my workplace, drugs requiring TDM services include antibiotics like aminoglycosides and vancomycin, anticonvulsants, paracetamol and theophylline. Patients with epilepsy require TDM services to indicate whether the patient is compliant to medications or if adjustments are necessary. As a clinical pharmacist, I advise doctors on which drugs need TDM, when to take the samples and how to interpret the results.
After ward rounds, I collect the discharge prescriptions for patients leaving the hospital that day. The discharge medications are filled and dispensed at the patients’ bedsides. I counsel the patients to make sure they are aware of what they have been prescribed and give instructions on how to take the medications given.
The rest of the day is spent reviewing patient profiles, their medical histories, treatment progress, investigation results and providing additional patient education on how to take the prescribed medications. Counseling is given to patients on special medical devices like metered dose inhaler and insulin pen, or high-risk drugs like warfarin. Patients who are not compliant to medications are also assessed and given advice on adhering to a treatment regime.
Working as a clinical pharmacist is both busy and challenging. However, I enjoy my work and hope that my clinical knowledge and experience can help in improving patients’ health outcomes.
Ny Shy Pyng is a clinical pharmacist working in a government hospital.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]