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Discussion

Do you have a unit-based pharmacist?

Hey all,

Do any of you have unit-based pharmacists? What exactly do they do? Are they effective?

I'm just curious because our pharmacy situation is getting out of control! We never have the drugs we need in the pyxis when we need them. The pharmacy is responsible for preparing our drips and unless the drug is a vasopressor it will take hours to get (imagine waiting for electrolyte replacement for critically low levels or frantically calling every 10 minutes for Heparin). It's frustrating and I wonder if having a unit-based pharmacist might alleviate some of our issues.

So how does it work in your unit?

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  • Experts

On the unit where I currently work, we only have a clinical pharmacist assigned to the unit for consultations only. We do all of our own drips, spend tons of time on the phone tracking down missing meds, arguing with techs that the not-in-Pyxis antibiotic orders were scanned "stat" and the stuff hasn't come, we are completely out of KPO4 because we've got four CRRTs running and so on. It's really quite pathetic.

Where I worked before, we had a satellite pharmacy right on the unit. All our drugs came to the bedside as unit doses and all our drips were mixed by the pharmacist under the hood. The routine meds for the day would be brought out at midnight and put at the bedside in the patient's med cupboard. Antibiotics were brought out 30 minutes before the dose was due. Drips were kept track of by the phamacist and when they were due to expire, a new bag or syringe would just appear. When we had kids with metabolic disorders and were changing the composition of their cocktails with every lab result, the pharmacist took care of it. And when there was a code anywhere in the hospital the pharmacist attended to draw up the drugs and keep track of how many doses of what had been given and when. Med errors were few and far between. Can't say that about where I work now.

We have a unit based pharmacist :redbeathe! I can't imagine not having one.

I can be in a room and yell out a question of compatibility and they will look it up for me (or just know it) and they help with everything. If the pyxis isn't stocked she will call and inform mail pharmacy. If the pt is going south she will mix our levophed, or bring over the code cart, or even clarify/correct the mistakes the young residents make when writing orders. For instance, when starting Xigris, we have this big ol form to fill out to find out if the pt is indicated. She will actually look up the labs and fill out the form for me. Stuff like that. Love our pharmacist!

When she is here, I never have to call the pharmacy-ever. It's actually a big pain to work weekends because we don't have her.

We have a unit pharmacist and respiratory therapist in my level one ICU. They are always immediately present during codes.

Our pharmacy has a satellite office on the unit, but we still end up mixing a lot of our pressors and stat cardiac drugs that aren't in the pyxis. Plus...they are long gone by the time night shift rolls around so you have to call pharmacy at the beginning of your shift and let them know how many bags of insulin or vasopressin you think you might need by the end of the shift. Sometimes you end up mixing that yourself anyway!

Our pharmacy has a satellite office on the unit, but we still end up mixing a lot of our pressors and stat cardiac drugs that aren't in the pyxis. Plus...they are long gone by the time night shift rolls around so you have to call pharmacy at the beginning of your shift and let them know how many bags of insulin or vasopressin you think you might need by the end of the shift. Sometimes you end up mixing that yourself anyway!

We mix all our own drugs on the unit (except for morphine sulphate 50mg for pca). We spend so much time ordering drugs, chasing orders and going to collect them, it is a real waste of time. The thought of having things mixed for us sounds great, but can't see it happening here.

We had so many problems with tardy/missing meds and anesthesiologist complaints (Rx policy won't let them mix their own meds for routine cases) we now have a satellite pharmacy located between (and within shouting distance:icon_hug:) of the CV & Surgical ICUs and the Main OR. All ICU orders are scanned directly to this pharmacy, so they never become part of the main hospital's PYXIS queue. Right now they are doing an antibiotic time study that tracks order, delivery, and dispense times-- so techs will actually hand deliver them to the bedside. The pharmacist also responds to all codes in CV and SICU, and has the designated "scribe" role. Many times they are the ones who are calling out Rx suggestions or letting us know that it is time for more epi, etc.

When I worked in the Trauma ICU we had a unit based pharm-D. She/he was heaven sent. They made rounds with the docs and were efficient with problem solving as well as a great resource.

An invaluable service.

We have a unit-based pharmacist on our unit. They make rounds with the doctors/residents and they are a really good resource to ask questions to. Almost all our meds come up mixed already, but I'm sure they would assist if needed. The most common thing I go to them for is the doc orders PO meds that could be liquid or just not crushed, and the patient has an NG tube, so I talk to them about changing things. I like have the pharmacist on the floor. They are extremely useful.

For the SICU where I work, we have a unit based pharmacist untiil 11pm.

Where I work, they have a unit based pharmacist during day shift, but at night we do not. We have to fax all of our orders down to pharmacy and then they tube us the meds. Sometimes we do have an issue getting medications in a timely manner at night and occasionally it takes several frantic phone calls to get what we need. If we have a code, the pharmacist and usually a tech come to wherever the code is and prepare meds, answer med questions, etc.

  • Experts

Since our pharmacy staff goes home at 2230 every night, we'd better have all the drugs we need ordered by about 2000 hours. We have a night cupboard but it doesn't hold everything. Sometimes we call around to other units to see if they have it in their Pyxis, which sometimes works. PEds ER comes to our unit all the time for certain antibiotics and for concentrated electrolytes. When we have to call in the on-call pharmacist for something that could have (should have?) been ordered earlier, we get in deep doo-doo.

When we have to call in the on-call pharmacist for something that could have (should have?) been ordered earlier, we get in deep doo-doo.

I had to make sure I read that correctly...your hospital has no pharmacy on the night shift? wow. I wouldn't hesitate calling the on-call Rx for new orders. Perhaps if they get bugged enough, they'd give you some coverage.

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