Most of my days start by walking into the pharmacy and asking my team at Fresno Heart & Surgical Hospital “How can I help?” The pharmacy team consists of pharmacists, pharmacy technicians, pharmacy students, and other personnel who work together to match the correct prescribed medicine to the patient order and check for the appropriate dose, route, frequency and dosage form (whether it should be topical, oral, injected, etc.)
 
We also validate the integrity of the drug itself, by visually inspecting for any particulate contamination in parenteral preparations for injections, ensuring protective packaging such as a light protective wrapper is intact, and checking that our expiration dates reflect manufacturer recommendations and professional guidelines… All the while we work briskly to verify and deliver orders in a timely manner to waiting surgical patients and their doctors and nurses. We couldn’t do it without incredible team work and communication.

Team huddles keep us in the know

Every day, the pharmacists lead a team huddle to go over any changes, updates, or any other important news. We discuss our current inventory and explore alternative suppliers for medications affected by national drug shortages. With some medications that are no longer being manufactured, our pharmacists and buyer team work together to purchase alternative products and notify ordering prescribers.
 
In keeping up with changing regulations regarding the IV sterile room, our IV leads go over areas of improvement such as our cleaning workflow and cleaning product changes. We also take time during our huddles to acknowledge a team member who helped complete a special project or picked up some extra shifts during a time of staffing shortage. Those huddle discussions are transcribed and attached to email so that our evening and night staff can stay in the loop.

Multi-tasking is our middle name

The pharmacists here wear many hats, are super multi-taskers and adapt quickly to urgent needs. It is not uncommon to go from verifying orders in the queue to checking in the daily deliveries from our wholesale distributer, to checking doses readied for send out into the IV room, to checking our TPN compounder (a computerized machine we use daily to make IV nutrition for patients unable to eat) and then back out to sign off medication refills to go into our Pyxis med stations. The Pyxis are automated dispensing cabinets that we refill with medications and from where doctors and nurses pull medications to give to patients.
 
In between the multiple medication checks, we answer calls from nurses asking about IV compatibility, from physicians asking us to help perform medication reconciliation or to adjust a medication dose for kidney dysfunction, and from staff asking us to troubleshoot a problem in Pyxis or our electronic medical record system, Epic.
 
We also refill and replace emergency medication kits, audit our processes and medication supplies for hospital regulatory agencies and compliance purposes, review reports concerning any potential movement of a controlled substance to an unintended person, plan for any national drug shortages and recalls, and analyze our inventory  to see how we can save on costs.

Our biggest challenges these days

We face the same problems hospitals pharmacists do across the nation – mostly the challenge of extreme drug shortages and how to minimize the worsening opioid epidemic.
 
There has been a plethora of drug shortages due to drug manufacturer consolidations, recalls of improperly made medications, and most recently, natural disasters such as hurricanes that greatly impact our pharmacy and hospital. Emergency syringe medications that are stocked in crash carts have been in such a severe shortage that the FDA allowed certain lots of syringes to be used beyond the expiration date printed on the package and allowed imports from some international sources. We are combating this issue by removing affected medications from our Pyxis automated medication dispensing units and by keeping tight inventory. We are also purchasing directly from the manufacturer, and communicating with our other hospitals to share any unused medications so that nothing goes to waste.
 
Since the majority of our patients are cardiac and bariatric surgery patients at Fresno Heart & Surgical, pain management, particularly after surgery, is an area we’re focusing on. Given the national epidemic of opioid addiction and overdoses, we’re working to decrease the use of opioids while still managing pain symptoms so that patients are able to recover and go home. Here, our bariatric surgeons are using non-opioid medications before, during, and after surgery in efforts to minimize the possibility of addiction. We are working with them to provide non-opioid medications in various Pyxis units so that these medications are readily available for each phase of care that the patient is in. For patients that may have swallowing difficulties after surgery, we procured liquid formulations of the medications the surgeons are requesting so that patients are able to take medications that might otherwise come in a large pill.
 
We have defined shifts with associated responsibilities but that doesn’t mean we don’t step out and help out where needed. We often deliver medications to patient rooms ourselves and step into the IV room to make an IV mixture urgently needed for surgery if the assigned pharmacy technician is unavailable. There is a tremendous amount of cooperation and camaraderie that allows us to work through our busy and challenging days – and ensure our patients, nurses and physicians have exactly the medication they need at exactly when they need it. I love this busy, challenging job helping doctors and nurses care for our patients.

Diana Viet
Pharmacist Clinical Specialist
Fresno Heart & Surgical Hospital