Chris, a pharmacy student, asked me how community and hospital pharmacists can improve their work relationships. I think pharmacists can always improve how they work. And the primary area for improvement is enhanced communication.
Pharmacists have worked in most large hospitals for decades. Their role was often confined to the hospital pharmacy with an almost exclusive focus on dispensing medications. Hospitals and pharmacy departments have evolved and now include increased numbers of trained pharmacy technicians. This allowed for the development of clinical pharmacists who work on the hospital ward. I have extensive experience as a hospital clinical pharmacist.
For the first three years of my career, I also worked in a community pharmacy located near a large hospital. I became skilled at tracking down hospital physicians to clarify the occasional discharge prescription.
In this post, I’ve incorporated both these perspectives to create tips for patients and their pharmacists. Clear pharmacist communication can prevent a medication misadventure. Most errors in healthcare are a result of communication breakdown. Strengthening community and hospital pharmacist communication will provide better quality and safer patient care.
Tips for hospital pharmacists
- Notify community pharmacist when patient is admitted, discharged or deceased: Patients are often too ill or forget to inform their community pharmacist when they are admitted to hospital. Hospital pharmacist should notify the community pharmacist when their patient is admitted. This is often the time where the hospital pharmacist confirms the patient’s home medication list. Hospital pharmacists should tell the community pharmacist when their patient dies in hospital. There are many stories of community pharmacists going to fill medications or attempt to call a family/patient, only to find out later that they are deceased.
- Inform the community pharmacist of new drug allergies: Patients can have severe side effects or experience allergies to medications while in hospital. This crucial information is either never communicated or is delayed in reaching the community pharmacist. When you are preparing to go home, your hospital pharmacist should review any new drug allergies or intolerances with your community pharmacist.
- Provide handoff at discharge: Handoff is the transfer of authority and information to another healthcare professional. At discharge, your hospital pharmacist can handoff your care to your community pharmacist. The hospital pharmacist should provide a brief summary of the main problems in hospital, explain the reasons for stopping, starting or changing medications, and discuss important follow-up appointments or tests.
- Anticipate medication insurance coverage problems: For less common drugs and in particular, very expensive drugs, your hospital pharmacist can begin to identify and solve medication coverage problems. Any work on obtaining medication coverage should be communicated to your community pharmacist.
- Teach hospital prescribers the fundamentals of good prescribing: Hospital pharmacist must coach hospital prescribers (e.g., physicians, medical students/residents, nurse practitioners) on how to correctly write clear, legible, and prescriptions. Every discharge prescription should clearly indicate the prescriber’s name and the telephone number.
Tips for community pharmacists
Community pharmacists play a significant, but largely unseen role, in helping you when you are hospitalized. They provide your medication list and unique insights about your medication experience to hospital based health professionals.
- Maintain an updated medication list: Your medication list is essential information when you are hospitalized. At every visit, patients should review their medication list with their community pharmacist to ensure the records are up to date.
- Identify medication coverage problems and medication availability problems: Your community pharmacist should review all new discharge medications and start to identify potential problems with medication coverage. The community pharmacist must ensure they have an adequate supply of your prescribed medications.
- Learn to navigate the local hospital’s communication system: Community pharmacists may clarify medications when a patient is discharged from hospital. Due to limited resources, hospital pharmacists are not always involved in every patient discharge. Community pharmacists need to learn how to navigate their local hospital switchboards, to contact the prescriber who wrote the discharge prescription.
- Prepare for handoff: Community pharmacist can now take an active role in the follow-up monitoring (including laboratory results) when patients are discharged from hospital.
Enhanced communication between your community and hospital pharmacists can improve your hospital stay and discharge home. When you are hospitalized, find out if you have a hospital pharmacist assigned to your care. Don’t hesitate to ask the hospital pharmacist to communicate directly with your community pharmacist. If you don’t have a community pharmacist, choose one that you know, like, and trust. Your community pharmacist can share life-saving information about your health and medications if you ever find yourself admitted to the hospital.