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This is Part Three in a three-part series on pharmacist prescribing. Part One provides an overview of pharmacist prescribing and Part Two reviews prescribing in community settings.

Clinical pharmacists can now be found working on many hospital units. Professional collaboration with the care team puts these pharmacists in an excellent position to improve and streamline the care of hospitalized patients.

As I’ve highlighted in previous posts, pharmacists are now able to prescribe most medications. In addition to the more traditional prescribers such as physicians, surgeons, and dentists, you’ll now encounter other prescribers that can include nurse practitioners, physician assistants, midwives, and clinical pharmacists, inside the walls of many hospitals.

Why should hospital pharmacists prescribe?

The reason is that the clinical pharmacist focuses exclusively on medication therapy to make certain each medication is used effectively and safely. This role is especially important when you have multiple prescribers involved in the care of a patient.

For example, patients who are in intensive care will have a primary intensive care medical team which includes one chief physician, commonly referred to as the attending physician, and possibly several other physicians in training, called residents and fellows. In addition to the primary care team, there could be a consulting surgeon who has operated on the patient. And then you might have another physician such as an infectious diseases specialist who has been asked to assist with the management of a complex infection.

As you can see from this example there are many potential prescribers who each may recommend specific medication(s). This typical scenario positions the clinical pharmacist to coordinate all the medication related needs of the patient. The pharmacist can optimize medication doses, manage drug interactions, and liaise with the different prescribers. Pharmacist prescribing enables us to collaboratively coordinate and optimize the complex medication regimens of patients.

Another example of pharmacist prescribing includes assisting with the routine prescribing workload when working within a hospital team. Patients are frequently discharged rapidly from the hospital and there are situations where a discharge prescription has not yet been written. In this scenario, the pharmacist can discuss the discharge plan and raise any discharge questions with the physician, write the discharge prescription, and teach the patient about their discharge medications. In this circumstance pharmacist prescribing can enhance the discharge process and can minimize delays for patients.

To ensure safe and improved hospital care prescribing pharmacists are ideally embedded within a collaborative interdisciplinary team. The team and the pharmacist should be clear as to the expected prescribing standards. When deployed thoughtfully and correctly, pharmacist prescribing can certainly improve the timeliness of medication availability, medication dose optimization, and patient discharges. Pharmacist prescribing should not be viewed as a means to replace the majority of prescribing that routinely occurs in the hospital.

Photo courtesy of Richard Saxon via Flickr.