Manitoba Pharmacists

02 YOUR HEALTH YOUR PHARMACIST Paging the hospital pharmacist By Jim Timlick ommercially available medications work fine for most people. However, one size fits all solutions may not be appropriate for a specific patient. When an off-the-shelf medication won't work for you, compounding pharmacists work with your doctor to make a medication from scratch to meet your specific needs. Common compounded dosage forms include Gummy bears, lollipops, topical medications that are absorbed through the skin (creams, ointments, gels, lotions), loz- enges and troches that dissolve under the tongue, nasal sprays, eye and ear drops and many more. Compounding offers solutions to people who: • Need a specific strength of a medication that isn't commercially available. • Have difficulty taking their medication. Maybe they need it in liquid form, or chewable form or in a form that can be absorbed through the skin. Compounding can change the form of the medication to one that the patient is able to use. • Have allergies to preservatives, perfumes, flavours and dyes. When a medication is compounded we can control exactly which additives go into each compound. • Need a medication that isn't available anymore. Some medications go off the market. This can be very distress- ing for people who have successfully used those medica- tions for years. In some cases, a compounding pharmacy can re-create a discontinued medication. pharmaCists Can provide different types of Compounding serviCes: • Hormone treatments for both men and women. Un- der the direction of a physician, a compounding phar- macy can compound hormone creams, troches, capsules, suppositories and other dosage forms to help balance the hormones. • Pediatric preparations. A compounding pharmacy can make small-dose forms, low-dosage forms, flavoured forms and other modifications to help your child. • Pain medications. Pharmacists can work with your doctor to help treat your pain. Oral pain medications and medications that are usually injected can be com- pounded in a topical form that can be rubbed on the skin. They may be used to treat a sore joint, painful wounds or neuropathic pain conditions like shingles and diabetic nerve pain. • Calming medications. Sometimes, nursing home pa- tients with dementia go into delirium. They can become aggressive and may pose a real hazard to themselves and others. There are medications that can be given to calm the patients. However, administering a medication in pill form or via injection may be traumatic for both the pa- tient and the caregiver. In that case, a topical cream offers a solution. A nurse can sit with the agitated patient and rub the cream into their wrist, which can be a calming action in itself. • Medications for your pet. Ever tried to get medication past the sharp pointy teeth of your cat? Wouldn't it be easier if you could rub it into their ear? Doesn't your dog want medications shaped like little dog bones? Ferrets are too small to take commercially available dog medica- tions. A compounding pharmacist can get the right dose for them. They can work with your veterinarian to help out the furry, scaly or feathered members of your family. Let your compounding pharmacist's imagination help you. He or she can work with you and your physician, vet or dentist to come up with a solution to your most pressing problems with prescription medication. ■ C Custom Care Medications made to order When off-the-shelf medications won't work for you, compounding pharmacists can help create medica- tions from scratch to meet your specific needs. Photo by the manitoba Society of Pharmacists Compounding pharmacists practice the time-honoured art and science of preparing personalized medications. Hospital pharmacists like Travis Warner are actively involved in determining individual health-care plans. Photo by Darcy Finley hey may not have catchy nicknames like Hawkeye or McDreamy, but they do play a key role in the delivery of patient care at hospitals throughout the province. Although you aren't likely to see a hospital pharmacist on an episode of Grey's Anatomy or Saving Hope, odds are you've come face-to-face with one if you've recently spent any significant amount of time in hospital as a patient. While they once laboured in anonymity dispensing prescriptions in the bowels of health-care facilities, hospital pharmacists now play a frontline role in the treatment of patients. They take part in rounds with physicians and nurses, consult with patients and play an integral role in determining a drug therapy plan as part of each individual's health-care team. "People are kind of surprised there are pharmacists in hospitals. We're al- ways around, we're just not as visible as other health team members," says Travis Warner, a clinical pharmacist at St. Boniface Hospital. Warner says the role of a hospital pharmacist has become far more proac- tive in recent years. While a big part of their job is still to act as a safety net to ensure patients receive the correct medication and the proper dosage, they are far more involved in determining individual health-care plans. "It's a very active discussion between ourselves and the rest of the medical team. It's a very collaborative process," Warner says. Jamie Falk, an assistant professor with the College of Pharmacy in the Uni- versity of Manitoba's Faculty of Health Sciences, says this more collaborative approach has resulted in an improved flow of information and better care for patients. Meeting face-to-face provides a hospital pharmacist with a far better under- standing of a patient's condition, Falk says, and allows them to determine a therapy plan best suited to their needs. It also allow pharmacists to explain to the patient why a particular drug therapy has been chosen and answer any questions they might have. "Knowing where the decision is coming from and why someone has come to it…is far better than if you are just receiving an order from the phar- macy," he says. Another key part of a clinical pharmacist's role is investigating a patient's drug history and determining a medication reconciliation so the meds they receive in hospital match those they are taking at home. "It's when people experience a transition in care where there is the great- est risk of something going wrong," Warner says. "Part of our role is to pay close attention so we are not missing anything and we're doing things as they should be done." That attention to detail doesn't end even if the patient's stay is about to. Hospital pharmacists usually meet one last time with a patient prior to them being discharged to provide counselling on any medications they might require and to answer any questions. "The education aspect is very important," Warner says. "It's very gratifying to help people understand what is going on and how they can deal with it." ■ T

• Cover