Sunday, September 11, 2011

And Here is Your Box of Medications

Posted by Matthew Lewis at Sunday, September 11, 2011

The plan for Monday is to do our initial medication education for one of our very successful lung transplant patients. I have discharged two patients so far, one new and one who came in with a problem post transplant. They each had such different needs that it is definitely note worthy.

The old transplant patient had to come into have a surgical incision and drainage of the fluid between his lung and chest wall because a Candida albicans infection got so bad it was pushing on his lungs preventing breath. He also developed acute kidney failure due to his anti rejection medication tacrolimus having elevated levels secondary to an interaction with the fluconazole first prescribed to treat the chest infection. Surgery went well and eventually he was educated and discharged in much better shape than he came in. We made a large number of changes to his medications, but the patient and his wife had created their own medication spreadsheet with their own code and notes, so it was just a matter of writing down the new regimen and going over the two new medications (voriconazole for the C. albicans and dapsone to replace Bactrim single strength as PCP prophylaxis). We didn't even give the patient medications since he's a veteran he can go through the VA.

Now, the new transplant patient literally received a box of medications. I thought it was just an exaggeration, but there was a duffel bag inside a box filled with about 20 different pills, three insulins, a blood pressure cuff, diabetes testing supplies, since he had prednisone induced diabetes, there was a nice folder of all the medication guides and receipts, and a few other goodies. How many other pharmacists can claim that they give their patients duffel bags to contain all the patient's meds? However, this medication inundation comes with education to match. We take the time to show the patient every single medication so they can help catch dispensing errors because unintended interactions or wrong dosing can cause kidney damage, liver damage, graft (donated organ) rejection, or maybe even worse things. We also give the patient a schedule on how to take all their medication to avoid drug-drug side effects and help the patient get a grasp on what their new, medication filled lease on life is going to be like.

There is a lot of talk about how pharmacists deserve to be paid for counseling and able to bill insurance for things like medication therapy management. To really show what a pharmacist is capable of and how crucial they are, a transplant pharmacist should be used as an example to insurances and Congress. These pharmacists have to routinely manage patients who usually have 20 or more medications which consist of different dosing times, dosage forms, and will sometimes require interaction management for drugs that must be given together but have known interactions. The pharmacist here also has to make sure medications for multiple co-morbidities (which are a lot of times induced by required anti-rejection medications) are ordered and appropriate while inpatient. On top of that all, the transplant pharmacist must make sure that every medication ordered has a niche in the therapy of the patient because every chance to cut medications protects the patients from adverse reactions, drug interactions, and saves money. Who else can do that with the speed and accuracy of a pharmacist?

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