Professional Advice / Opinions:

Pain Management and Palliative Care

By:  Monica Correia, PharmD Candidate c/o 2013

This past year of advanced pharmacy rotations, has been a tremendous learning experience for me; I was exposed to the day to day functions and roles of pharmacists in a multitude of environments.  While each experience allowed me to focus on a different aspect of pharmacy, the rotation which left the biggest impact on my perspective of the role of pharmacists and patient care was in Pain Management and Palliative Care with Dr. Ahmed at Beth Israel Medical Center.  It was during this rotation that I became aware of the importance of working as a team member with other medical professionals to tailor care to individual patients.

One of the most vital concepts which I learned during my rotation was the necessity of creating goals of care for each patient. The majority of patients in the Pain Management and Palliative Care Unit were elderly, terminally ill cancer patients suffering from multiple comordities, such as, Alzheimer’s disease. They were patients who were unlikely to receive any benefits from cancer treatments aimed at delaying progression of their disease.  While these patients were in the Pain Management and Palliative Care Unit for end of life care, the medical team would establish attainable goals of care for each individual patient.  For many patients, a major goal of care was to ensure the patient’s comfort.  Therefore, before starting a medication, an assessment had to be made as to the benefits, risks, and side effects associated with treatment.  Each member of the medical team was able to provide input as to whether the medication and its dosing would be appropriate for the patient. The role of pharmacists and interns in this assessment was substantial.  By reviewing literature as to the efficacy and safety of medications, pharmacy members were able to contribute as to whether a medication’s benefits would outweigh the risks associated with therapy.  The medical team would also determine whether a medication with little benefit in a particular patient, should be used when the potential side effects imposed could cumbersome and compromise patient comfort. One example would be determining whether the use of Exelon patches in an elderly patient suffering for Alzheimer’s would be appropriate.  As part of the pharmacy team, we would review the literature concerning Exelon to determine its cost-effectiveness.

Another component of the rotation was providing inservices on drug therapy in the Pain Management and Palliative Care Unit.  These inservices were tailored for the needs of the medical members to which they were presented.  For instance, the  interns were responsible for creating an inservice handout for the nursing staff on non-steroidal anti-inflammatory drugs.  Since the information was for nursing staff, we focused on the administration of these medications and the monitoring parameters associated with them.  It was by performing inservices that we, as pharmacy interns, were able to share our knowledge pertaining to drug therapy with other members of the medical team.

All of the members of the Pain Management and Palliative Care Unit greatly welcomed the input of the pharmacy team, including the input of the students.  All of the attending physicians would ensure our involvement during patient rounds by asking us questions which would force us to delve into new medical literature concerning drug therapy.  It truly was a very hands-on experience that allowed me to apply knowledge from my course work and encourage me to continuously research for new information regarding patient therapy.  It served as a crucial experience for me; it taught me that pharmacists have the potential to greatly impact patient care using their drug information skills.  They are able to constantly provide input regarding appropriate drug therapy and monitoring, as part of the medical team.  Not only did this rotation help me to recognize that pharmacy has a very influential role in patient care, but it also helped me realize my potential to contribute to providing appropriate care.

Published by Rho Chi Post
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