Featured, Professional Advice / Opinions:

The Future of Pharmacist Practice

By: Dr. Bernard Sorofman

Foreword: Dr. Bernard Sorofman is a pharmacy professor and Chair of Pharmacy Practice and Science, as well as the Executive Associate Dean at the College of Pharmacy for the University of Iowa. One of our student editors, Ebey P. Soman, had the privilege to attend and meet Dr. Sorofman at a “Lunch with a Leader” seminar hosted by Dean Mangione. Recently, the question of the direction our profession is heading towards has become a paramount focus of my interest. Thus, we asked Dr. Bernard Sorofman to be our guest author to provide his insight and vision as to what future we, as professionals, should strive towards.

The Rho Chi Post editors would like to take this opportunity to personally thank him for his insight.

I have been asked in the past, and now for this essay, what I see as the critical issues for pharmacists. Here is a case that illustrates for me my future for pharmacist practice.

A 70 year old woman of non-descript ethnic and religious background entered the pharmacy where one of my pharmacist colleagues practices. She was known to my colleague as one of their patients with whom he had worked for many years. The purpose of the visit was a complete medication review. She reported allergies to medicine and four different diagnoses that resulted in a current medication list of 11 different drugs. Important to this discussion was that she had a recent history of “3-4 blood clots.” The pharmacist had access to her laboratory values and noted that they (INR, specifically) were low, especially low for a person with recent clotting. He determined via the interview that she was not taking her warfarin. Here is where he focused.

The patient, Ms. BA, was not taking her warfarin. The reason was unusual. From the report: “She stated an aversion to medications that are the color blue. She reports not taking her potassium chloride because it is blue and it made her vomit.” The pharmacist determined that Ms. BA had been dispensed 4 mg generic warfarin tablets that were blue. The solution was obvious: find another generic manufacturer who did not have blue colored pills in the prescribed strength or alter the milligram strengths to fit the need. The situation was easily resolved and follow-up was planned for a week from the event in order to monitor the INR. Although thinking it strange, the pharmacist did not bring up the issue as an inappropriate concern. He took it seriously. After all, it was leading to non-adherence of a critical medication.

This case, unusual as it may appear to be, is a great example of what I see as the future for all pharmacist practices. The first is medication safety. Warfarin is a medication that should be managed carefully. The safety of a patient‘s health hinges on the monitoring and control of therapeutic levels. Such a medication, should it be misused or not used, can lead to adverse medical events. It is the pharmacist‘s role to assure safe medication practices. Second is the pharmacist‘s role and responsibility to assure that their patient gets the best outcome possible for their condition. Ms. BA needed the therapy to prevent adverse medical outcomes from blood clots. The pharmacist would find a way for her to have medicine she could take and established a monitoring plan to assure proper outcomes. Finally, the pharmacist assured that the patient had access to medication that she could and would use. The blue pill aversion was real and blue tablets were avoided. Whether you think it foolish or not, she would not take the blue medicine and it was a barrier to access to therapy. A solution was found.

I don‘t know the results of the follow-up by my colleague. I do know that he would follow up with her as it is his style of practice – assure appropriate access to pharmacotherapy for all his patients, create situations where medication safety is paramount, and assume responsibility for optimal outcomes by monitoring. There are pharmacists who practice like my colleague, but way too few. My future for pharmacist practice is when this is the norm. The blue pill situation is not the unusual part of the case here; it is the comprehensive way in which a pharmacist performed their role. I know many student pharmacists, and have seen many new practitioners enter practice. They give me confidence that the next generation of pharmacists, those now entering practice, will succeed in creating my vision.

Published by Rho Chi Post
Both comments and trackbacks are currently closed.