10 September 2015:
The 3rd Year Makerere University Pharmacy Students started a new chapter of their training today at Mulago National Referral Hospital. It was their first day on the patient wards as active participants and not just observers. Their task today was light as they haven’t yet started to learn about diseases and their pharmacotherapy yet, but I wanted to get them out on the wards anyway, to put what they are learning into a more patient-centered perspective. So in class they studied adverse drug effects (ADE) (side effects) and drug-drug interactions (DDI) and the mechanisms of each. Instead of just having them do an assignment where they can research and study the ADE’s and DDI’s of common drugs, I felt that seeing patients who are taking these drugs and then learning about these issues would help them to experience the role of the pharmacist. If pharmacists are well-informed about the common ADE’s of drugs, they can help their patients avoid them or identify if an ADE is the reason the patient needed to come to the hospital and then recommend the offending drug be stopped. Likewise, if a pharmacist can review a patient’s medication regimine and identify whether or not DDI’s are possible, the pharmacist can recommend changes to prevent the occurence of a significant DDI. Sometimes this means changing drugs, but sometimes this means just administering the drugs in a different order. Tomorrow I’ll get to see what they learned during their first presentation of the semester.
In the afternoon, I helped Gonsha Rehema, the PSU (Pharmaceutical Society of Uganda) Intern Trainer who recently worked with me in the USA, teach the Pharmacy Interns about the importance of documenting the ways we are helping patients. For a long while, even in the USA, Pharmacists have been the “quiet” helper in terms of positively impacting patient care. Everyday Pharmacists worldwide are preventing ADE’s and DDI’s and helping to make sure the right dose of a medication is given but for some reason, we seem to keep this information to ourselves. This may be in part because we think it is just a natural part of our job, but in a world where no one’s job is secure anymore, especially with the advent of so many advanced technologies that can assist in healthcare, it is important that we start to speak up and make what we do known to the people- both patients and other healthcare practitioners. If we don’t and allow our jobs to be phased out or downsized, we may just find that the era of safer medication use will come to an end. All healthcare practitioners are valuable and critical parts of the healthcare team and together we can improve patient health outcomes, but we can’t just say this to others. It really is up to us pharmacists to prove it. Don’t get me wrong- I’m all in favor of technological advancements but as I was explaining to the 3rd year students today, what may be a significant DDI necessitating a medication change in one person, may not be a problem for another. This is where “ART” meets “SCIENCE”. In medicine, there is rarely black and white. As I tell my students back home, when teaching in the classroom I need to teach it to you in black and white because as learners it would get so confusing to try and learn a million nuances. But once you get out into practice or into experiential learning you will find out it is “all gray”. Each person is unique and although we do follow evidenced-based treatment guidelines, we still need to consider each patient individually.
When I was here in Uganda last year, at one point there were about 75-80 Pharmacy Interns at Mulago Hospital. It was a wonderful thing because finally there could be extra staffing on the busy wards and one pharmacist could stay in the dispensing area while the other went on ward rounds to assist the physicians. I was so pleased with this improvement! But when I came back several months later, the number of Interns had decreased to only about 30. You see there was an overlap of when they started so when the group that finished in July left, the Hospital Administration refused to take anymore. I heard that they said they didn’t think they needed them. This was such a let-down. If only the Pharmacy department could have captured the good work the Interns and Pharmacists were doing when they were actually at full staff and written a report, the Hospital Administration could have seen that it will probably cost them more in inappropriate and unsafe medication use leading to longer durations of stay in the hospital and serious ADE’s than it would have cost to keep the number of Interns high.
So my goal today when talking to the the Pharmacy Interns was to convey the importance of documenting every time they help identify and solve drug therapy problems. Hopefully this data will then be collected and be the start of a way to justify the staff needed to improve safe medication use. Another side benefit of documentation that I always relay to my Wilkes students is that if for no other reason at all, document so that you remember the good you are doing and let in motivate you in your work. Everyday so many things happen and if you don’t write them down you won’t recall all of the times you potentially saved a patient’s life or recommended a more effective pain killer, or helped to heal an infection faster because you made a recommendation to change the antibiotic.