Hospital pharmacy. Everyday life vs. challenges

A hospital pharmacy is not a public place, visible to everyone in the hospital. Usually there is not even a signboard or a green cross at its entrance. How is such a pharmacy different from a commercial pharmacy, and why is it so difficult to spot on the hospital grounds, although it is said to be the heart of the hospital?

Joanna Jurkowska, M.D.: Hospital pharmacies, for logistical reasons related to deliveries, are usually located on the lowest floors, where few people reach. But those interested know very well where they are. Here, medicinal products are purchased on the basis of concluded tender contracts for hospital needs. The hospital pharmacy fulfills aggregate requests for medicines from individual departments or clinics, but also prescriptions for a specific patient, but does not sell them to individuals. This is the case with parenteral nutrition preparations, antibiotics, infusion fluids or cytotoxic drugs, among others. Some medicinal products are prepared under special conditions, on site i.e. clean rooms in accordance with good manufacturing practice to ensure their microbiological purity. There is no room for the individual patient

No hospital can function without a hospital pharmacy, just as an organism cannot function without a heart. Without its perfect operation, proper patient care, adequate supply of medicinal products and safe pharmacotherapy cannot be guaranteed. The hospital pharmacy is simply the foundation of hospital operation. Unlike a general pharmacy - in addition to purchasing and distributing medicinal products - it prepares specialized preparations for parenteral nutrition, prescription drugs, daily dose drugs, infusion fluids, radiopharmaceuticals and monitors adverse drug reactions, and its employees participate in clinical trials.

That is, a hospital pharmacy is also a laboratory that requires special skills and pedantry from the pharmacist. To what extent is he responsible for creating a drug for a specific order?

The pharmacist prepares the drug for a specific patient based on the prescription prescribed by the doctor. The first action he takes is to check the formulation. If he assesses that there may be a problem with the stability of the drug, he contacts the doctor to change the formulation.

To reduce the risk of confusion, a second pharmacist re-verifies the prescription and then makes the drug according to his knowledge. After the drug is made, the correctness of its manufacture is verified by visual assessment and comparison of the composition of the made product with the prescribed prescription. All the steps and actions taken by the pharmacist in the preparation of the drug are intended to ensure that the patient receives an effective, safe and high-quality medicine. There is no room for mistakes here.

I understand that this work requires not only accuracy, reliability and focus, but also health, because it involves the risk of exposure to harmful substances?

Pharmacists who prepare cytotoxic drugs are exposed to hazardous substances resulting from their mutagenicity, teratogenicity and carcinogenicity. To reduce health risks, closed systems, personal protective equipment, properly equipped rooms with constant monitoring are used to prepare such drugs. So there are many health-related restrictions, such as the working hours for drug formulation. An employee working in contact with cytostatic drugs cannot perform other activities during which he will be exposed to ionizing radiation. Cytostatic drugs, although a boon for people with cancer, can pose a serious health risk for personnel working in contact with these preparations for long periods of time, contributing to the development of various diseases.

The mode of operation in a hospital pharmacy is 24 hours seven days a week? Do cito orders happen, at night or on the weekend?

Such situations occur most often during weekends. In this case, the pharmacy manager or his replacement, who is always available by phone, comes to the pharmacy and dispenses medicines if necessary. The pharmacy where I am the manager works 7 days a week on a one-shift basis, but there are pharmacies that are on duty in the afternoon. I believe that pharmacists should also work in the afternoons and on weekends, as this would ensure constant access to medicines.

Working in hospital pharmacy offers many interesting professional challenges, so why are pharmacy graduates reluctant to choose a career in a hospital?

For young people, working in a pharmacy in general is not an attractive proposition, and working in a hospital pharmacy for pharmacy graduates is the least attractive. They prefer to tie their careers to pharmaceutical companies, the cosmetics industry, or clinical research companies, where they can expect to earn more. Only 10 percent of graduates plan to work in a pharmacy, and a small percentage of them will want to work in a hospital. Probably the main factor influencing this decision is financial conditions, but also the need for intensive further training. There are not enough pharmacists in all pharmacies, and there are more and more challenges - such as those related to pharmaceutical care. In the hospital, on the other hand, there are more challenges related to the preparation of medicines, and this is what a graduate usually has to learn in practice, because after graduation he is not fully prepared for such tasks.

Are any special qualities necessary to become a hospital pharmacist?

The qualities that a hospital pharmacist should have include accuracy, versatility and patience. The ability to work as part of a team, as well as manual skills, are essential because of the need to prepare medicines. Sometimes in a situation where quick drug preparation is needed, a sober mind must be maintained, so the ability to work under time pressure is useful.

A shortage of qualified personnel in hospital pharmacy would mean a crisis in hospital operations. Are we facing a staffing impasse soon?

For several years, we have seen a shortage of hospital pharmacists. As of today, we are short of master pharmacists who have experience in the parenteral nutrition lab or the cytotoxic drug lab. In my pharmacy, the average age of the staff is 50, considering how small a percentage of pharmacy graduates choose to work in hospital pharmacies, we are definitely facing a hospital pharmacist shortage crisis. Outside the medical community, few people are aware of this, but the situation is really difficult and calls for change, more incentives, including financial ones, for pharmacy graduates to choose this place to build their professional careers.

It is important to remember that with the entry into force of the Law on the Pharmaceutical Profession, additional responsibilities have been imposed on hospital pharmacies for the distribution of medical devices. These include a very wide range of devices from class three to class one. As a result of the changes, there has been a need for pharmacists to thoroughly expand their knowledge and increase pharmacy staffing. This is an urgent challenge for the system.

So what should be done to encourage pharmacists to work in the hospital?

Students should be shown that the work of a hospital pharmacist is not only product distribution, but also the preparation of a wide range of drugs, participation in clinical trials, and the opportunity for comprehensive professional development. Another factor that could encourage young people to choose this life path would be the development of clinical pharmacy.

And how is the work of a pharmacist in a hospital pharmacy different from that of a clinical pharmacist?

In Poland, pharmacists with specializations in hospital and clinical pharmacy work in hospital pharmacies and have the same responsibilities. And it's a pity, because pharmacists who work on the wards and have contact with patients are also needed. In our country, in Polish hospitals, it is very rare to find people who have the opportunity to work directly in hospital wards with the patient. A clinical pharmacist is someone who works with the entire medical team: doctor, nurse or physiotherapist. He evaluates and analyzes the effectiveness of the pharmacotherapy used. He participates in the selection of medications, evaluates the risks associated with their use and monitors possible side effects. He supervises the selection and optimization of drug doses, verifies drug interactions, thereby improving the safety of pharmacotherapy and optimizing costs. This model of division between hospital and clinical pharmacists is present in many countries.

I am absolutely convinced of this, that we can modernize our work using existing models. This will not only make job offers more attractive and encourage people to take up work, but also hospitals will benefit in many objective ways, including financially.

Interviewed by Barbara Mietkowska