Similar to many hospitals in the country, Robert Wood Johnson University Hospital Hamilton in Hamilton Township, N.J., had just one critical-care pharmacist working in its intensive-care unit. That changed about two years ago.
Liza Andrews rounded on the 20-bed unit a few times a week and the remaining hours were filled by general pharmacists working remotely who did their best to solve routine prescription problems happening on the floor. Andrews would often receive calls from nurses who needed advice on her days off.
“The pharmacist in the satellite didn’t feel comfortable making specific recommendations,” Andrews said.
The result was disjointed care. ICU patients would experience changes to their drug regimen when Andrews came in after the weekend because she saw unaddressed problems after reviewing their charts and rounding on the floor. That’s because Andrews has expertise that general pharmacists don’t have. Critical-care pharmacists receive training on how to treat critically ill or injured patients who need specific pharmaceutical interventions to manage both their main condition and underlying health concerns like high blood pressure or poor nutrition.
ICU patients “are some of the most complex patients in the hospital and they have a lot of chronic disease and chronic medications they are on so there is a lot of consideration that has to be taken when it comes to medications,” Andrews said.
Interested in changing the approach, Andrews asked leadership in late 2016 if the hospital could hire another critical-care pharmacist. Her proposal was rejected for budgetary reasons. So she instead asked if she could train the hospital’s general pharmacists during their usual shifts. Leadership agreed. Andrews called the resolution “a compromise.”