Decision Making in Hospital Pharmacy

Introduction

Pharmacists often face situations where they need to make quick, informed decisions that may impact patient safety.

  • While many clinical decisions are based on facts, there are many "less straightforward" scenarios that require analytical and critical thinking skills due to their complexity.



Multiple Priorities

During your first night shift, there are few things happening at the same time.

  • Many patients are waiting at the dispensing counter.
  • A nurse is waiting for the medications to be filled for patients at the ward.
  • A doctor phones and says she needs advice from a pharmacist immediately.
  • The fridge temp-guard is ringing.

In this situation, you have to

  • Prioritise your work according to clinical urgency and the need of immediate actions.
    • Which jobs are most likely to put patients at risk if I delay doing them?
    • Any task that has serious consequences if left unsolved?
  • Ask for helps if overwhelmed.
    • Remember, you are part of a team!
  • Communicate with the people you are dealing with, explaining the situation and what you are currently doing.
    • I do apologise but I am a new pharmacist on duty tonight. Right now, I am ..



Change in Medication

As an outpatient pharmacist, you encounter a situation where a patient's prescription for rosuvastatin has been increased from 5 mg ON to 20 mg ON.

  • If the patient lipid profile was not being adequately controlled, this may be a legitimate change.
  • However, the patient is not informed about the change.
To ensure patient safety, you decide to contact the doctor to verify if the increase in dosage was intentional or a prescribing error.

  • Contacting the doctor may prolong the waiting, which potentially frustrate the patient.
  • Nonetheless, no assumption should be made without speaking to the doctor.



Unfamiliar Dosing

You receive a prescription for albendazole 400 mg OD for 3 days for an 8-month-old, 11 kg baby. The prescription is for cutaneous larva migrans, a parasitic skin infection.

  • The patient's mother is concerned because the medication box only indicates the albendazole is approved for babies over 12 months.
To handle this unfamiliar situation, you may

  • Admit that you do know, but you will need to look into it for her.
  • Buy yourself some time (if can) to consult various reliable drug references and resources to ensure you have accurate information before providing advice.
    • Avoid giving hasty or potentially incorrect guidance.
  • Seek help from experienced pharmacist if the situation remains unclear.



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