Where do pharmacists work? Everyone is familiar with the pharmacist at your neighborhood pharmacy. But did you know that pharmacists are embedded in medical teaching services in hospitals? How about working in an operating room? An emergency room? Recommending intravenous nutrition or antibiotics for resistant infections? Do you think pharmacists are found in physician offices to manage chronic diseases such as diabetes or hypertension? Would you find a pharmacist conducting research with drugs to receive FDA approval for marketing?

Pharmacists work in three predominant areas – the community, the hospital and the ambulatory care clinic. The types of services offered in each area depend on the patient and prescriber needs. Satisfy your interest by entering the tabs describing pharmacy practice in each of the three areas.

The influence of a pharmacist in a hospital is everywhere. Pharmacists work with physicians to create a formulary of specialty drugs necessary to care for advanced disease. Pharmacists work in many areas of the hospital where critical and rapid decisions for drug administration need to be made. Pharmacists may act as consultants for prescribers to select drugs, calculate medication doses for individualized pharmacotherapy, or to feed a patient who cannot take oral nutrition. Pharmacists monitor medication use for desired outcome, adverse events, drug interactions, and for duplication of therapy. They create sterile forms of medication for intravenous infusion and work with nurses for the safe administration of drugs. Pharmacists use robotics and bar codes to dispense and deliver medication to nursing units. Pharmacists also educate patients on new prescriptions to improve adherence, and help the patient procure their prescriptions so therapy will continue and the patient will heal after discharge. In many institutions, pharmacists will contact patients after discharge to inquire how the patient is feeling and how their medications are working.

A national shortage of physicians has created a need for new interprofessional practice models. Nurse practitioners and physician assistants emphasize diagnosis, while pharmacists monitor and adjust chronic use medication. The pharmacist provides many of the same services that are performed in a hospital, but have the advantage of managing patient issues over long periods of time to see the benefit of drug choices. They may specialize in specific patient populations such as diabetes or pain or hypertension where medications are a critical component of patient care. In many settings, pharmacists may provide their own specialty clinic within the physician’s office.

The insurance industry emphasizes optimal patient health and quality outcomes to minimize new medical problems or acute decompensation of chronic disease. The health care team in the ambulatory setting therefore oversees all aspects of patient health, such as immunizations, smoking cessation and nutrition. The pharmacist is ideally suited to provide those types of services. They screen patients for healthy habits and work with patients if they need to make lifestyle changes.

The ambulatory setting is a growing area of pharmacist employment. Technology is now available for medication to be dispensed in a physician’s office. The pharmacist can use that technology to guide drug selection, counsel patients on medication use and provide a packaged form of drug to take home. The physician’s office provides a new arena for practice and invites the innovative pharmacist to create new models of public health.

The practice of pharmacy in the community is evolving as well. Due to the rising cost of health care, individuals attempt to care for themselves whenever possible. Therefore, new symptoms or complaints are typically seen by the pharmacist as the gateway to health care. Pharmacists are adept at triaging patients to the appropriate level of health care, either self-care, physician’s office, urgent care centers or the emergency room. If patients are capable of caring for themselves, the pharmacist will guide the best choice for over the counter medication choices.

Pharmacists are typically the only member of the health care team with a complete list of medications. Patients, physicians and the insurance industry request pharmacist to review medication to simplify drug regimens and to determine when a medication may be causing adverse outcome. This process of medication therapy management may lead to a collaboration agreement between a physician and pharmacist. Under a collaboration agreement, a patient care protocol is developed between the physician and pharmacist. The protocol allows the physician to defer many decisions involving selection, adjustment and monitoring of medication management to the pharmacist. Because the patient sees the pharmacist more frequently than the physician, the pharmacist is better suited to guide therapy under these protocols.

Community pharmacists are a key component of public health, as they provide immunizations, smoking cessation, and monitoring of diabetes and blood pressure. Pharmacists may perform components of a physical exam, such as vital signs to detect individuals with need to enter the care of a physician. Because over 80% of the population is within 1.6 miles of a pharmacist and the pharmacist is typically the most trusted medical professional, patients come to the local pharmacy for their health care needs.

Of course, the community pharmacist is also responsible for dispensing medication with the occasional need to compound a unique dosage form. Pharmacists will screen each new prescription for duplication of therapy, dose, ability of patient to utilize the selected dosage form, and any drug or nutrient interactions that could harm the patient.