Transition into hospital pharmacy

[farmadiazepine]

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Hi all,

I'll be starting a hospital pharmacist job very soon, staffing, and I wanted to know if anyone has any advice on the transition from retail to hospital. I have zero hospital experience. I have been in retail pharmacy for a while now, 4 to 5 years as an intern and 4 years as a pharmacist.

I know hospital pharmacy is different drugs, and a different checklist of things I have to go through when working on a prescription or an order.

I have about 2 months of solid training with the hospital, so I'm not too worried. I just want to know if anyone has any advice or any recommendations on things I should review or look over? Just basics so I don't have to stop every single step of the way.

Still working retail though, now at a corporate chain part-time and at a couple independents per-diem.

 

[SClENCE]

Congrats

 

[bryanbishop2006]

Learn the hospital's policies and procedures (especially for things you'll be doing lots of like formulary substitutions, IV to PO, renal dosing, and pharmacokinetic dosing). Try to learn tips and tricks for whatever EMR/CPOE system you'll be on. Often times there are many ways to skin a cat and some are more effective than others. Verifying scripts is actually easier since you usually know more about the patient than you do in retail (pregnancy status, renal function, complete drug list).

Learn about the different doctors. Learn which doctors respond to calls/pages and which are impossible to get a hold of. Learn which ones where it's better to go through their CNP/PA than it is through them. Learn which ones are receptive to pharmacy recommendations and which ones aren't (helps you pick your battles).

Figure out drug shortages early on because that's been huge the last few years and can greatly impact you. Learn what resources you have (many non-academic hospitals are dropping micromedex because of cost). Lexi is usually standard but maybe other places are using Clinical Pharmacology or books.

If the hospital does pediatrics get familiar with that hospital's pediatric dosing charts. Peds is far from my forte and I've learned that lexi pediatric dosing can vary widely.

Learn what you can and can't do within the hospital. For instance in my current position pharmacists have a read-only MAR. At my previous institution we could do actions on the MAR. This greatly affects things like adjusting times or rescheduling drugs for whatever reason. If I can guarantee you one thing, it's that you will get a billion calls about MAR issues no matter where you are.

I would recommend either knowing where to find hospital/nursing policies or printing out the important/lengthy ones if they aren't easy to readily access. This comes up a lot with respect to what drugs can nurses administer. What drugs need to be given centrally. What drips/infusions can be given where (ICU, telemetry, med surg).

2 months is a good training period and you've been a pharmacist for a while so I think you'll be fine. Depending on how well you do medication reconciliations at your new hospital always have a wary eye when verifying continuing home medications. Hospital specific drugs tend to be easy verifications. Getting the drug/dose/frequency right for home meds is so much more difficult and fraught with error IMO.

 

[mustang sally]

Make sure you learn where to look to see if the provider left a note on the order!

Sometimes people don't understand how to use CPOE very well, so they will put basically anything in and then leave a note somewhere as to what the order is really supposed to be 🙁 .

 

[gwarm01]

Make sure you learn where to look to see if the provider left a note on the order!

Sometimes people don't understand how to use CPOE very well, so they will put basically anything in and then leave a note somewhere as to what the order is really supposed to be 🙁 .

I've seen so many med errors because of this.

 

[WVUPharm2007]

It isn't as hard as it looks. Learn the formulary, learn which antibiotics do what, then the rest will accumulate over time.

 

[farmadiazepine]

Thanks for the advice everyone. I appreciate it. I'll keep everyone posted.

 

[winnguyen]

What about calculations? What is a good reference or resource or refresher to use to get me back up to speed and comfortable with hospital pharmacy calculations. My brain has turned to mush from years in retail.

 

[Sparda29]

Only calculations I ever had to do was CrCL, IBW, vanco trough, body mass, etc. Pretty easy to memorize. But there are tons of calculators out there on the internet.