Will you dose?

[iLurk]

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Just wondering, how many of you medical students plan to let pharmacists dose vancomycin or aminoglycosides for you, if you should have a reason to prescribe those meds?

 

[LossForWords]

Just wondering, how many of you medical students plan to let pharmacists dose vancomycin or aminoglycosides for you, if you should have a reason to prescribe those meds?

If it's a hospital pharmacist that rounds with the team, absolutely.
If it's a pharmacist that's never even seen the patient before, probably not.

 

[J ROD]

Or you can just be a pharmacist like me and dose it yourself.....

I love dosing vanc....

 

[Samoa]

Delegate when you can. There's plenty of work to go around. Plus they know what they're doing, and care about doing it themselves; I just want it done, and done right. Everyone wins.

 

[WellWornLad]

Why wouldn't I let someone do one of the dullest parts of my job?

 

[Samoa]

If it's a hospital pharmacist that rounds with the team, absolutely.
If it's a pharmacist that's never even seen the patient before, probably not.

There's no need to see the patient. With the necessary numerical data, some pharmacist in China could dose aminoglycosides and vanc.

 

[J ROD]

There's no need to see the patient. With the necessary numerical data, some pharmacist in China could dose aminoglycosides and vanc.

not totally true...what if the patient is an amputee...we had that come up one time and if we did not know that info from being there if could have been a problem.

 

[Samoa]

Dosing is weight-based. The effect of amputation is probably less than the natural variability between normal people of the same weight. In addition the weight-based dose is just an approximation, to be refined based on measured drug levels, which will address whatever remaining variability can be accounted for.

Like I said, China.

 

[Praziquantel86]

Just wondering, how many of you medical students plan to let pharmacists dose vancomycin or aminoglycosides for you, if you should have a reason to prescribe those meds?

Why wouldn't you?

 

[SouthernSurgeon]

I will do the initial dosing because our computer ordering system makes it very easy with suggested dosing based on patient weight. I will also make basic adjustments after the initial trough levels come back. If it becomes in a pain in the rear I punt it to pharmacy.

I also got in a huge argument with a pharmacist over aminoglycoside dosing in a patient on CRRT...sometimes they are overly rigid and want to stick to the hospital protocol and are not that familiar with the most recent literature.

 

[TexasPhysician]

I wouldn't let a pharmacist dose anything for me until I know how intelligent they are (i.e. spent plenty of time with them). Just like there are good - poor doctors, there are good - poor pharmacists. I don't want anyone, regardless of degree, damaging my patients' health because of their lack of knowledge.

One pharmacist I know is excellent. She knows different drugs like the back of her hand. The few things she doesn't know, she admits and does a good job of finding the information.

Another pharmacist I've met seems to get everything wrong. She inputs orders wrong, questions the use of drugs that are FDA approved for the condition, etc. I don't trust her to dose any drug, much less input my orders to the computer.

This is not a flame on pharmacists. There are people in every profession that aren't up to par. Until you trust someone's knowledge base, I wouldn't trust them to do your job.

 

[Praziquantel86]

I wouldn't let a pharmacist dose anything for me until I know how intelligent they are (i.e. spent plenty of time with them). Just like there are good - poor doctors, there are good - poor pharmacists. I don't want anyone, regardless of degree, damaging my patients' health because of their lack of knowledge.

One pharmacist I know is excellent. She knows different drugs like the back of her hand. The few things she doesn't know, she admits and does a good job of finding the information.

Another pharmacist I've met seems to get everything wrong. She inputs orders wrong, questions the use of drugs that are FDA approved for the condition, etc. I don't trust her to dose any drug, much less input my orders to the computer.

This is not a flame on pharmacists. There are people in every profession that aren't up to par. Until you trust someone's knowledge base, I wouldn't trust them to do your job.

I think that's a fair assessment. Keep in mind though, many hospitals P&T committees have things set up so that pharmacy is responsible for followup dosing on a lot of these drugs (vanco, aminoglycosides, warfarin, etc.) any time the drug is ordered. I can't speak to a percentage, and I think it's probably more frequent in tertiary institutions. Obviously there are physician opt-out criteria in most cases, but from personal experience, that option isn't exercised all that often.

As far as remaining up to date on the literature goes, I'd have to respectfully disagree. The interpretation of the literature may be different from profession to profession, and I agree that pharmacists may be a little more conservative in their approach. This does not, however, mean that they're unaware. As always, their are obviously exceptions to this and you may have met one of the exceptions.

 

[mmmcdowe]

I mean, I'd trust the pharmacist. It's not like doctors are necessarily better at it. Just saw a patient who got nuked by a department with 3x the normal therapuetic dosage. Praying for enough recovery to keep the patient off dialysis.

 

[SouthernSurgeon]

I mean, I'd trust the pharmacist.

A lession you will learn very quickly in medical school and residency is never to trust anyone based on their title. Pharmacists can make prescribing errors just as easily as residents. Radiologists can miss things on reads. I've certainly made my share of errors this year and am not trying to preach from my soapbox or anything, but just saying "I'd trust the pharmacist" is not an acceptable answer. If I just "trusted the pharmacist" I can think of several major prescribing errors that would have occurred under my name

 

[MDpride]

so doctors work gets delegated but what about responsibilities?

is pharmacist license under threat like doctors if they make mistake doing their delegated job?

If anybody who get work delegated by doctor makes mistake and is not responsible for it then, as a doctor i'd like to do it myself.

 

[MDpride]

If hospital pharmacist turns out to be one who reads and follow literature conservatively, then doctor and pharmacist are not going to be on same page. in that case, whose decision is final?


is it possible in the future that doctors have to abide by guidelines set by hospitals P&T committe or hospital pharmacists with no leeway ?

is it possible in the future that doctors job will be limited to making diagnosis and ordering labs & tests AND pharmacist will take over for pharmacologic tx which includes not only prescribing but managing it?