I am a Senior Pharmacist assigned to an emergency pharmacy in a public service hospital.
In Pakistan, pharmacists are still struggling to prove their role as hospital pharmacists, especially in public service hospitals. At the same time, pharmacists are overburdened with multiple tasks to do at one time as the patient influx is higher due to unstable financial situations.
As a member of the emergency department, my responsibility is to assist my fellow pharmacists in handling incorrect medication orders for both emergency and outpatient patients, particularly those that come from outside hospital prescriptions. The interventions are communicated to the physicians and reported back to the patient's attendant, along with an explanation of whether they were accepted or rejected.
In addition, I oversee the inventory to ensure that all necessary items are accessible. If anything is not available, I promptly inform the physicians and nursing staff of alternative options.
A 55-year-old female, who had undergone a craniotomy and was being treated for tuberculosis abscess, was prescribed conventional amphotericin. The patient received 50 mg of amphotericin intravenously every 12 hours, which was mixed with 100 ml of normal saline. After the seventh day of amphotericin, the patient was discharged, and due to the unavailability of amphotericin in that hospital; the attendant was purchasing the injection and dilution from other medication stores.
Our pharmacist received the prescription for amphotericin on the twelfth day at our pharmacy. Being alarmed by twice daily dosing, the attendant was questioned. According to his statement, the hospital supposedly administered it in the same manner. However, the patient reportedly experienced an excruciating amount of pain during the administration.
Amphotericin is an antifungal drug used 0.25mg -1mg/kg/ day; max to 1.5mg/kg/day. Its most common adverse effect of fever and chills, so hydration is usually given prior to amphotericin administration. It is compatible with dextrose only, and the volume administered is decided if it is to be given peripherally or centrally.
One plus point was that the attendant had the consultant's contact number. I contacted the consultant through the drug and poison information center of our hospital, confirmed the intravenous line of the patient, and intervened according to the guidelines. The consultant gave me the rights to guide the patient with the right frequency, dilution, and dilution volume.
In this situation, there were errors in the frequency of administration (intended to be given once every 24 hours), the method of dilution (should have been in dextrose instead of normal saline), and the volume of administration (the patient had a peripheral line, so the amphotericin should have been diluted in 500ml).
It's worth noting that he was never advised on how to store amphotericin when he bought it, so he kept it at room temperature.
Intervening on outside hospital prescriptions poses a significant challenge due to the limited opportunities available to communicate with the prescriber. However, with this intervention we built a stronger rapport with our consultant. He asked us to counsel the patient about the correct way to take it and teach the patient the side effects and other important information.
I hope that by taking these small steps in a public service hospital, pharmacists will gain confidence in their ability to contribute to improving healthcare.
W.T
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