5 Pharmacy: Most hospitals have pharmacists during the day, at night, and in the ICU. They are AWESOME and a big help when it comes to doing dosing readjustment, medication interactions, antibiotic stewardship, etc. In some cases, you might have a pharmacist present during rounds, and they provide an active part in teaching as well. In which situations will you need their help? Medication interactions: Sometimes the EMR will flag a notification if you´re sure you want a patient to be on two medications. If unsure about how dangerous the interactions are, call a pharmacist and talk to them about it! Dosing readjustment: Especially for patients with big AKIs, they constantly try to readjust the meds depending on the GFR. Allergies: Sometimes you really want to give a cephalosporin to a patient who is allergic to a penicillin, and you are unsure; they can look at previous hospitalizations and see if the patient was previously given a cephalosporin without any problem. Patient with biologics or immunotherapy: Sometimes you’ll be unsure of how long is acceptable for a patient to stop taking a medication you’re not familiar with. Call a pharmacist and ask! Restarting antipsychotics, mood modulators, or mood stabilizers: They have better access to the pharmacy dispense record and can assess if the patient has been on the medications recently. It is very helpful when patients are poor historians. If any doubt about a dose, compliance, or prescription.. CALL A PHARMACIST! They are very helpful. 4. Palliative Care: Most hospitals have a team called “Palliative Care” that can help in different situations. It is a support team for doctors, patients, and their relatives to carry the burden of their disease. Palliative care doesn’t only mean end-of-life care. I n which situations will you need their help? Pain management: Patients with chronic pain or pain difficult to manage are good candidates for palliative. They are experts in pain management and can help adjust the opioid requirements for a patient and have a safe plan to continue the pain management at home. Start difficult conversations about goals of care. For example, a patient who was recently diagnosed with ALS might want to know the course of his disease. Down the line, it would be helpful if they would consider artificial nutrition. Patients should be encouraged to think about how they would like to live their lives, given the consequences of their diseases. Code status conversations: Every hospital encounter can be an opportunity to talk about code status. Code status means how a patient would like to proceed in the event of cardiac or respiratory arrest. In simpler words, do they want chest compression, defibrillation, and intubation after an arrest. This becomes especially important in patient with many comorbidities, where their chances of surviving after code are low or the chances of them having a significant life quality decline after a code are really high. The obvious, palliative care conversations. This comes when performing any type of treatment would provide more harm than benefit to the patient, so de-escalation of aggressive care measures is warranted, and transitioning to Comfort Care focus is needed. They can also help set up hospice if needed.
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