One day, a pharmacist was concerned about an order for meperidine 100 mg IV Q3H PRN pain for an ICU patient with declining renal function (crcl was estimated at 20 ml/min). The pharmacist called the physician to suggest another pain medication. The hospitalist snapped back, “I am at lunch now. Do not bother me with these stupid recommendations. There is nothing wrong with using Demerol.” Click. He hung up.
The pharmacist entered the order and documented that he contacted the physician with no resolution. I witnessed the conversation and was disappointed by the outcome. The patient’s life was at stake and this was no time for passive behavior. Quickly, I paged the physician again. He called back and screamed into the phone, “What is it now?”
“My name is Karine and I’m a pharmacist. I saw that you ordered Demerol on this ICU patient with a creatinine of 2.8. I just wanted to know how much Ativan you want to order in case he gets seizures.”
“What are you talking about,” he asked?
I reminded him of the seizure potential with Demerol. He responded, “Never mind. I will call the ICU to cancel the order.” Later that day, he found me in the cafeteria to ask which pain med he could consider. He didn't apologize for his rude behavior. He was relieved that the patient was not harmed by his order. This is a true story, which demonstrates the importance of our presence and communication to the medical team.
A medical team is like a machine compromised of cogs which must mesh together evenly to function. The function is to provide the best medical treatment for our patients. Cogs consist of physicians, pharmacists, nurses, case managers, physical therapists, and respiratory therapists. To work effectively means to communicate effectively. To date, this type of communication is not taught in any medical, pharmacy, or nursing school. It is a learned skill which comes with experience and time. If you lack this skill, then no matter how good your pharmacy advice is, it will not be well-received by the team. This can be discouraging to you and to the team. And every medical team needs the pharmacy cog to mesh with others. In the meantime, this article might help give you insight on how to communicate with your team, starting with the physician as they are the ones who ultimately make the final decisions in the care of our patients.
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