Caring for wounded solders: R.Ph.s' role

Over the past few years, more than 2,200 U.S. soldiers have died in the wars in Iraq and Afghanistan. In addition, more than 16,000 soldiers and Marines have been wounded but have survived. Ironically, this is due largely to new, high-tech ceramic body armor and new field medical and evacuation systems.

Among the surviving wounded, traumatic brain injury (TBI) appears to account for a larger proportion of casualties than it has in other wars. Veterans Affairs estimates that 60%-62% of this patient population has some degree of TBI in combination with other disabling conditions, such as amputation, burns, fractures, and hearing and visual impairments, which it defines as polytrauma. The consequences of brain injury are enormous, possibly affecting vision, speech, epilepsy, and an increased risk of dementia.

The Minneapolis Polytrauma Center has 12 inpatient beds, in addition to outpatient care. The complexity of the patient cases in the center provides a unique challenge for staff members, requiring multidisciplinary team care. Sheila Johnson, Pharm.D., is a clinical pharmacist at the Minneapolis Veterans Medical Center's polytrauma center, where she has an important role in the patient care plan. She is on the unit daily to discuss the patients' medication therapy with other staff members. In addition, Johnson participates on biweekly medical rounds along with a physician, dietician, occupational therapist, speech therapist, physical therapist, unit nurse, and social worker to monitor a patient's progress through the rehabilitation process.

The average stay in polytrauma centers is 40 days; however, many patients remain for months and some for more than a year. The staff members of the centers are responsible for providing a complex, long-term rehabilitation process for the patients. "These patients are on numerous psychiatric medications, such as antidepressants, hypnotics, seizure medications, and antibiotics, in addition to other medications. This makes medication adjustment difficult. Many of the patients cannot speak; therefore it is hard to determine if it's a medication that is causing a change in the patient's medical condition or if there is some other cause," added Johnson.

The other staff members of the polytrauma center see Johnson as a valuable asset to the team. One of her roles on the team is to assist the physicians in modifying the medication doses as well as assisting in selecting the optimal medication to treat the patient's condition.

The physicians at the center are specialized and extensively trained in psychiatric medications and in treating psychiatric conditions. However, when prescribing nonpsychiatric medications such as antibiotics and warfarin, they turn to Johnson's expert recommendations for these conditions. Johnson stated, "Sometimes my role is to listen on rounds. There are times the physical therapist will determine that patients cannot complete their physical therapy sessions because they get agitated." Johnson views this as a possible medication-related problem and an opportunity for her to make a difference in the patient's condition by a medication dosage adjustment that may prevent future agitation.

The magnitude of the injuries suffered by the soldiers causes additional psychological stress to both the soldiers and their families. In addition to the rehabilitation services offered to the patients by the staff members of the polytrauma centers, patients receive support and medication counseling and education.

Johnson finds it a privilege to serve these patients and their families because they have given so much. She views her role as "making sure that the patient is receiving the correct medication at the optimal dose." The experience is "heartbreaking at times and extremely rewarding at others," she concluded.

THE AUTHOR Is a writer based in New Jersey.