Playing to strength: Pharmacists on the team

During college-bowl season, an online feature about North Carolina brothers Casey and Connor Barth, both placekickers, got us thinking about the practice of medicine and how it relates to teamwork in sporting events.

The entire multidisciplinary team can be compared to a football team. Our opponents are the many things we struggle with or fight against every day - disease, interruptions that distract us from important tasks, insurance companies - you can probably cite others from your own practice.

The lineup

The most obvious counterpart to the quarterback may be the physician. After all, both are leaders, heroes even, of their respective teams. Not all roles are as highly esteemed or as obviously necessary as the quarterback’s, but we all know that the quarterback alone cannot carry a game. Other players for the offense include the nurses, CNAs, respiratory therapists, physical therapists, etc., who act as the running backs and wide receivers. They are essential players to have on the field to advance the ball toward the goal.

Pharmacists and pharmacy technicians may be more like the offensive line, performing unrecognized and less visible tasks. Also unacclaimed and overlooked are the members of the special teams. Pharmacists can certainly relate to these players who, like them, must attend training camp, practice, and games, with little opportunity for playing time. As Casey Barth, one of the placekicker brothers, recently said in an interview, “Sometimes they need you and sometimes they don’t.”¹

Ups and downs

Studies clearly indicate the utility of the pharmacist as part of the patient-care team. Medical errors are reduced and outcomes improved by having pharmacists attend rounds in the intensive care unit as well as the general medicine floors.^2,3 However, in pharmacy, as in many other professions, there are good days and bad days, with most falling somewhere in between.

Pharmacists may participate in rounds during times of low census or low acuity and not have the opportunity to make significant interventions. Similarly, frontline pharmacists in order entry or dispensing positions may check hundreds of doses without finding any problems requiring their expert intervention. These periods of lull can lead to feelings of uselessness and idleness. It can be easy to forget significant interventions recently made or times that consultation was sought. During these lulls, pharmacists may begin to feel unnecessary and worry about earning their keep, so to speak.

Also like special team members, pharmacists can sometimes make the difference in a win or a loss. Catching those medication errors or preventing adverse drug reactions is like having a kicker come in on the last play to score the field goal that wins the game.

Don’t forget the punt

The punter, another lesser-known player whose role it is to kick the ball away to the other team, is very important for field position. This brings to mind the role of pharmacists in antimicrobial stewardship. The impact of antimicrobial stewardship may not be effective right away, but it does have a positive impact globally on resistance patterns; it’s like providing better field position against the hospital-wide antibiogram.

If you find yourself doubting your utility in your patient-care role, remember the loneliness of the special teams players and keep your eye on the ball. They may need you on the next play!

References

1. Brett Friedlander. Casey Barth doesn’t get a kick out of unfulfilling UNC Pro Day. StarNews Online. March 26, 2013. http://acc.blogs.starnewsonline.com/35972/casey-barth-doesnt-get-a-kick-out-of-unfulfilling-unc-pro-day/

2. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999; 282(3):267-270.

3. Kucukarshan SN, Peters M, Mlynarek M, et al. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units. Arch Intern Med. 2003; 163(17):2014-2018.

Amy Holmes is a neonatal clinical pharmacy specialist for Novant Health Forsyth Medical Center in Winston Salem, N.C. James Crecraft is a clinical staff pharmacist for Novant.