Exercise leadership during rotations


How many times have you tried to get in touch with a prescriber to sort out an issue regarding a prescription, only to be on the receiving end of the following phrase, “I am paging the physician right now for you?” Does this sound familiar to you? Well, if you are like me, then you would probably dread hearing those words because they usually mean that the issue will not be resolved soon and the patient will have to wait in order to get their medication. 

Although there are times when the prescriber will contact you right away to resolve the issue, more often than not it can take some time before they get back to you. While no one in particular is to blame for the delay, it is still problematic for patients as they transition from one setting to the next. 

There are ways you can exercise leadership during rotations and use what you have learned in different practice settings to improve the transition of care for patients and health providers.

A game of cat and mouse

When I first started working in the community setting, I got a hefty dose of the struggles that many patients face when they are transitioning from the inpatient to the outpatient setting. Once, I came across a prescription for albuterol nebulizing solution that I was trying to bill to the patient’s Medicare part B insurance. Unfortunately, the prescriber who had sent the prescription did not include a diagnosis code. When I called the hospital number on the prescription, I was connected to the answering service department. The woman I spoke with assured me that she was paging the prescriber. As the day went by, I waited to receive a call back from the prescriber so that we could fix the issue at hand, but I never heard back from him. 

The next day, I gave the answering service another call. Again, they told me they were paging the prescriber, but still no one had answered the page. In the meantime, the patient’s caregiver called the pharmacy numerous times regarding the patient’s medications, but each day that week I had to explain to the caregiver that if the albuterol is to be billed through the insurance, we need a new prescription with the diagnosis code. This game of cat and mouse continued into the following week, when I was finally able to get in touch with the prescriber to resolve the issue. I was baffled that something so simple as a diagnosis code could become the rate limiting factor for the transition of care process. 

The lag in the transition process is not only a burden for patients, who might go days without medication, but also a burden to prescribers and pharmacists as well. The amount of time devoted to resolving issues like these could have been used for more meaningful tasks, such as spending extra time counseling patients on their medications. It was not until I had the opportunity to experience different pharmacy settings on rotations that I was able to understand the relationship between them and why the patient may experience a bumpy ride during his/her transition of care. 

Become proactive

The inpatient and outpatient settings are two separate pharmacy worlds that are connected by an electronic “portal” that sends and receives e-scripts. The lack of understanding that prescribers may have about what occurs on the other side of the “portal” is likely contributing to the chaos that a patient may experience during the transition of care. This is one area where pharmacists can take the lead and ensure that the transition from inpatient to community will be a smooth one for the patient. In fact, student pharmacists who join the health care team on rotations should also play an active role by utilizing the experiences they have had in various settings to promote a seamless transition for patients. 

There are countless ways that you can promote a smoother transition of care as a student. For example, you can encourage prescribers to use the pharmacy notes section on an e-script to communicate their intentions regarding medication changes, so that when a pharmacist in the community receives the prescription, he/she does not waste time contacting the prescriber to clarify the change. You may also offer to educate prescribers about the requirements of a prescription, in order to ensure that the patient does not experience a delay in obtaining the medications. 

Although it may not seem like much, collectively, all these small actions can have a positive effect in health care by reducing costs and readmissions to the hospital. The quicker the patients can receive their medication, the less likely that they will have an exacerbation 
requiring hospital readmission. Therefore, student pharmacists and pharmacists should become more proactive in mitigating the challenges currently faced with the transitions of care.

19A_Maria-Zdravkova---On-Rotation.pngMaria Zdravkova is a final-year PharmD candidate at St. John’s University College of Pharmacy and Health Sciences.