What is a Clinical Pharmacist, and how can you become one?

clinical pharmacist hospital pharmacy May 18, 2022

Before I transitioned into hospital pharmacy, I would hear the term “clinical pharmacist” thrown around, and to be honest, it kind of annoyed me. At the time I didn’t really understand the term and what it encompassed. The title felt like a divide between ‘us’, and ‘them’. If you are a community pharmacist working in a patient-facing role you may have had similar thoughts as I did.  I mean, aren’t we all doing clinical work? Why the need for distinction in job titles? 

Well, what if I told you that we all have the potential to be practicing as clinical pharmacists - with or without the title?  Yep! Once you’ve read this post, you’ll have a clear understanding of what a clinical pharmacist is and isn’t.  You’ll discover how small, intentional actions in your day can have you feeling more aligned to your purpose as a pharmacist (regardless of your job title), and bring greater satisfaction to your work.

What exactly is a Clinical Pharmacist? 

Did you know that in a hospital setting, pharmacists are often referred to as “clinicians”? It’s not a term we hear in community pharmacy, but in hospital circles, it is quite common, with many health services classifying their pharmacists as “allied health clinicians”, alongside physiotherapists, occupational therapists, speech pathologists, podiatrists, radiographers, dieticians, social workers and more.However just because a pharmacist works in a clinical setting, such as a hospital doesn’t mean they are necessarily a clinical pharmacist. Let’s look at a few definitions. 

Clinician:  a practitioner who spends most of their total weekly working hours engaged in clinical practice (that is, in diagnosis and/or treatment of patients including recommending preventive action)1

Clinical Pharmacist:  Hospital pharmacists who are embedded into medical wards and units and provide clinical pharmacy services to patients at the bedside. . Clinical pharmacists also work in community health services, aged care facilities, rehabilitation facilities, and general practice clinics.2  

I would also add to this definition consultant pharmacists who do medication reviews  (HMRs).

Some of the roles of a clinical pharmacist include:

  • Reconciling medicines. They check what the patient is actually taking, by gathering a medication history and comparing it to the prescribed medicines. This includes medication chart reviews and documenting recommendations on a “medication action plan” or “medication management plan”
  • Counselling patients and carers on new, and often complex medicines.
  • Working within a multidisciplinary team, usually of Drs and nurses to provide information and recommendations on drug dosing and administration, and other medication management issues.
  • Interpreting lab results and undertaking therapeutic drug monitoring (TDM)

Pharmacists who aren’t spending most of their time engaged in patient care, such as those in higher-level positions such as Directors of Pharmacy, or those in educator or other administrative positions would not be considered ‘clinical pharmacists” even if they practiced in a clinical setting. 

So what about community pharmacists? Can they be considered clinical pharmacists too? This is such a good question. Personally, I would say there have been times when I practiced clinically as a community pharmacist, and times that I didn’t. The key is reflecting on how often in your day you are engaged in the activities listed above; counselling patients, reconciling their medicines, communicating with their GP eg. 

While our scope of practice continues to expand, is this allowing us more opportunity to practice clinically or less?  I’ll let you decide.

Clinical interventions

Remember those pesky clinical interventions? Yeah, me neither.  Well,  I have tried to forget them. Clinical interventions made me feel like my worth was defined by a number (while everything else I did was ignored!). Being told my 50-word documentation was too long was completely deflating. Because how could you possibly meet the “guidelines” for documentation in just a few words? You can’t.  

So while I dislike the idea of recording clinical interventions purely for profit, because let’s be honest here, pharmacists didn’t all of a sudden become more ‘clinical’ because of this funding. It’s almost insulting if you think about it. We were really just doing our jobs. But now someone wanted us to prove it, and incentivize us to do so. Which ultimately led to dodgy practices and some pretty skewed data I’m sure. But I’m probably getting off track here….

Recently I had a mentor session with a lovely young pharmacist who’d spent the last 3 years working at a discount pharmacy. She was feeling ready to make a change and progress her career but was feeling unprepared clinically and this was keeping her stuck. 

So I asked her more about her work. What time does she have with patients? Are there any specific areas she is feeling particularly skilled in? Where are her knowledge gaps?

It turned out her work environment was difficult in this respect. The pharmacists are mostly encouraged to stay in the dispensary. Staff are rostered to the scripts in and scripts out counters. She reported very little opportunity to talk to patients. 

I gently challenged her on all of that. Because regardless of time pressures,  rostering, and the whole “this is how things are done here”, she still had a responsibility as a pharmacist. No one can stop her from counselling a patient on their medicines, making a recommendation for better treatment, or checking a patient’s inhaler technique. We can all become conditioned to the environment we are in, and slip into automatic mode. We become so consumed with the administrative work, that we forget that the core part of our role is actually clinical and patient-centered. 

Pharmacy isn’t fast food. It’s medicine. We all play a part in that perception. Every time you choose not to talk to someone because the scripts are piling up, even though you know you should. When a treatment plan seems unusual, you’re concerned about a potential interaction, duplication of therapy, or misuse, but you’ve got patients waiting and feel it’s too hard to resolve. So you say nothing. 

The guidelines for clinical interventions state that “Pharmacists have a fundamental role in, and responsibility for, optimising health outcomes and minimising medication misadventure.”3

Acknowledging what your role is as a pharmacist (irrespective of the kind of pharmacy you work in), and ensuring that those around you understand and respect this too, will help your confidence in stepping outside of the dispensary and lead to greater job satisfaction. When you provide a clinical intervention that truly improves a patient’s care, that moment then and there raises the profession as a whole. It’s where we begin to move towards this practice of “clinical pharmacy”. Because ultimately it’s not about a place of practice, it’s about the practice itself. 

How to practice as a ‘Clinical pharmacist’ every day

If you feel that the struggle is real, and you have no time in your day to provide meaningful clinical care, then may I suggest a few areas you could reflect on? First, consider whether or not you are delegating appropriately. There are jobs that you don’t need to do. Not doing them can help you claw back whatever time you can for the important stuff. Do you and your staff feel confident telling patients the wait time, and politely handling those who hover around the counter, interrupting your work and making you feel distracted and anxious? It’s hard to step away to talk to a patient when there’s a crowd of people staring at you! 

How effective are your communication skills? Do you let your team know when you’re going to be stepping out of the dispensary, so someone can continue with the work while you’re with a patient? Do you have a system for handling issues that are taking too long? For example, offering to call or text the patient with an answer when you have it or finding another solution such as offering to deliver the medicine at a later time.

Are you prioritising what really matters? This takes practice. Too often I’ve seen pharmacists lose themselves in following up a script with a Dr, which was never an urgent matter when there are patients in front of them who need attention now.

I wonder if many of the pressures we face day to day are in part self-sabotage. We feel bad if the blister pack isn’t ready, or we don’t have a medicine in stock. We don’t want to keep people waiting. However, people wait for literally everything else! They wait for a barista coffee, for the petrol pump, in traffic, on the phone, at the GPs, in the ED, for a haircut. Yet community pharmacy has been driven to the point of doing something so fast, that so long as it scans correctly, no one is even looking at it. I locumed in a discount pharmacy once that had stopwatches in each basket. The whole thing is actually terrifying. 

So how can you begin to practice more clinically every day? I know for some of you, this may seem impossible. However, just start by reminding yourself of what your job really is, and defend that!  When you are dispensing, wherever possible try to take a few extra moments to look at that patient’s medicines as a whole. What health conditions do they have? How old are they? You can assume some renal impairment in the elderly population, even if you don’t have access to lab results. 

As technology improves, we are gaining more and more access to patient information, such as lab results, immunisation status, and previous dispensing and prescribing history. This is an amazing opportunity to use this information to practice more clinically; to reconcile medicines, document a plan, communicate with the healthcare team, and make meaningful “clinical interventions”. 

Not confident in teaching a particular type of inhaler technique? I get it - there are so many devices these days. So when you come across something you don’t understand, make a note of it. Knowledge gaps are only a weakness if you encounter them over and over, and don’t make an effort to address them. Don’t use the dispensary to hide from the work that you are there to do. You are so much more capable of using your clinical skills, trust me. 

So while a clinical pharmacist may work in different settings, providing different services, the core meaning is to provide direct patient care. I hope this has given you a new perspective on the meaning of clinical pharmacy and given you an opportunity to reflect on your own practice.  Implementing just a few small intention actions that allow you to work as a ‘clinical pharmacist” will not only provide greater job satisfaction, but will make a big difference to the patient, and the profession as a whole. If the idea of being a clinical pharmacist in a hospital setting interests you, but you aren’t sure where to start with the clinical learning, check out my list of free online courses.

References

https://www.aihw.gov.au/reports-data/health-welfare-services/workforce/glossary#:~:text=clinician%3A%20a%20practitioner%20who%20spends,clinical%20and%20non%2Dclinical%20hours 

https://shpa.org.au/about-shpa/about-hospital-pharmacy

https://www.ppaonline.com.au/wp-content/uploads/2019/01/PSA-Clinical-Interventions-Guidelines.pdf