What does it take to be an emergency medicine pharmacist?

‘No day is the same’: AJP speaks to a specialist pharmacist about what it’s like working in a hospital ED

Christopher Hidayat recently moved to Canberra to take up a new role as Lead Pharmacist in Operations at Calvary Public Hospital in Bruce.

Prior to this, he was an emergency medicine pharmacist working in the busy ED of Westmead Hospital, Sydney for over three years.

He completed his internship at Dubbo Hospital, about a five-hour drive west of Sydney.

Here is a transcript of the above video interview, where we ask him about working in the ED and what you need to make it in the role.

AJP: Emergency medicine pharmacist seems like a very hectic kind of role, how would you describe a normal ordinary day in the life of an emergency medicine pharmacist?

Chris: In terms of the role, being an emergency medicine pharmacist, working in the ED setting is really unpredictable, demanding at times and I guess you don’t really know what’s coming through the door.

So it really varies day to day throughout and I think that’s what I like about working in the ED. It makes no day the same, you get to see all sorts of different presentations across a whole range and spectrum of specialties, a range of acuity of patients.

It really makes a day not only challenging but also rewarding, doing all sorts of different stuff. No day I guess is really the same.

AJP: Interesting! So what is the craziest thing you’ve seen on the ward over your three plus years in emergency medicine?

Chris: Yes, so I guess the more stressful situations are where you get patients who come in and are really sick, who are quite acutely unwell and deteriorating quite quickly, and they’re often in the resuscitation part of the emergency.

And they often quite are stressful environments at times, where we’re quickly trying to determine what’s going wrong with the patient.

 Often in the situations they might be using for example, if it’s an overdose they might be using drugs like antidotes, I guess which the staff on the floor may not be familiar with because it’s not their day-to-day stuff they use, sometimes in those roles I’ll step in as the emergency medicine pharmacist and just provide guidance about dosing administration, how to best give things.

It just decreases a lot of stress and offloads a lot of the work for a lot of the doctors who I guess aren’t familiar with these sort of drugs as well as the nursing staff as well.

AJP: What are the more common presentations you see, something that you see several times a week?

Chris: In Westmead, it serves a big Western Sydney population which has an ageing population – which all of Australia does – higher rates of chronic diseases and a lot of that is your cardiovascular, diabetes and renal disease type of patients.

You’ve got a lot of patients on heaps and heaps of medications unfortunately and a lot of my role during the day is to sift through these patients, see which ones are high risk, prioritise those in terms of who we should see or who would benefit most from having a pharmacist input or review, and so I guess we prioritise those sort of patients who come through the door in the ED.

Christopher in the workplace. Source: Supplied.

AJP: And how big is a pharmacy team that covers the ED?

Chris: At Westmead, in September 2017 to be specific, that’s when we re-established the pharmacy service for the emergency department. Prior to that, for a significant time, there was no pharmacy service so it was a big role that myself and another colleague did a lot of work in terms of bringing the service back to fruition.

So we started off with a 1.5 FTE pharmacy service, that was only a temporary trial just to see what being in the ED, what value we would provide, what value we would add.

Obviously over time we’ve proved ourselves in terms of what value and benefit we added to the patient care and not only the patients but also the department in general, in terms of medication safety and obviously that was quite enormous in terms of the value that pharmacists could play in the department.

I guess you could say a year or so down the track, we were eventually able to secure 2 FTE permanent pharmacists for the ED which is what it’s at, at the moment. That’s quite an achievement for Westmead.

And I think a lot of that came with the relationships we’ve built with a lot of the medical and nursing staff there over time, I think that’s what made a really big difference.

AJP: What would you describe are the most important qualities for a pharmacist who might be interested in working in this area would have?

Chris: You’ve got to be broad in terms of your clinical background. EDs are environments where you see a bit of everything so often if you’re thinking about working in an ED, making sure that you have clinical knowledge that’s backed or supported by several years of experience, often in critical care settings, cardiology or surgery or medical wards where it will give you that foundation to be able to use your knowledge across a whole span of specialties.

Skill wise, emergency departments are often very noisy, stressful environments, so making sure that you’re a person who can prioritise, have good time management skills, especially be able to work as a team. It’s very much a team environment. And having good communication skills as well is important.

AJP: Thanks for your time. Bye.

Chris: Bye.

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