Throughout the day, the CPST performs various troubleshooting functions in the ICU, activities that were previously handled by the clinical pharmacy specialist. These troubleshooting activities might include dealing with issues related to ward stock or narcotics, handling drug-distribution problems, expediting “stat” medication orders, clarifying physicians’ orders, looking for missing medications, documenting use of Special Access Programme drugs and study drugs, investigating drug misadventures, and documenting unusual medication-related incidents. The CPST consults with the clinical pharmacy specialist as needed to solve these problems. By having the CPST serve as the initial pharmacy contact person for staff from the ICU and centralized pharmacy dispensary, issues can be quickly triaged, with the clinical pharmacy specialist becoming involved only for issues specifically requiring his or her input.

Compatibility of Drugs for IV Administration

A typical patient in the ICU might be receiving multiple drugs by IV administration throughout the day. These medications may be administered either on an intermittent dosing schedule or by continuous infusion. Nursing staff with questions about IV drug compatibility may approach the ward- based pharmacists for help. These questions can come at various times of the day, including during patient care rounds. The CPSTs at the Royal Columbian Hospital are trained to search for the answers to these IV compatibility questions using a stepwise approach (Figure 1). The CPST first determines the specific IV lines available and the medications being infused through each line. Next, the CPST searches for compatibility information in reference books, IV compatibility charts, or in electronic resources and prints a copy, which is made available for the pharmacist or nurse to add to the patient’s medical record. The CPST then applies the information obtained to the medications that the patient is receiving and identifies the best option. All information is presented to the clinical pharmacy specialist for discussion and approval.
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Reporting of Adverse Drug Reactions

Patients sometimes experience an adverse drug reaction during their hospital stay, and the pharmacist may choose to document and submit these cases to Health Canada. The CPSTs can assist the pharmacist by filling in some details on the adverse drug reaction reporting form, such as the patient’s demographic characteristics, information about the health product, and contact information; sometimes the CPST is even able to document the entire case. The CPST gives the partly (or fully) completed form to the clinical pharmacy specialist; once the form has been completed and approved by the clinical pharmacy specialist, the CPST goes on to fax and file the report.

Figure 1. Compatibility protocol

Figure 1. Compatibility protocol for IV drugs.

Student Orientation

CPSTs have taken over the role of student orientation during their first day of clinical rotation. In addition to their typical patient care activities, the pharmacists at the Royal Columbian Hospital are regularly asked to orient students as part of undergraduate, residency, and doctor of pharmacy programs. At the start of the rotation, typically on a Monday morning, the clinical pharmacy specialist would spend a few hours familiarizing the student to the unit and its staff, patient and drug information sources, the in-house computer program, and the patient monitoring form. Now that this task has been delegated to the CPST, the clinical pharmacy specialist’s time on these days can be better spent preparing for patient care rounds.
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