Pharmacists Really Do Have Prescribing Power

I read with interest my fellow Brain Blogger’s article on pharmacists and their essential value to the medical team. While pharmacists do not have prescribing power and often get a bad rap as being “pill counters,” it is clear to me that their position in the medical team food chain is equivalent to having prescribing power.

At the very least, a good medical team or ICU team will have a pharmacist as part of the team to help with medications. This includes making sure the patient has no allergies, that there is no resistance or cross reactivity between medications, and checking to make sure the prescribed medication is clinically indicated. In this situation the pharmacist is sort of like the medical case manager. He or she “owns” the prescriptions of that team.

In most advanced hospitals these days, medicine orders are entered electronically. Even those hospitals that are in the dark ages use faxes to fax paper copies of doctors’ medicine orders. For the hospital that uses electronic prescribing, the pharmacist really does have a whole lot of power. When an order is entered it is routed through a software program that the central pharmacy manages. When something is out of whack, you will undoubtedly get a page from central pharmacy questioning the order and in many instances asking for justification of the order.

Some hospital pharmacy software programs are so sophisticated that they raise red flags when expensive drugs are prescribed when there is a cheaper equivalent. When the pharmacist pages you, it is you the physician who must double check your prescription and your order, not the pharmacist. The pharmacist is kind of like the banker on the show “Deal or No Deal”. He sits in an office overlooking the entire prescribing force of the hospital and uses his phone to corner any deviant physician!

Actually, the reality is this – the pharmacist is there to do what physicians are meant to do but that usually do not have the expertise to do – to make sure prescriptions are done correctly, dosages are appropriate, medications are cost-effective.