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Health // Doctor in the House
Rasa Fournier

Managing Hospital Rx Resources

Kara Izumi
Clinical pharmacist at The Queen’s Medical Center

Where did you receive your schooling and training?

I went to pharmacy school at Washington State University-Spokane, and undergrad at a small, private school in Tacoma, Pacific Lutheran University.

How long have you been working as a clinical pharmacist?

Eight years.

How did you choose this field?

I went into pharmacy because I like the science behind it, and I wanted to be able to interact with people rather than being behind a counter. I went into clinical, meaning hospital, rather than retail pharmacy, because I like being in the middle of the action. I like thinking on my feet and being able to be part of the decision-making process with the team that manages the drug therapy.

What is it that you do?

I’m a drug consultant. My job here is in the ICU (intensive care unit). I make sure all of the medications are appropriate for what they are being used for, that the appropriate dose is being used, that it’s safe for the patient and that there are no negative drug interactions.

A lot of people don’t know what hospital pharmacists do. Everyone thinks of a pharmacist as behind the counter at Longs, but there are a lot of different things pharmacists can do. Being clinical and rounding with the medical team is one.

Do you directly interact with patients or do you mostly plan the drug regimen behind the scenes?

I work in ICU, where most of the patients are pretty sedated, so I don’t necessarily get to interact. We have pharmacists on every floor. We have a pharmacist who does discharge counseling for many of the patients going home, so they directly interact with patients. We have pharmacists who have clinics, so they see the patient and talk to them about their medication, and therefore have a lot more direct contact. The patient population I work with are mostly asleep, so I end up interacting more with the staff, but our other pharmacists do a lot of patient counseling.

Is chemistry one of the biggest components of your expertise?

In school, before we get into pharmacy school, we have to have a lot of chemistry, biology and math. Those are some of the important areas. Once we get into clinical practice, it’s a lot of keeping up on current data because there are new studies that come out all the time focusing on different new drugs. Studies may show that there is a bad side effect of the drug or there is an interaction we didn’t know about before, so a lot of what we do involves keeping up on research.

With all of the medications for various diseases and possible side effects, like drowsiness and worse, how hard is it to come up with the appropriate medicine amounts and combinations?

It takes practice. That’s what I like about it ― it’s a challenge every day. You can’t do the same thing every day with every patient. You have to tailor it. It’s like a puzzle you have to figure out using the knowledge that you have, and then looking at any other information and figuring out the best thing to do for that patient.

Do you have to know every drug that’s out there or just certain classifications?

You have to know the categories, and you can make an overall decision based on that, but you have to know a little about each drug, too, because each one can have a little bit of a different effect. The biggest thing pharmacists do, both in a hospital setting and outside, is look for drug interactions. There are a lot of interactions that people don’t know about and that even doctors don’t know about, because they can’t possibly keep up on everything.

It’s important to always check with your doctor and pharmacist before taking anything like non-prescription medications or herbal supplements that actually can be really dangerous. They may interact with the drugs that you’re on that have been prescribed. The reactions may be ones we don’t know about because they haven’t been studied.

In that case, we don’t know anything is wrong until something bad happens. A lot of what pharmacists do is make sure the drugs are safe for the patient, and part of that is being careful about herbs and supplements a patient may be taking.

In addition to being a clinical pharmacist, you are a nutrition support specialist. What does nutrition support involve?

Within pharmacy there are a lot of different specialties that you can focus on. One of the specialties I have interest in is nutrition support, which is when someone can’t eat on their own. In a surgical trauma ICU, patients have a tube down their throat or maybe there’s something wrong with their bowels, so they can’t eat. We give them specialized nutrition, and one of the forms we use is an IV. As pharmacists, we are responsible for the IV form of nutrition because it’s considered a drug. I ended up specializing in that because I deal a lot with it.

Is there much variation in what you feed people through an IV or is it a basic formula?

It’s pretty basic. We just tailor it to specific needs because a little person is not going to require the same amount as a bigger person. Or if their kidneys or liver don’t work very well, you have to account for that as well.

Tell us about the award you won recently as Hawaii Pharmacists Association’s Innovative Pharmacist of the Year.

You may have heard in the media about drug shortages in the last few years. Drug shortages have impacted patient care when we can’t give them the drug that they need because it’s not available. A lot of what I’ve helped our ICU team with in the last couple of years is coming up with alternatives. If we can’t give them this drug, what is the next best thing that we can use? And how do we manage and get appropriate care when we have a lack of resources?

Solving questions like that is what I won the award for. I helped the hospital come up with policies and procedures on what to do when we have a drug shortage, and I also was named Queen’s Employee of the Year.

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