I was blown away by how many of you had questions when you saw me shadowing in the OR! It is definitely not the typical place you find a pharmacy student, so I do understand. As I have previously mentioned, I have been lucky enough to observe surgeries on multiple rotations. On my institutional IPPE rotation after my P3 year I got to see an open heart CABG, and on my ambulatory APPE rotation this past summer I got to see a total hip and total knee replacement. Clearly, I am definitely not one to get queasy when the chest splitter or bone saw are brought out but I know a lot of people are far more squeamish than myself. For those of you that DO want to witness a surgery, talk to your preceptors about your desire while on rotations. Every institution I have been at so far has been very open to having students in the OR to observe. But again while I am in the operating room, all I am doing is watching, a pharmacists role is surgery is NOT a physical hands on role. So what is a pharmacists role in surgery then?From my personal experience there are two sides to a pharmacist being involved with surgeries. There are clinical pharmacists like my internal medicine preceptor and then there are pharmacists that staff the OR pharmacy.
As you may recall, the official title of my internal medicine assignment was “General Surgery,” for two weeks I was rounding with a surgical medicine team. My role or my preceptors role in this setting is very similar to my medical rounding I talked about in this post. The only difference is all of the patients you are rounding on will be having surgery and that tends to be the larger focus (less medication interventions/drug questions), but still the pharmacist is there to point out any concerns or answer the teams questions. The medications the pharmacist is concerned with are the ones the patient will be receiving on the floor (not in the OR) and what changes will occur, if any, to their home medications.
Switching gears over to the OR pharmacist…they are more concerned with the medications given right before or during a surgery. The pharmacy is in the middle of the OR wing so that all 23 operating rooms are in close proximity. The whole wing requires hospital cleaned scrubs and hair nets at all times(masks must be added anytime you enter an actual operating room) and no food/drinks are allowed (yes no coffee boo). After being in the OR satellite pharmacy for the day, I feel like I have a pretty good sense of their work flow. Here is a general overview:
The pharmacist looks at the list of surgery cases the day before and gets an idea of what the ORs will need. They also attend an afternoon meeting with the head nurses to discuss any specific medications required or medications that the pharmacy needs time to order and prepare.
In the morning the surgeons send a list of medication orders for each surgery case. The pharmacist checks and approves the orders and then these medications may be pulled out of the OR Pyxis machines by the surgery staff when they need them. Nurses may also stop by to grab things in person that the doctor is asking for.
The pharmacist/tech also received calls throughout the day for orders they cannot get out of their Pyxis machine. Sometimes they call for STAT orders, meaning that they are needed in the operating room NOW. The orders are pulled or mixed and then directly delivered to whichever OR called for them.
The OR pharmacy has an isolator glove box so that the pharmacist or pharmacy tech can prepare IV bags, solutions/flushes and anything else that needs to be sterile. In the afternoon they prepare batches of IV bags for the next day. If something has a shorter BUD then these tend to be made the day off. The OR pharmacy technician also pulls medications to restock all the OR Pyxis machines in the afternoon.
Since this satellite pharmacy is designated for the OR, the bulk of the medications they handle are those that you would typically see used in surgeries. These include:
Antibiotics – A lot of operations require certain antibiotics before or during surgery. While I was there I think we had 6 orders for gentamicin, which I thought was used a lot anymore, but this certainly isn’t the case in surgery. A lot of the antibiotics are only a one time dose. If you want to learn more about what antibiotics are used for different types of surgeries, take a look at the Surgical Care Improvement Project (SCIP) guidelines:
Local Anesthetics – lidocaine, bupivicaine, etc. These are sometimes injections and other times just solutions put on the surgical area. The medications also come plain or with EPI (epinephrine), which constricts the blood vessels to keep the anesthetic in that area longer. Also normal anesthetics like Propofol.
Analgesics – IV Tylenol, Toradol, Morphine, Fentanyl, etc
Neuromuscular Blockers – vecuronium, rocuronium, etc. These paralyze skeletal muscle and make it easier for the surgeons to cut through.
I hope this post answered most of your questions regarding a pharmacist’s role in surgery! If you have any additional comments, please leave them in the comments below here (or on my instagram post).