SOUTHWEST ASIA --
A
pharmacist’s role is recognized as dispensing medications, counseling patients
and maintaining a collaborative practice with providers. Over the past decade,
pharmacists have steadily made advances to increase their presence in the medical
field.
Studies show a
correlation between insufficient pharmacist manning and substantial direct and
indirect costs to an organization and its customers. These potential costs
include failure to meet legal and regulatory requirements, increased medical errors
and reduced patient safety.
Research also shows pharmacists
reduce medication errors and their associated costs. Specifically, the landmark
Institute of Medicine report, “To Err is Human: Building a Safer Health
System,” cited the importance of pharmacists in reducing medication errors and
recommended increased involvement of pharmacists in the pharmacy and patient care
units.
In 2014, the Society of Air Force
Pharmacy reported that at any given time seven out of 459 pharmacists and 12
out of 1219 pharmacy technicians employed by the United States Air Force were
working in a deployed environment. While this seems to be a small percentage of
the number of pharmacists and pharmacy technicians employed, each pharmacist
and technician must be prepared for deployment settings.
In most circumstances these deployed
environments are found to be positioned at sustained locations. However,
pharmacy personnel are trained for the instance of an Expeditionary Medical
Support (EMEDS) clinic, which is a rapidly deployable medical facility.
Air Force pharmacists
and technicians complete regular training on how to operate in an EMEDS
environment. The mission of an EMEDS package is to have the capability to
quickly deploy and provide forward stabilization medical care to war fighters
and civilians when authorized. There are three EMEDS packages, the EMEDS basic
package, EMEDS +10 and EMEDS +25.
The EMEDS Basic package provides acute intervention and primary care services to support a
population at risk of 1,500 to 3,000 deployed personnel. EMEDS Basic
also provides capabilities for medical command and control, preventive medicine
and trauma resuscitation and stabilization. The Basic package has the ability
to increase services to the other two packages by adding limited general and
orthopedic surgery, critical care, primary care, aeromedical evacuation
coordination, urgent care and dental capabilities.
As a pharmacist
currently deployed with an EMEDS Basic package, I am able to speak to the
benefits and challenges of being deployed in such a unique state. The obvious
benefit is the opportunity to serve our Service members on the front line. Air
Force pharmacists support a mission larger than ourselves every day by taking
care of Airmen and their families. .
We have the resources to
deliver the best care possible to our warriors and their support systems. There
is no exception when deploying with an EMEDS team. The opportunity is the same;
it is just presented in a different environment.
From my experiences thus
far, the challenges of deploying with an EMEDS team are most important to
address. I don’t intend to highlight
them because they are negative attributes to being deployed. I feel it is
important to address them more so, because by discussing challenges, we are
able to improve upon them. If we are unable to improve upon them, then we are
able to allow each other to better mentally prepare.
The main challenge faced
in this environment is the lack of technology. Imagine daily tasks of filling
prescriptions, consulting with providers, ordering medications and ultimately
dispensing to a patient without the use of a computer. Envision logging
narcotic inventories and labeling medications to pass off to patients without
the use of a printer. Technology is a commodity that we use so frequently
throughout any given day that it is almost unfathomable to entertain the idea
of not having it available to complete simple tasks.
From my experience
technology will find its way into the setting. However, it is important to at
least initially plan for not having it. In my own instance, preprinting the
necessary forms was a lifesaver. Forms such as the AF 582, AF 579, and the AF
781 are necessities to bring with you to a clinic in the process of building
from the ground up.
Bring a bundle of each
and plan to make copies of the forms in the weeks to come upon arriving. Also,
acquire some address labels and preprint prescription labels for patient
baggies (baggies, not vials in this atmosphere). Prepare for the worst case scenario, but realize
that technology will find its way to you eventually even in the most basic
environment.
The second major
challenge I came across was inventory management. In my scenario, I deployed by
myself as the pharmacy team. Let’s face it; we rely heavily on our pharmacy technicians.
They are a wealth of knowledge we are accustomed to working with daily. They usually
manage our inventories at home stations and then we can deploy to a location
where we order our own medication supply.
Additionally, medication
orders in the deployed setting are received anywhere from two to four-4 weeks
of the order being placed. So, drug utilization is to be determined, while also
ensuring an on-hand supply of at least one month is being maintained. Speeding
up the delivery is out of the question.
However, begin
anticipating medications that will most likely go fast. Plan to communicate
with providers from the early stages of setting up to determine which
medications they prefer to prescribe.
It’s important to use
all resources available. For instance, determine which military bases are
nearby and establish relationships to share supplies if necessary. Be proactive
in collaborating with all military branches in this endeavor. We are all a part
of the same military, the same team, regardless of branch.
The last recommendation I
feel is helpful is not necessarily a challenge, but more so a piece of advice.
Be willing to step out of comfort zones, ask questions, and have pride, but
lose your sense of ego.
Network whenever possible. Deploying in
general is such a unique opportunity. Take the chance to learn about other
career fields, but to especially gain knowledge on our own career field. Take advantage of opportunities that
pharmacists wouldn’t have at home station. Walk into a deployment with an open
mind, and take the opportunity to leave a deployment as an improved Air Force
Officer and medical provider.