Vallarie Basa

HESI
Transcribe Interview
Brad Pharmacy Clinical Pharmacist, Pain Management (SMP)
July 18, 2016
Q: Please state your name and job title for me.
A: My name is Brad R., I am a clinical pharmacist and I primarily work is in pain
management in inpatients setting as well as safe medication practice (SPM). Those are
the two things that I work in and the two titles that I have.
Q: Please tell me more about SMP?
A: So, briefly I will tell you about SMP which is the minority of what I do because there
is another pharmacist here who is an expert in that area so I just kind of help her out with
that but, I primarily do the pain. SMP are pharmacists who closely watch and monitor the
medications that are given in the hospital. We also follow adverse event or bad things that
happens for various reasons. There are many reasons when accidents and mistakes
happen and SMP pharmacists are responsible for tracking and trending those things.
While trying to figure out why those things are happening and then figuring out solutions
to fix those things in the hospital and so thats what we do in that capacity. When we do
that we make recommendations to the committee and that is for the whole hospital called
the SMP Committee. It consists of a large number of nurses from each department and
doctors also sit on in too. During these meeting we say hey, we found these things
happening with this particular medication. This is what has been happening and this is
how we think we should fix it. And then well all talk about it in that committee and
when we all make a decision based on the information. Those recommendations go up
the chain to be implemented on a bigger level. So thats just the SMP, there is a very
important role in the hospital. Especially a big hospital because as you can imagine how
many medicines are going out everywhere to how many patients everyday so, the bigger
the hospital is the more important that becomes I would say just because of the volume of
medication that is dispensed increases, so there are more opportunities for mistakes to
happen.
Q: Can you please tell me more about pain management?
A: As far as pain management goes that is what I am primarily hired to do and in that
capacity, what I do is I act as a consult. So, doctors and sometimes nurses will call or
type me in a computer order for a consult for a patient that we have in the hospital and
when that happens I will go up. When that consult is called that is because a patient is
having consistent problems with pain and they want me to go in there and make my own
assessment and recommendations based on what I see and what I think. Now, right now I
dont get to specifically write medication or prescribe anything to the patient but, I am
able to go to the doctor and say hey, I consulted this patient and I went in there to do my
own assessments and these are the medications that I think should be changed, added or
stopped, and this is what I think. So then well talk and the doctor will either decide to
go with what I recommended and sometimes not. Then, I can put in the orders based on

the order that they have given me. So, in that capacity I really act as a doctors second
opinion as far as pain goes. Its only kind of of related to pain. Although, there are other
topics of concerns thats mainly what Im suppose to do. Now, there are other things that
I do in my pain capacity role. Up on our orthopedic unit, which is where we have
selective surgeries for hip and knee replacements. On that floor, because we know that
the hip and knee surgeries will be painful ahead of time we can do something about it. I
target that specific floor in the hospital and I go up there everyday and I actually round
with nurses. So the nurses will come into a room everyday and well all talk together with
case managers and social work and a big interdisciplinary group and we make decision
about the patients current state including pain management and recovery. In my role I
am able to assess patients and whats really neat about that role is that I get to teach
nurses about medications. If they have questions, many of the nurses have questions and
they have learned so much that they dont really ask questions anymore and thats great
because you know that they already know and are proactive and helping patients even
when youre not there. But, they will also come to me and ask for patient assessment and
thats okay too. As a result of this project, which we started in March/April, we have
really decreased the amount of patients pain up on that unit and also increased the
patient satisfaction with their pain management while they are in the hospital. That has
really been rewarding because you feel really good quickly when you know that you
helped the patients, made them feel better and did your job well. There are a lot of things
for instance if you are in a different part of medicine and taking a patients blood pressure,
thats really great and medically important and necessary but the patients doesnt
necessarily know and feel that differently one way or the other. Compare to a patient who
is having severe pain and I come in and make an intervention and I come in the next day
and the patient thanks me and tells me that they feel a lot better after I consulted with
them you can see how that very rewarding. In effect that when you feel so much, you get
a lot of day-to-day enjoyment and reward out of your job. You feel like you have direct
impact on patient care, which is really important too.
Q: So your job has more patient interaction compared to the other pharmacists?
A: Yes, now youre right but every pharmacist has a different area of expertise so, there
are other clinical pharmacist here too that have the same amount or more patient
interaction like I do but they just work in different areas. So for example there is an ICU
specialist and they do incredible work in there. That is really a hard job because you are
dealing with the most critically ill patients that need the most help so, that are really
important and demanding job. Another example is an infectious disease specialist, so she
specifically works very closely to the infectious disease doctors in figuring out which
antibiotics and antivirals are appropriate for patients and all of the other different aspects
(time, place, dosage and more) because all of these aspects can be very beneficial or
hurtful to the patients based on that. Last example would be a specialty in psychiatry
specialization in medication. There are all kinds of things that can have different
specialties.

Q: My next question is what type of schooling did you go through?

A: You go through pharmacy school and pharmacy school now it used to be a lot
shorter but it would probably take a minimum of four years and you would take your
Pharm D. degree which is a doctorate of pharmacy once you graduated now after you get
that you take the board exams in California or wherever youre at and you pass the board
exam you be a licensed pharmacist with a Pharm D. degree and will be able to work at
any licensed pharmacy in California okay. But the difference is that not all pharmacist
stop there. Like the specialties that I mentioned before like the ICU pharmacist, that
would require some residency. So after they graduated and got their Pharm D. they did
either a one-year or two year residency. So then it becomes a total of fiver or six years
Q: Would those years be on top of the four years?
A: No, you would have a total of six years after the residency. After your residency
thats what makes the specialties for the ICU, Infections and psychiatry so then that gives
you a leg-up when you do applications because you have more school than a lot of the
pharmacist that just got their Pharm D. and you can get more specialized clinical
positions. I didnt do a residency but I did work for two years at a consult paying service
that basically acts like a residency. So, when I was hired my boss just said that the
residency that I already has counted for that. So because I had so much practical
experience dealing with pain on the job with pain issues and pain consults that it fulfilled
that requirement and thats how I got my job here.
Q: How long have you been working at Sharp?
A: Ive been working since the beginning of October. So I am one of the newbies.
Most people at sharp have been working here for a long time.
Q: How long have you been a clinical pharmacist?
A: Ive been a clinical pharmacists since I graduated pharmacy school in 2006, I had a
couple of other jobs and then I worked at that pain consult for two and a half years and
that really made me a clinical pharmacist in pain at Memphis, Tennessee. I recently in the
last few years moved up to California and Ive only been working in this job since
October.
Q: How do you like it so far?
A: I really like it. Like I told you its very rewarding. Its also very challenging, its not
something that you go to everyday. Its not the same thing everyday and you get patients
and its a problem that someone else cant necessarily figure out.
Q: So youre like a problem solver?
A: Exactly! Im thinking about what did they miss? Or what am I missing?. What
aspects are not yet figured out? What questions have we not asked the patient that would
help us figure out what the problem is? The other thing that is kind of hard is how you
psychologically deal with these types of situations. Some people would not want to get
into rooms when patients are gasping, screaming, upset, crying, moaning, yelling and
being understandably upset because they are in so much pain. So, its one thing to do that
one in a while but my job is to do that pretty much all the time. So, depending on who

you are, you may not like that particular part of it and you may not stay with it because
its just hard for you to see that many people in pain that often so that something that you
kind of have to figure out for yourself. Do the benefits of the job out way the negatives? I
get so much rewarding feeling and positive reinforcement for when I help patients that
the times thats really hard and negative makes you thankful for the times you helped but
also makes you say that its worth it because its part of your job. But, you can see where
certain people wouldnt want to do that for their job now because they dont want to see
that all the time and being able to get experiences like this, coming in and getting to see
what people do gives you an idea of what these health care professionals do in a daily
basis. Today, Im talking to you right not but the other days I am up there on the floors to
see someone who has broken a bone or something and their in a lot of pain and they are
crying and it can be very unpleasant at time. Especially when youre tying to help and
you can necessarily find out the best thing for them. Now the best thing is that you work
as a team. Youre not going to fix everything by yourself. But you have teamwork.
Another thing that I do in the hospital is talk to different groups and tell them about pain
management so that they learn more and can do more on their own. I work as a teacher. I
went to the supervisory committee of the anesthesiologist and they were the only ones
there and their affiliated supervisors
Q: Shouldnt anesthesiologist be an expert with pain because they are the one who
administer the medicine to take the pain away?
A: Yes, youre right and for the most part they are. They do know more than pretty much
tan any other group but youll see this in different areas of the hospital not just with
medicine or pain. The recommendations of what to do and the practice of how to do it
Q: Evolves?
A: Changes and evolves, exactly. Youre good. So I go and tell them the new thing and
new way. For example, for a long time I talked to them about ethic of treating a pain with
strong opioid medications and not really considering how closely and severely addicted
people can be or the effects of it. Now you know that we even have the CDC that states
that were a living in an opioid epidemic, meaning that the Percocets, Norco and
morphines are being considered the opioids and epidemic in the US. The way we
prescribe medications is changing. We have to figure out way to deal with patients pain
that use non-opioids. We have to stay away from those as much as possible and that
doesnt mean that we have to get rid of them completely but, we only have to go to them
when we absolutely need to and they problem I that medical group and community has
been giving it first. Resulting in many people addicted and now they are dying in huge
number from just an external overdose. We have more people dying in this country now
from opioid prescription overdose than car accidents. Its a big problem, so in February
there were recommendations that came from operating patients that needed a pain
management and how it change so I update the anesthesiologists what those new
guidelines are to combat the problem that we have and I am going to go in and talk to
another group about it in the first week of August to get everyone on the same page and
the same guidelines for the patient, to change the happenings. We have to do something
in the country before it worsens.

Q: What initiated you interests to work in the healthcare field?

A: Thats a good questions, I first had a lot of interest in science because both of my
parents were biology teachers. So, I grew up with a lot of interest in science, my parents
were interested in it and I read and learned a lot about it and really liked it. Then, as I got
older I took more and more science classes and read some more and got really interested
into it and I decided that I wanted to be in the health care field because that where you
can apply science best. I was really interested in how medications worked and the
different effects it had on the body. High school is really where it started and then in
college but, I was interested in science from my parents at a very early age because we
would talk about it around the dinner table and things like that but, in high school I took
more and more science classes. I took chemistry, biology and physics because those were
out preparation classes for college and then when I got to college I took on more science
courses starting off and I actually took more chemistry and biology but with my interest
of how the brain is affected I also took a lot of psychology classes. The way those classes
work together is that three sciences interest me. Even today I still study and read about it
for pleasure as well as to learn more and do my job well. When pain medications are
given those opioid, of course they affect your brain and how it affects you as far as
addiction goes is a direct impact on how your brain works. All of those things combined
together and thats how I ended up in the pain field as a subsection of what I saw and
studied in college and became a specialist in.
Q: What College did you go to?
A: I went to a really small college in Arkansas but I got my pharmacy degree from the
little rock medical school campus because the medical school, pharmacy and nursing
were all in the same campus. I did most of my pain management work at Memphis,
Tennessee because we had a hospice care company that did pain management.
Brad: The good thing about healthcare is that if youre interested in it and you find the
other student I told is that you just have to make sure because health care is so
challenging that you really have to find something that you find rewarding personally
because you have a big investment in time and money. So when if you make that
decision you want to make sure that you tried out that field and that you have enough
interest and really know that you get personal satisfaction from it because let me tell
you.
Q: What other jobs or careers have you had in healthcare?
A: As an intern I worked at retail pharmacies. I worked for mail order pharmacies and
some of those depending on what you like people like that where theres minimal patient
interaction and get sent out. You basically look at prescriptions all day and do computer
work and I had a job, I stayed with it as long as I could but, everyday was a struggle to go
to work. I didnt find it rewarding and I didnt get any satisfaction from it. The money
was great and the schedule was even great but it didnt matter. I found out that those
things really didnt matter when you came to a job. It was something about what you feel
and what your heart tells you
Vallarie: There has to be some type of compassion

Brad: Exactly, there has to be compassion and satisfaction where you are feeling like the
time that youre putting in is making a difference in some way (for me) because I had all
the other things and it still wasnt enough and I got out of it. I could not do it anymore. It
was just because I didnt think or fell that it mattered they were I needed it to. So, just
make sure that before you put in the time, effort and money into something make sure
youre that youre really going to find it rewarding when you come out because if you
make a mistake and you hate it now you have to compensate, pack back loans and do
things that you didnt want to do in the first place. Any kind of experience or shadowing
offered make sure that you take advantage in any area and ask a lot of questions and go
see it for yourselfMake sure that youre honest with yourself, know the risks and know
your limits. Also, keep in mind that you are never imprisoned into one area. There is
always room to grow and explore so, stay curios.
END