Hospital pharmacists helped create bariatric surgery education program

Pharmacists help prevent pill-taking problems

As increasing numbers of hospitals add bariatric surgery to their services, it's an opportunity for hospital pharmacists to become point people in developing patient education processes and materials.

"The primary reason for having pharmacists involved is that after people undergo the surgery they have a very small opening in which they can get drugs through — it's the size of a pencil," says Jill Strykowski, RPh, MS, director of pharmacy for Mercy Hospital in Coon Rapids, MN, and Unity Hospital in Fridley, MN.

"Pharmacists are experts at changing the tablet dosage to some sort of liquid, and that's how we got involved," she adds.

Unity Hospital has involved hospital pharmacists in patient education for gastric bypass surgery for nearly 15 years. Its program has been refined with a formal, one-on-one education session involving a pharmacist as educator, and patients receive a small booklet that explains their medication changes and some general post-surgery medication issues.

"Bariatric patients have a pharmacy consult on the first day after surgery," says Phyllis Ehlers, RPh, a staff pharmacist at Unity.

"We go over their medications and tell them which ones would be likely to be continued and which were likely to be discontinued because of the surgery," she adds. "They have to have chewable tablets or liquids, so a pharmacist would recommend that an immediate release tablet is broken up or that a medication is switched to a liquid form or to a form that dissolves in the mouth."

In a poster analysis of the program's results, Ehlers and Strykowski found there were no re-admissions due to gastrointestinal blockage or medication misuse, and all recommendations made by pharmacists were accepted.

When a pharmacist works with a patient whose medication list includes a drug that is not available except as a tablet, the pharmacist will call the patient's primary care doctor to see if he or she could prescribe a similar drug in a different class, Ehlers says.

Pharmacists also advise patients about how their medication list will change because of the surgery.

For instance, diabetic patients who suddenly are eating very small portions of food might not have to take any or as many antidiabetic medications, Ehlers says.

Likewise, patients with hypertension, high cholesterol, and high triglycerides also might not need drugs to manage these conditions.

Pharmacists also discuss drug-drug interactions and how patients might change the way they take their multiple medications.

"We tell them that instead of taking all their pills and medications in the morning they should separate them into 15-minute increments, so the drug will be absorbed as much as it could be before they add another medication," Ehlers says.

Hospital pharmacists developed a bariatric surgery patient education booklet to reinforce the one-on-one teaching.

The booklet has bold-faced, sections, including:

  • How to swallow your medicine;
  • How to tell what type of medicine you have;
  • When to start taking your medicine;
  • How to take tablets;
  • How to take caplets;
  • How to take liquid medicine;

The booklet also has a chart in which a pharmacist can write the patient's medications and instructions for use.