David Hoff is a pharmacist, but he’s not the type you might picture. In fact, he rarely dispenses a drug.
“I’ve been doing this for 17 years, and the thing is, my mom doesn’t even know what a clinical pharmacist does,” he laughs.
It’s not for lack of trying to explain; it’s just that most people’s eyes glaze over when they hear phrases like “evidence-based pharmacological practices.” What it really means is that Hoff sets policies for the way drugs are administered, based on the best available scientific studies. Because of where he works, he does so mostly for critically ill babies and children.
He offers one example: “There’s something we do called pharmacokinetic monitoring, where we measure blood levels of certain drugs in the bloodstream, then adjust dosing to affect those levels. A multitude of published studies support keeping the lowest blood concentration for a certain medication below a certain point. Otherwise you can develop kidney toxicity. We want to set it to the right range to kill the bacteria but not kill the kidneys or the ears.”
Because he works with such a large group of neonates on a day-to-day basis, Hoff’s experience in drug administration is potentially very valuable to other hospitals. In fact, he publishes his results in order to share his findings. The topics are various: How to reduce adverse reactions when administering intravenous immunoglobulin. How to most safely use doxycyclene to treat fluid in the chest cavity. A weight-based protocol for giving a certain medication to premature babies.
“We are going to have the largest and most comprehensive study of this drug and its pharmacokinetics in premature babies ever published,” he says.
Hoff also works to reduce the potential for errors in drug administration. He’s the pharmacist reviewer on the oversight committee for CPOE Order Set development at Children’s. What that means is that he scans patient therapy orders for uniformity—are the same treatments and equipment settings always prescribed in the same situations?—and for potentially confusing abbreviations.
He’s also instituting point-of-service bar coding, a protocol in which nurses scan a patient’s wristband and a medication pump automatically loads the correct amount of the correct drug. It’s not just a time-saver; when nurses are treating one-pound preemies, the tiniest error can be catastrophic. A recent high-profile example is Dennis Quaid’s twins, who were given 1,000 times the proper dose of Heparin. The goal is to reduce the potential for incidents like that. Hoff is working hard to adapt technologies that will make it as foolproof as possible.
“A lot of what I do as a clinical coordinator is make medication use safer,” Hoff says. “Being in a hospital is about as dangerous as bungee jumping, from what I’m told. Overall it’s a safe experience, but it can get much, much better.”
