Inpatient Pharmacy Services
The Inpatient Pharmacy is a 24-hour a day, 7-day a week, 365 day a year operation to ensure continuous and comprehensive patient care. In recent years, advances in distributive medication technology have provided pharmacists the opportunity to spend more time interacting with physicians, along with offering direct clinical support.
The hospital uses a modified version of EPIC, named “HealthLink.” This computer system provides computerized physician order entry (CPOE) and electronic medical records, allowing easier access to vital patient data, including progress notes, drug interactions, clinical interventions, lab monitoring, and allergy screening. Moreover, the SCVMC Medical Library and online databases, including Micromedex and UpToDate, provide the pharmacy staff the information necessary for answering drug information questions. The critical care areas are serviced by decentralized pharmacists throughout the hospital.
Daily activities include participating in rounds, providing of transition of care services, performing therapeutic monitoring of drugs, assisting providers with drug information, managing investigational drugs, and developing protocol guidelines. Our pharmacists participate in a variety of medical staff committees including:
- Anti-Infective Evaluation Subcommittee (AES)
- Critical Care
- Formulary Management (FMS)
- Medication Safety
- Medication Utilization Management (MUM)
- Pharmacy & Therapeutics (P&T)
- Specialty Pharmacy
Ambulatory Care Pharmacy Services
Ambulatory Care Pharmacy Services provide outpatient prescription dispensing and patient counseling at multiple pharmacy locations throughout Santa Clara County:
- Enborg Lane Mental Health
- Valley Health Center at Tully
- Valley Health Center at East Valley
- Valley Health Center at Moorpark
- Valley Health Center at Milpitas
- Valley Health Center at Sunnyvale
- Valley Health Center at Gilroy
- Valley Health Center at Downtown
- Valley Health Center at Bascom
- Valley Health Center at Lenzen
- Valley Specialty Center (VSC)
Other notable services related to our outpatient pharmacies:
- Our newly opened Discharge Pharmacy, located in the main hospital, acts as the primary conduit for our Transition of Care (TOC) Pharmacy program.
- Our Pharmacy Information Center processes refill requests and mail order prescriptions. They also assist patients, physicians, and front-line pharmacy staff with a variety of services in an effort to reduce wait time for patients in the pharmacies.
- Our state-of-the-art Central Fill Pharmacy mails out approximately 3,000 prescriptions a day to our patients.
- Our Specialty Pharmacy is a practice site for pharmacy residents, managing high cost pharmaceuticals, such as drugs for Hepatitis C treatment.
Ambulatory Specialty Pharmacy Services
The Anticoagulation Clinic is under the supervision of Dr. Michelle Wilson, M.D., and is staffed by three full-time pharmacists and one full-time pharmacy technician, five days a week (Monday-Friday).
Anticoagulation Clinic staff manage approximately 1100 patients requiring warfarin or direct oral anticoagulant (DOAC) therapy. The clinical pharmacists at Anticoagulation Clinic are responsible for a wide variety of duties, including:
- Screening daily drug-drug interactions
- Daily international normalized ratio (INR), DOAC, and low molecular weight heparin (LMWH) monitoring
- Providing warfarin or DOAC dosing interventions based on hospital protocol
- Supplying patients with warfarin or DOAC refills
- Communicating with interdisciplinary healthcare providers to assist with the management of perioperative anticoagulation for warfarin and DOAC patients
- Ensuring the validity of initiating warfarin and the appropriate therapeutic target range when receiving new patient enrollments
- DOAC monitoring and transitioning as appropriate for eligible patients
- Providing warfarin and DOAC education classes
- Instructing patients on the proper usage of LMWH
The Diabetes Clinics are located at various health clinics throughout Santa Clara County: Moorpark (4 full-time pharmacists), Valley Specialty Center (1 part-time pharmacist), Milpitas (2 full-time pharmacists), Tully (2 full-time pharmacists), Sunnyvale (1 part-time pharmacist), and Gilroy (1 full-time pharmacist). The clinics are overseen by Dr. Patricia Salmon, M.D., Director of Center for Diabetes and Metabolism. Diabetes care managers at SCVH&HS are responsible for providing up to seven in-person appointments (up to 45 minutes per appointment) and up to 4 follow-up phone call appointments on a daily basis. The pharmacist is responsible for providing intensive education (lifestyle and pharmacologic) for patients with Diabetes Mellitus Type 1 and Type 2 and managing their chronic diseases using P&T approved protocols. The protocols include Glycemic, Lipid, Aspirin, Microalbumin Screening and Management, Painful Neuropathy, and Hypertension Protocols, which follow the current standards of care. The pharmacist optimizes medication therapy to provide the most effective therapeutic options with minimal side effects to meet patients’ individualized goals.
The Geriatrics Clinic encompasses a multidisciplinary team of four geriatricians,, two charge nurses, medical assistants, licensed vocational nurses, two social workers, a psychologist, and a full-time clinical pharmacist. The clinical pharmacist may consult with all healthcare providers regarding disease-state management in order to provide optimal care in geriatric medicine. In addition, monthly meetings are held to discuss and develop strategies of care for difficult patient cases. The clinic is overseen by Dr. Nirmala Gopalan, M.D., Director of Geriatrics Clinic, who is also supported by licensed and certified healthcare providers in this field.
The geriatrics pharmacist offers MTM services, transition of care (TOC) follow-up visits, authorizes medication refills under the Refill Authorization Protocol, and manages chronic disease states using P&T approved protocols. A few of the protocols include Lipid and Hypertension Protocols, which follow the current standards of care. The pharmacist may also utilize other SCVMC approved protocols, such as Anticoagulation and/or Diabetes, if certification and training has been accomplished. The clinical pharmacist in the Geriatrics Clinic provides medication-related education or teaching to other healthcare providers, which involves presentations on clinical pearls, side effects, how-to instructional demonstrations, etc. Primarily, the clinical pharmacist optimizes medication therapy to provide the most effective and timely therapeutic options with minimal side effects to meet the geriatric patients’ individualized goals.
Heart Failure Clinic
The Heart Failure Care Management (HFCM) Clinic, located in the Cardiovascular Center at the Valley Specialty Center, is a multidisciplinary effort comprised of a cardiologist, a nurse coordinator, a pharmacist, a health education specialist, and a licensed clinical social worker. Other disciplines on the team may include a PGY-1 pharmacy resident and a pharmacy intern. Dr. Aravind Swaminathan is the Medical Director of the Heart Failure program and functions as the primary attending physician. In addition to Dr. Swaminathan, the Cardiology Clinic has eight additional attending physicians.
The clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all heart failure patients and providing transition of care discharge and post-discharge education and medication counseling. Primary duties in the outpatient setting include management of outpatients in the Heart Failure clinic utilizing a P&T-approved and IRB-approved protocol.
The Ira Greene Partners in AIDS Care & Education (PACE) Clinic is a large primary care clinic for HIV-positive residents of Santa Clara County. PACE Clinic has been providing HIV care since the beginning of the epidemic and has an established reputation throughout the Bay Area for being a pioneer in HIV medicine. PACE Clinic is a teaching site for physicians from Valley Medical Center and Stanford Hospitals. We serve nearly 1,500 HIV-positive patients in addition to providing HIV preventative services (PrEP, PEP) to a growing number of patients. PACE Clinic is an inclusive and safe space for people from any background or walk of life. We value diversity, individuality and freedom of expression. Staff and patients are encouraged to be themselves.
PACE Clinic relies on clinical pharmacists to provide medication optimization and initiation of HAART therapy under broad collaborative protocols that allow the pharmacist to order medications, lab tests, diagnostic images and specialty referral. Pharmacists at PACE Clinic are the point of contact for most patients entering the clinic, whether HIV treatment naïve or experienced. Residents rotating through PACE Clinic will have the opportunity to work one-on-one with newly diagnosed HIV-positive patients to start HAART therapy and counsel on coping and living well with HIV prior to the first physician visit. PACE Clinic pharmacists focus on infectious disease management broadly, and residents will have the opportunity to design, initiate and monitor treatment plans for hepatitis C and B, opportunistic infections, & common infectious diseases including SSTI, STIs, H. Pylori. Moreover, the rotation focuses generally on learning how to operate as a primary care clinician. Residents will have the opportunity to learn how to manage common acute and chronic medical conditions (such as hypertension, hyperlipidemia, diabetes, asthma, and osteoporosis) while practicing their skills in patient interviews.
The Valley Homeless Healthcare Program serves homeless patients of Santa Clara County. Operating on a walk-in basis, the clinic is dynamic and fast-paced, dealing with both urgent and chronic care issues for the underserved and most vulnerable patient population. The clinical pharmacist is responsible for managing chronic conditions (diabetes, congestive heart failure, hypertension, hepatitis C, opioid dependence, anticoagulation, and more) using multiple collaborative practice agreements, refilling controlled and non-controlled prescription medications, performing patient consultations, acting as a liaison between the patient and outpatient pharmacy, and answering drug information questions from providers. Residents who participate in the rotation will have an opportunity to sit in on interdisciplinary addiction groups for the provision of Buprenorphine therapy to patients with known opioid dependence and assist with mobile and "Backpack Medicine" services offered by the Valley Homeless Healthcare Program.
Patients who are in custody and will be transitioning home are served by a team of healthcare providers in the Re-Entry Clinic. The Re-entry clinic pharmacists manage protocols for a variety of chronic disease states including Hepatitis C, substance use disorder, hypertension, diabetes, and heart failure. In addition, pharmacists aid physicians in medication optimization (monitoring for drug-drug interactions, adverse side effects, and appropriate doses/drugs), patient education, facilitating prior authorizations, answering drug information questions, and improving medication compliance by filling pillboxes and providing medication calendars.
Refill Authorization Clinic
The Refill Authorization Clinic, consists of a group of three full-time pharmacists and two full-time technicians. Refill Authorization Clinic staff process an average of 600 refill requests per day (Monday-Friday), and follow a P&T Committee-approved protocol for approving refill requests.
Renal Care Clinic
The Nephrology Division at SCVH&HS offers a broad range of inpatient, outpatient, and educational services. Inpatient services include consultation, peritoneal dialysis, hemodialysis, CRRT, and plasma exchange. The inpatient team consists of the nephrology attending physician, fellow, resident, and students. A nephrology social worker provides valuable support as well.
Outpatient services are centralized in the Renal Care Center (RCC), which houses outpatient hemodialysis, along with an outpatient clinic. The peritoneal dialysis unit is located in Valley Specialty Center but has close communication with the RCC. The dialysis unit offers outpatient services to approximately 180 hemodialysis patients and 50 peritoneal dialysis patients. RCC pharmacists review orders pertaining to epoetin alfa, continuous ambulatory peritoneal dialysis (CAPD), and hemodialysis. Other services provided by RCC pharmacists include:
- Transition of care visits for patients recently discharged from Santa Clara Valley Medical Center
- Medication therapy management
- Vancomycin per pharmacy protocol for hemodialysis patients
- CAPD vitamin D analog for peritoneal dialysis per pharmacy protocol
- Triage of prescription-related problems
- Quality assurance audits of medication errors
- Active involvement in Quality Assurance Performance Improvement (QAPI) meetings for hemodialysis and peritoneal dialysis
The Public Health Pharmacy provides services to the various Park Alameda Health Facility medical clinics, immunization providers, Public Health Nursing, as well as to community partners exposed to communicable diseases. The Public Health Pharmacy specializes in tuberculosis and HIV-related medications and serves as a resource to area physicians and other health care providers on the proper use of these agents. In addition, annual Public Health flu vaccine clinics allow for pharmacist interns, pharmacy residents, and pharmacists to administer influenza vaccines to Santa Clara County residents.
Public Health Pharmacy also works closely with the Santa Clara County Health Officer in matters related to public health, such as disaster preparedness, and provides medications needed to help control the spread of communicable diseases. Public Health plays an integral role in several initiatives, including the Vaccines for Children Program and Better Health Pharmacy, a drug repository and distribution program that provides free medications to the public.