TRAVIS AIR FORCE BASE, Calif. - Many people think that the base has two pharmacies: one on the second floor of David Grant USAF Medical Center and one in the Base Exchange mini-mall.

However, it may surprise people to find out that this is inaccurate.  Another common misconception is that pharmacists and their technicians “just put pills in a bottle” or “lick, stick, count and pour.”

The 60th Medical Group pharmacies accomplish much more. There are actually five separate and distinct pharmacy operations occurring at Travis Air Force Base, California.  Pharmacy operations typically fall into three general classifications:  outpatient, inpatient and clinical.  However, these classifications can be broken down.

Outpatient pharmacy operations are what most people see and think of when they hear the word pharmacy. Civilian providers at DGMC write more than 500,000 prescriptions at Travis outpatient pharmacies.  Additionally they refill patients’ phones through an automated system.

The inpatient pharmacy mission

The inpatient pharmacy is tucked away in DGMC, providing 24/7 pharmaceutical care to patients staying in the medical center or visiting the emergency department. The inpatient pharmacists and technicians play an integral role in patient care, providing drug information and ensuring medications are accurately and safely delivered to patients.

Pharmacists and technicians prepare medications that the nurses administer.  They make more than 180,000 intravenous solutions annually, providing antibiotics, feedings and pain relief to thousands of patients.

Before the nurses can administer these medications, the pharmacy staff has meticulously prepared them in a sterile environment, in a special room, with special breathing masks and in special clothing to make sure that nothing contaminates the contents.  The care taken in this room and the preparation process of these IV solutions is similar to that in an operating room.

In addition to making IV medications, the pharmacy staff maintains 47 Pyxis medication consoles for the nurses to access patient medications. These automated dispensing machines located in each unit and clinic throughout the hospital are stocked with all the unit dose medications needed by the staff daily. The pharmacy staff restocks these machines with more than 1.6 million unit dose medications annually, enabling patients to receive medications in an accurate and timely manner.

Inpatient staff also manages the medications for surgery patients. Each night, the pharmacy staff reviews each surgery case coming in the next day, prepares the needed medications and delivers them to the surgery center so each patient’s medications are ready and waiting for them when they arrive. In addition to prepping each specific patient case, inpatient pharmacy staff also restocks the eight operating rooms and two delivery rooms every night so the anesthesiologist will have all the necessary medications during the procedures.

Expanded after hour services

TRICARE beneficiaries seen in the DGMC emergency department who needing medications during non duty hours no longer need to wait until the next day to pick up their medications or go to a civilian pharmacy to get them filled. The inpatient staff manages an after-hours emergency department pharmacy with a distinct formulary of pre-packaged medications for this purpose.  This not only saves the Air Force more than $1 million annually, but also saves time and potential co-pays for patients who required immediate medications. 

Clinical pharmacy services

Clinical pharmacists work in both the outpatient and inpatient settings.  While guests are in the medical center, a team of providers’ visits throughout the stay – on this team is a pharmacist.  He or she will help the team with proper dosing, possible interactions between medications, and proper administration to maximize the benefit of the medications you will receive.  Maximizing the medication can help minimize the length of a stay.  In addition to participating in patient rounds, clinical pharmacists monitor patients on high-risk medications who are at DGMC, providing dose-adjustment recommendations to providers to ensure safe and effective therapy. 

In the outpatient setting, clinical pharmacists are privileged providers, able to see patients during scheduled appointments.  At DGMC, clinical pharmacists operate an anticoagulation clinic (making sure blood thinners are working just right and adjusting dosages as needed) and a metabolic clinic, which assists in maximizing cholesterol and blood pressure therapies.

In addition, clinical pharmacists work with the Family Medicine Residency Clinic to offer a medication therapy management clinic. During an appointment with this clinic, a team consisting of a medical provider, a pharmacist and a social worker reviews all of a patients medications and provides an optimized medication therapy plan to the patient before they leave. When a pharmacist works in a clinical setting like this, it increases access to health care.

Infusion Pharmacy Services

The last type of pharmacy we have here at DGMC is the infusion pharmacy. This is physically connected to our Hematology/Oncology Joint Infusion Center, and processes all the chemotherapy medications for patients in this clinic as well as the Joint Radiation Oncology Center. Altogether, they provide approximately 1,000 prescriptions per month to these clinics. Since this pharmacy is primarily providing chemotherapeutic agents, the staff has to go through a rigorous chemotherapy training course and become certified before being able to work here. All the medications are made in a special isolation hood. The operations at this pharmacy are much more unique than in the other 4 pharmacies. They work hand-in-hand with the nurses and providers in the oncology center and meet each morning to review the patients for the day and discuss any pertinent issues. As the patients arrive for their therapy each day, the pharmacist monitors all their labs and works with the providers to ensure they are optimizing therapy.

Pharmacists in all operational settings consult with your providers and provide professional expertise by discussing drug interactions, proper doses and personalized medication selection.  So, as you can see:  pharmacy is much more than, “lick, stick, count and pour”.