Connections of past reflections with new perspectives

Posted by Akin at Sunday, October 18, 2009

My current institutional pharmacy rotation at the Karmanos Cancer Center in Detroit has been meaningful. I was able to do a clinical inpatient rotation in August that was also in cancer, so this present rotation provides reinforcement of some of the major cancer topics that I have learned before, but now from the perspective of the dispensing side.

During my clinical rotation, I was able to work-up patients who were taking chemotherapy regimens and got to see how patients responded to the medication and how they generally appeared and felt during treatment. From this new perspective at Karmanos, I get to see the entire behind-the-scenes process starting from after an order is first written by a physician all the way to the finished medication being sent to either the outpatient infusion clinic or to the inpatient floors. The process involves prudent verification including triple and quadruple checks of dosing calculations, proper documentation, and preparation of drugs in the IV room.

I was given the chance to go under the hood and prepare some IV chemo myself. I was trained to use an interesting device called a Phaseal to prevent accidental spilling of the hazardous chemo. One of the days when I was in the IV room, a chemo vial was accidentally dropped and spilled on the floor. After the chemo spill was cleaned, a demarcated line on the laminated floor remained from where the medication had been even though the medication was cleaned within a few minutes of the spill. These agents are pretty powerful! I certainly wouldn’t want to get any on my skin.

If I could do my clinical cancer rotation again, knowing what I now know from this current institutional rotation, I think I would approach things a little differently. For example, seeing firsthand the power of some of the chemo, I think I would be a little more understanding of some of the patients who looked pretty miserable on the days that they were getting these agents. Another example is with dose recommendations. Now knowing how difficult it is for the techs to measure between the graduated lines on a syringe, I would probably be more likely to round doses to nice whole numbers.

I think I understand why pharmacy residents are required to staff on weekends at the hospital. It helps to understand the behind-the-scenes verification process when on rounding teams. Your contribution to the team can put into consideration things such as IV preparation, inventory, and Rx order travel time that physicians are unaware of. This rotation allows me to integrate past familiarity from previous rotations with current experiences. I’m enhancing my learning and fortifying knowledge so that I can remember key concepts for years to come.