Saturday, August 28, 2010

A NICU Experience

Posted by Karen at Saturday, August 28, 2010

I cannot believe these past 4 weeks just flew by!

My first rotation was at the UM Neonatal Intensive Care Unit (NICU). Most of our patients were premature (less than 37 weeks gestational age), and some of them weighed less than 1 kilogram.

It was an unforgettable experience, not only was it the first time that I worked with the neonatal population, I also had a lot of other “first times.” Some of these were…

1. Going on rounds by myself
2. Making an intervention
3. Applying pharmacokinetics in real patients
4. Looking at patients’ flowcharts 2 hours before rounds started
5. Preparing for topic discussions using only primary literature

Throughout the four weeks, we met with our preceptor, Dr. Mehta, where we had our topic discussions on neonatology and patient case presentations. Although we were working with a very unique patient population, the thought process that we learned on working up patients is applicable to any patient, no matter how young or old. Dr. Mehta also emphasized the importance of transitioning from our role as a student to a health care professional:

1. Talk like a healthcare professional-in order to effectively communicate with other health professionals, we have to know the correct medical terminology. Dr. Mehta asked us how caffeine worked for the treatment of apnea of prematurity, and after struggling for the right term, our final answer was “something in the brain” (the correct answer was the brain stem).

2. Know your drugs (one thing that Dr. Mehta constantly stressed to us)-just knowing the doses, side effects and mechanism of action is not enough. Since we are the drug experts, we cannot forget about the pharmacokinetic and pharmacodynamic profile, routes of administration, compatibility with other drugs (if the drug is administered intravenously), relative cost, therapeutic effect, and monitoring parameters. Yes, most of this is memorizing, but once you have mastered this knowledge, you will appreciate why a drug is dosed every 24 hours versus being infused continuously or why one drug can be immediately discontinued versus another that has to be tapered down for a week. Everything will start to make more sense.

3. Know the current literature-information changes all the time. Everything that we do has to be evidence-based. We have to know the current literature on drug therapies or else we cannot make any recommendations without evidence-based medicine. Time after time, whenever we asked Dr. Mehta about drug-related questions, she would refer to current studies that supported her answer.

4. Be confident :)

I took away some good lessons from this rotation. From learning how to communicate more effectively to evaluating drug therapy based on systems (respiratory, cardiovascular, etc), I can see the improvement in my abilities today as compared to my first day four weeks ago. As my colleagues and I stepped out of the NICU yesterday after rounds, we were sad that we had to leave. For me, this was a place where I began my transition to becoming a pharmacist.

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