Institutional Phamacy

Posted by BJ Opong at Tuesday, February 15, 2011

Institutional Blog
My rotation for the month of January was an Institutional rotation at Sinai Grace Hospital in Detroit. Due to some last minute changes I had the pleasure of having my institutional rotation at the same hospital where I work. I was a little uneasy at first because I didn’t want to end up just getting put to work since I knew about the day to day operations of the pharmacy having spent the last 2 years there as an intern.
The rotation ended up being a good one because I was able to see a lot of things on the management side of hospital pharmacy that I was completely unaware of. During the 1st week I was able to work on an audit that was being performed looking at PTT and heparin administration times. The audit looked at when the PTT was sub or supra therapeutic and how long did it take for the pharmacist to respond with a change in the rate of heparin infusion. From this information management will be able to determine where the major problem is and how much needs to be done to correct it. It was very helpful being a part of this audit because it allowed me to see how administration assesses problems to determine how to correct it.
I was also able to attend a couple of medication use evaluation meetings. During these meetings a committee made of pharmacy and nursing personnel discussed the different medication error issues that came up over the past month ranging from IV medications administered after expiration to patients receiving the wrong medication. The errors were all graded based on severity and the committee then discussed what could be done to prevent such errors moving forward. I enjoyed this because it gave me a better appreciation for the level of thought and planning that goes into implementing new safety measures and computer warnings for medications.
The remainder of the rotation was spent shadowing different pharmacists working in various services in the hospital to see what their job entails. I was able to shadow the pharmacists on the general pharmacy services and learn how Vancomycin, Heparin, Coumadin, and Aminoglycosides are dosed on the patient floors. One observation that I made while working on the dosing was that a lot of time gets spent filling out consult forms which can take away from some of the other responsibilities of the pharmacist. The most interesting thing that I was able to see during the rotation was during my day with the OR pharmacist. The pharmacist let me spend a few hours of the morning watching a coronary artery bypass graft. It was nothing like I expected, for some reason I expected the room to be very tense and uptight given the seriousness of the procedure. The doctors and anesthesiologists were very laid back and willing to answer questions. It was great being able to see the procedure and the immediate actions that various medications had on the heart. Also I was able to stand close enough to look down directly into the patient’s chest. One observation I made was that I don’t ever want to be in a position to have my chest opened for surgery. The amount of force and torque they used to open the chest is probably the cause of most of the post surgical pain patients’ experience.