Amb Care in 3 different clinics

Posted by Amanda at Sunday, January 29, 2012

I finished my ambulatory care rotation this past week. For amb care you have clinic visits with patients. So you them one on one and they come in and you talk with them for about 30 minutes regarding their disease. The main diseases we target are diabetes, hypertension, and hyperlipidemia. I had my amb care in three different clinics: chelsea, livonia, and saline. I was able to see many different patient populations. I also saw many different patients from the extremely motivated to the less motivated.

During the visits I would talk to them about how their medications are working, if they are having any side effects, and if they have missed any doses. Then we would talk about either their blood sugar readings, blood pressure readings, or both. We would then discuss if they are where we want them to be. If they aren't then we would talk about diet, exercise, and medication changes. All the patients were very sweet and they were open about their lives. They were very welcoming to students.

As a pharmacist in amb care we are able to prescribe any of the medications that can be used in diabetes, hypertension, or hyperlipidemia. Also I would have to take the patient's blood pressure. This was a lot harder than I thought it would be.

On my last day in Livonia, I experienced my first foot exam. I performed two foot exams. It was an interesting experience.

I liked working in amb care and I learned a lot from this rotation. But I don't think amb care is the place for me.

Nutrition, kcals, protein, carbs, fat... my favorite subjects

Posted by Elizabeth Kelly at Friday, January 20, 2012

So anyone that really knows me... knows that I LOVE LOVE LOVE talking about calories and equaling calories in with calories out. Funny thing is that I never really realized you could do that IN the hospital. I love my clinical nutrition rotation with Dr. Sarah Nordbeck at Royal Oak Beaumont. There are so many different aspects of this rotation that I love that its really hard to sum it up, so I will just make a list.

1) It is great to work with a pharmacist who has such a great rapport with her physicians and the physicians give her a lot of autonomy.

2) I get to manage my own patients and I was given a lot of responsibility early in the second week and I have thrived on it. I am so sad that my last day is next Thursday.

3) I get to do math!!!! And the numbers actually make sense. Plus I get to use my critical thinking skills.

4) I get to meet a lot of wayne state pharmacy students and a lot of the residents.

5)Papa Joe's has really good mediterranean food.

6) The whole nutritional support team is fantabulous.

7) Last but not least I get great guidance from a preceptor not only about nutrition, but about pharmacy practice in general, what to look for in a residency or a job, and many of life's pearls.

There are a few cons however:

1) The closest fridge is way too small. I am not entirely sure where to find the bigger one with the freezer... I guess it's finally time to investigate!!!

2) I am worried every day that I am going to get run over by one of the machines that goes down the hall outside pharmacy. It's actually kind of scary!!! lol

3) To tell you the truth there really aren't any negatives...

Four months til graduation!

Liz

P.S. You don't have to go to midyear if you are applying in-state only. I have gotten plenty of interviews without spending all the money.

Home Infusion

Posted by Christine Rabah at Thursday, January 19, 2012

So the past 2 months have been crazy- I think my classmates summed up Midyear very well, so I won't get into that. I chose to have December as my off month, but didn't get to do much relaxing. From Midyear, to thank you cards, to applications & letters of intent, to planning my wedding on top of all that...whew is all I gotta say!

Fast forward to January..My current rotation is at HomeMed home infusion, which is fulfilling my "nontraditional rotation" category. Nontraditional it definitely is! I can confidently say that being here (especially the first week) was the most I've ever been out of my comfort zone. HomeMed consists of pharmacists, nurses, dietitians, and pharmacy techs working together to fill orders for patients to administer at home (either administer themselves or by one of the nurses). The bulk of the orders consist of antibiotics, chemotherapy, and total parenteral nutrition (TPN). TPN is used when patients don't have a well-functioning gut, so they get their nutrients and lipids intravenously.

I've gotten to shadow every part of the process. I've seen referrals come in for home infusion in intake, then they come to the pharmacist on whatever team the patient is assigned to (a team consists of a pharmacist, tech specialist, and tech associate) who verifies the order. it either gets compounded in the enormous clean room or picked in the shipping area, where another pharmacist will check the compounded product and the medications to be shipped. Many deliveries go out per day. HomeMed also provides the Cancer Center with their infusions. Once the patient receives the medication, they can administer themselves or have a nurse come to the home for administration. Patients can be taught to give themselves the medication if they have some type of access site (port, PICC line, etc).

Some medications get delivered to the hospital to give to the patient just before they are discharged. In these cases, there is a HomeMed training team at the hospital consisting of nurses who will meet the patient in their room and show them how to hook up their infusion. I was able to go to the hospital one day to shadow this process. There can be many challenges with home infusion. One of the patients I shadowed was an infant who needed TPN. His mom couldn't speak English, so all translation of how to do the infusion had to go through the dad, who would not be home during the day to make sure it gets done correctly.

I was also able to go with a HomeMed nurse (separate from the hospital's training team) to a patient's school so he could get his infusion. This patient was one that I had seen on a previous rotation, so it was really cool to see what happens after discharge. Other activities I've participated in were presenting a journal to the HomeMed pharmacists, a review of enteral nutrition (including seeing all the different tubing devices) with a dietitian, and a review of types of access lines with a nurse. I am currently working on a presentation to present during a pharmacist meeting on the importance of double checks of medications.

This rotation has been very different than what you think of "typical pharmacy," but interesting nonetheless.

(Non Traditional) Pfizer Canada

Posted by Hussein at Monday, January 16, 2012

Pfizer Canada

(click to see Pfizer Canada)

After an interesting array of rotations that included Oncology, Cardiology, Infectious Disease and Transplant, I find myself now out of the hospital and behind the scenes. But even here the preceptor is a U of M Graduate! He completed his residency in pharmacokinetics, and is a big Wolverines fan. From football to pharma, you’ll learn quite a lot. This rotation site develops your experience with the inner workings of a pharma company. We often hear a lot about industry, but when do we actually get to experience some of it!

If you’ve ever wondered about what is on that label you’re reading in the pharmacy, or had to check a product monograph for information, or wondered why drugs are manufactured in certain amounts or concentrations, this rotation will tell you. Have you ever thought about how a product lands on the shelf at CVS et al., or where on that shelf it lands, or even how big that shelf must be? The simple answer is: for every pharma question, there is an Act, a law, a rule or a regulation that covers that information. And if there isn’t, chances are a company (with whom you may do business) has an already established policy.

(Click on the picture to learn about the new Pfizer logo)

At this Pfizer rotation, students are provided with their own office, and access to all of Pfizer’s resources – which is tremendous. Students are part of the department of Scientific and Regulatory Affairs, under Pfizer Consumer health. The department applies for new and maintains registrations for drug products, ensures that products and their marketing comply with Canadian regulatory requirements, and conducts regulatory vigilance. This department acts as a liaison between various departments like marketing, and regulatory bodies such as Health Canada and the FDA.

My time here so far has been too short, but amazing. And if you are not from Toronto a major benefit of this rotation – aside from the learning experience - is the ability to see and experience Toronto! It’s something the preceptor encourages and Toronto amazing and vibrant city!

Random Fact: Did you know that Pfizer Canada is Pfizer’s second largest affiliate? It’s larger than China and all of the EU combined!

Hussein

From Administration to Midyear to Institutional

Posted by Nina Cimino at Sunday, January 08, 2012

Wow! What a month! It's been a while since my last blog post but it feels like it has been forever with all that has happened between then and now, so I'll try to fill you in as best I can.

Administration Rotation
First, I finished my administration rotation with Dr. Stevenson and Dr. Clark at UMHS. What an amazing rotation- I HIGHLY recommend that you rank this rotation as your non-traditional experience if you are at all interested in pharmacy administration. I found this rotation extremely beneficial for getting a broader view of all that goes on in a hospital pharmacy department. When you work or rotate in a specific pharmacy or satellite that is part of a larger department, there are often many policies and procedures that just seem to be there. Rotating in pharmacy administration helped me to understand the rational behind many of these policies, and why it is important to do things a certain way.

I also gained an understanding of the many external factors that impact a hospital pharmacy department, such as:

• Pharmacy law and rules from the Board of Pharmacy- such as those surrounding the electronic prescribing of controlled substances (including C-IIs)
  
• Political factors- such as proposed cuts in Medicare and Medicaid reimbursement
  
• Economic factors- pressure to increase productivity while lowering expenses

Another great thing about this rotation was the opportunity to work on projects that I found really interesting, all while meeting people who were great role models! I worked on a lot of projects, including one surrounding transitions of care and one on electronic prescribing of controlled substances. Throughout both, I learned a lot about important issues in pharmacy and got to work with great people who really inspired me to become a leader and advocate for the profession of pharmacy.

Midyear
Oh boy. It's really not as stressful as it sounds going into it, but if you want to pursue a residency after graduation, Midyear is a big deal. It is also a great opportunity to discover a lot about residency programs all in one place. In order to get the most out of it and not be too stressed, I recommend preparing early. To prepare, I would recommend:

• Researching which programs you're interested in (think about which rotations they offer, location if that is important to you, size of the program, and whether or not they offer a PGY2 program)
  
• Developing a list of questions for each programs- try to think about which questions you may want to ask residents, and which you'd like to ask directors. Each person will have a different point of view, and all will be valuable to you as you think about where you would like to apply.

Once you come back from Midyear, be sure to get your applications as soon as you can- things will get very busy very fast with the holidays, and many people go on vacation, so I really think the sooner you can get your applications out, the better.

And...don't forget to have fun! Not only is it fun to experience a new city, but Midyear is a great way to meet pharmacists and pharmacy students from all over the country and hear about their experiences!

And now...Institutional Rotation
After a much needed break, I started my institutional rotation this past Monday. Since I have mainly worked in outpatient pharmacies, or had non-traditional pharmacy internships at the FDA, this institutional rotation is a good opportunity to gain experience in an inpatient environment. The hospital where I am completing my rotation is a cancer hospital, so while institutional focuses on general inpatient pharmacy, this rotation provides an inpatient perspective with an emphasis on oncology. Before this rotation, I had pretty minimal experience in the IV room, and even more limited experience with compounding chemotherapy. Even after just a few days in the IV room and chemotherapy lab, I'm already starting to feel more comfortable compounding IVs. I have also gained experience in unit dose preparation and order entry verification. In the weeks to come, I am looking forward to gaining experience shadowing the pharmacists on the BMT floor, and learning about what happens to the IVs after they leave the pharmacy by shadowing nurses in the infusion center.

2012 .. It's Finally Here!

Posted by Jenna at Saturday, January 07, 2012

2012 .. the year we've been waiting for is finally here! It's hard to believe that May 19th is right around the corner and that soon we'll join the list of distinguished Michigan Pharmacy Alumni. Just 4 rotations (or for some 5) stand in our way! 

2012 .. also a year of huge uncertainty. Many of us spent our winter break finalizing applications to PGY-1 residency programs or fellowships while others may have started job hunting. The next 3 months will be the most exciting, nerve-wracking, and unexpected times that many of us will face. Applications are in .. now we sit back and wait to hear back from programs, leaving our futures in limbo until that magic day in March, aka Match day. 

So, I'm trying to compile all of my advice regarding Midyear, residencies, and applications into 1 spot. Here goes nothing:

Before Midyear
1. Start identifying what's important to you in a residency.
2. Research, research, research. Go to Midyear prepared.
3. Work on an 'elevator speech' - who you are and why you want to complete a PGY-1 residency.
4. If you're looking at 'specialty' PGY-1 programs (administrative, pediatrics, managed care) or fellowships, join PPS. 
5. Come up with thoughtful questions to ask, it may help programs remember you if you deter from the 'run of the mill' questions.

At Midyear
1. Be yourself. 
2. At the beginning of each showcase, visit programs that are lower on your list to get your nerves out of the way. You don't want to be stumbling over your words at your top choice program.
3. Take 2 minutes after each program to jot down some notes, otherwise you're guaranteed to confuse programs when you go back later to jot down notes. It's okay to write (minimally) during your conversation, just try to maintain as much eye contact as possible. 
4. Be open-minded. Programs that were lower on your list may move to the top and vice versa.
5. Don't ask questions whose answers are on the program's website. 
6. Don't embarrass yourself when you're outside the convention center. It seemed like I saw a handful of people from my PPS interviews everywhere I went, which was nice!

After Midyear
1. Handwritten thank you's to everyone you spoke to, asap!
2. Make a master list of each program's application requirement. The 4 basic components are your CV, letter of intent, pharmacy transcript, and 3 letters of rec. Some programs specify who they want their letters from, some want your undergrad transcript, some have an online employer application, etc.
3. Get delivery confirmation once you send them. This helped me realize that one of my apps didn't get to the program! My faith in the USPS isn't the highest so I'd suggest FedEx for programs that want paper materials. 


I'll update the advice as more thoughts come to me :-)