Thursday, May 31, 2012

Pharmablogging from Detroit!

Posted by Nabeel Qureshi at Thursday, May 31, 2012

So after a few weeks of decompressing following my (last ever) finals, it’s back to the grind, but P4 is a different kind of beast.  The first 3 years of pharm school are like trying to drink from a fire hydrant, and what P4 will bring remains to be seen.  Thus far, it seems like it will be a lot of juggling various responsibilities (PharmD investigations, work, rotations, seminar, preparing for meetings, life, applying for jobs, etc.). 

My first pharmacy rotation is Drug Information at the Detroit Medical Center (DMC), and I’m excited to be back in the D!  Prior to pharmacy school, I worked & went to school in the Motor City.  I love the city.  Great place to work- Detroit has always been incredibly progressive in terms of pharmacy practice, particularly health systems pharmacy.  

DRH is 1 of 8 hospitals part of the DMC medical campus
This rotation is housed within Detroit Receiving Hospital (DRH), a 284 bed trauma level 1 center, where about 85% of the business is contingent on the emergency room.  It’s a unique patient population and as the rotation goes on, I’ll elaborate on that point.  Our drug info service responds to queries from across the DMC, and sometimes from outside places, such as an outpatient pharmacist with a patient recently discharged from DMC.

Drug information isn’t exactly the sexiest topic but is one of the key skillsets that pharmacists need, so it’s a good way to familiarize myself with the resources we’ll be using for the rest of our lives.  During a drug information rotation, you’ll learn where to find information, interpret it, synthesize it, and communicate recommendations.  You’ll learn how to know what you’re looking for because sometimes the question you’re asked isn’t really the one they want answered.  You’re kind of like a detective trying to get to the bottom of something, so the more information you can get out of the person asking you the question, the easier it will be to find an appropriate answer and provide a response.

For most of the drug info questions and curbside consults, the nurses and physicians will contact the pharmacist rounding with that team or in the inpatient pharmacy.  The questions we get in drug info can be more obscure, and the answer isn’t immediately apparent, so they require some digging.  We look not only at drug references, but also the available literature (secondary sources like review articles and meta-analyses are great for this, but sometimes there are only case reports or primary literature, depending on the topic).  Sometimes, there is no right or wrong answer, just a response that you can provide based on available evidence.

So far, I’ve fielded questions regarding a variety of therapeutic topic areas, including immunization schedules (read:  Tdap can be given without regard to interval between shots), drug stability (succynlcholine is stable at room temp for 14 days), how to minimize drug interactions causing serotonin syndrome (i.e. how soon to give sertraline after discontinuing metoclopramide), medication administration policies specific to DMC (i.e. there are none for giving dextran, a volume expander, in a non-ICU setting).  And then there are more involved questions such as whether or not there are increased bleeding risks during heparanization of patients on the hypothermia protocol post cardiac arrest. 

As a student, I’m also responsible for presenting an article to journal club, and doing a formulary review for a drug the DMC is considering adding.  I also attend meetings on antimicrobial stewardship (also known as ‘everyone get together at my preceptor’s place and hang out to discuss naughty prescribing behaviors’- see the IDSA and/or SHEA if you are interested in the topic), infection control, P & T, journal clubs, pharmacy grand rounds, etc.

Regardless of your first rotation, you’ll probably feel like a deer caught in headlights, unless you’re a self-proclaimed rockstar of pharmacy (you’ll meet these folks).  But gradually, you will become more comfortable in applying the skills you’ve acquired during pharmacy school in the real world.

To date, my only complaint about this rotation is that I have to wear a tie everyday.  Worse things can happen in life though.

More to come from Detroit!


Anonymous said...

Thanks for posting. Does this rotation give you much opportunity for patient interaction?? I'd love to hear about what patients are like in Detroit in comparison to others.

Miss N said...

Great posting!

You are lucky to be getting such diverse experience in terms of pharmacy and your article review.

In every professional you find the so called "self proclaimed gurus" who are there to learn. In my opinion knowing that you won't know everything and are there to learn is the best approach. As a teacher, I find those individuals benefit the most from experiential learning.

Good luck!