Thursday, June 7, 2012

Easing in. Testing the waters.

Posted by Janis Rood at Thursday, June 07, 2012

Day 1: I’ll admit it: half of me didn’t want to go.  I was afraid of looking like an idiot.  Knowing I can perform on exams isn’t the same as working up a real patient in real time.  I was really nervous.  Plus, I’m stationed at Mercy Memorial Hospital in Monroe.  A new system, with new people.  Fortunately, I’m not there alone; Corrinne Thomas is with me.  So, the first day went smoothly.  Tour.  Talking.  Introductions.  Done.  It went so quickly and I felt like I did nothing.  (I really didn’t do anything).
Week 1: I spent the entire week going through more than 300 adverse drug event reports, digging through each patient’s chart to see what actually happened, and logging all the information in a database.  While this may seem extremely boring and non-clinical work (I am on an Inpatient A: Internal Medicine clinical rotation), I enjoyed this exercise for the following reasons:
1) I was allowed to search through the patient’s chart on my own time in my own way.  This gave me ample time to familiarize myself with a new system.
2) I was able to see the entire clinical picture of a patient.  I could see why they came in, what the experts did, what went wrong, and what they did about it.  I learned some valuable things from things that you don’t learn in therapeutics.
3) An excellent reinforcement of common, and some not-so-common, side-effects of medications.  I always struggle with these, so having a week full of them filling my thought processes was definitely a good thing.
4) My preceptor was so happy that we finished, she offered us the opportunity to create a presentation and actually present the data to the P&T committee.  The P&T committee was so impressed with our data that they were inspired to press even harder for an anti-coagulation pharmacist.  This makes me feel good about advocacy for the profession.
General impressions after the first week: I like having Corrinne with me.  She’s fun, keeps me company for our commute, works hard, and saves me when I don’t know answers.  Plus, she’s a major whiz when it comes to all things computer.  In short, a seriously under-recognized resource.  My preceptor is so nice, I have no homework, and I’ve been able to spend the evenings finishing up all the other projects I have going.  I haven’t seen any patients yet…which is strange for a clinical rotation…but I’ve learned about the approach and I’m ready to jump in next week.
Week 2: I spent the entire week doing renal dosing.  I took all the reports for patients who have a SCr > 2, went through every medication, checked dosing and made all necessary recommendations.  Some of my recommendations were accepted, while some were rejected.  I enjoyed this work for the following reasons:
1) I’m finally working up real patients.  I’m doing good work that makes a real difference for a real person, which results in more than just a grade.  This is extremely satisfying.
2) I’m only focusing on one portion of the patient’s entire picture.  Don’t get me wrong, I always paid attention to antibiotic spectrums, CHF  guidelines, etc.  But it’s much easier to focus on one detail and get good at that one detail, rather than attempting to do a full work-up all at once.
3) I was able to reinforce all of the major drugs that are renally cleared, which ones are indicated for renal failure, and which are contraindicated.  An excellent review.
4) After the first day, I was following the same patients day after day.  I was able to see their progress as the week went on and manage all of their meds.  I felt like a real pharmacist.  This is not something that just a tech could do.
General impressions after the second week: I’m enjoying clinical work.  In a hospital.  I’m testing this rotation as a final rule-out for clinical or ruling it in.  Still to be determined.
Week 3: I spent the entire week doing pharmacokinetic dosing.  Anyone on vanco or an aminoglycoside came to me.  I dosed them, monitored them, and recommended changes.  I liked this exercise because:
1) The first day sucked.  I thought to myself, “Yeah, clinical work may not be so hot.”  It took an extremely long time to figure out what was important, what to calculate when, and how to chart this like the other pharmacists do.  BUT, the next day was better.  I knew what to do, and it went a lot faster.  By Thursday I did all of them by lunch.  All of my recommendations were accepted.  I knew what I was doing and did it right.
2) A particular physician is resistant to our recommendations.  This has been a good lesson in how to pick your battles, how to ask questions, how to get a professional word in edgewise, and how to get your point across.  Am I going to change this physician in 5 weeks?  No.  But, I’ll carry these lessons with me into situations in the future where I’ll have more time to make a difference.
3) I took a skill that was lacking (or so my therapeutics exam grade said) and made it a success.  While I was allowed to use online easy calc software or even my handheld Lexicomp, I forced myself to the more difficult cases by hand.  Doing pharmacokinetics long hand gives you a better view of the patient and makes you more confident in your answers.
General impressions after the third week: Hang in there.  You will be frustrated and feel incompetent at times, and you probably are.  BUT, if you keep working at it even the worst tasks can be mastered.  I’m enjoying my time, still having free time in the evenings to work out and finish projects.  I’m sad that I only have two weeks left.

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