Dipping my toe in the clinical pool

Posted by mariarx at Wednesday, July 18, 2012

So, my first rotation was health system administration with Dr. Brummond. I learned a TON during my 5 weeks with him - but very little of it was clinical. My interactions regarding medications maxed out at "which meds are on shortage and what do we switch to?"

For my 2nd rotation, I am at Providence Park Hospital in Novi, MI with the peds/oncology clinical pharmacist Missy. It's a pretty small hospital, around 200 beds, and has been open for 4 years now. Pharmacists at PPH take on an interesting role, with some duties falling into classic inpatient order verification; while others fall into antibiotic kinetics/anticoagulation monitoring. The great thing about it is all the pharmacists do everything. There is very little split between clinical/order verification roles.

My first week at PPH was spent mostly with technicians - messenger, IV room (where Frank threw me right in), packager, etc. I also got to spend some time with the OV pharmacists and checking orders that came through. I quickly learned to have lexicomp on stand by to look drugs up that I didn't recognize or know the dosing for.

Week 2 was half pharmacist shadowing and half reviewing kinetics. Oh boy, that was a doozy. Being handed a stack of practice cases and an equation sheet took me right back to P3 first semester therapeutics and Dr. Nagel's exam. Going through my practice problems was a test in frustration and insanity. No matter what I tried, I never seemed to get the right number, and man were my peaks and troughs all over the place. After making me suffer for a couple days, my pharmacist handed over the handheld PCs that have the nifty PK calculators on them. Although, I think I'll have to do some kinetics problems every once in a while so that I don't forget it completely. It's somewhat comforting to know that 'real pharmacists' use the same equations we got in class.

Week 3 was probably my favorite. In addition to starting 10 hour shifts (woo 3 day weekend!), I also started ICU rounding. At PPH, the OR/critical care and metabolic support pharmacists split ICU rounding duties. Each day of rounding started off with printing out a rounds summary report of all the ICU patients, and then going through their profiles and MAR compiling the big picture. The first day of rounding, it took me the full 3 hours to go through my patients. During this week I usually had lexicomp, micromedex, Dr. Carvers bug-drug list, wikipedia, google, and dosing nomograms on standby at all times. I was constantly looking things up and writing little notes down. Rounds each day varied from 1 hour to 2.5 hours depending on the intensivist, number of patients, and any unforeseen circumstances that arose. My second day, rounds started an hour late since the doctor was at a code (on a patient that soon joined us in the ICU). The 4 days of ICU rounding were great, and make me even more excited for my ED rotation in October.

This week has been all about antibiotic kinetics and anticoagulation monitoring. Pharmacists at PPH monitor drugs such as vancomycin, aminoglycosides, heparin, warfarin, rivaroxiban, and dabigatran. I got to work up initial doses for these drugs, and then do follow up monitoring for the rest of the week. This is where I really feel the pain of paper charts. PPH is half electronic and half paper. So, each day when we work up coumadin doses, or dose vancomycin or gent we have to then troll through the hospital to find our patient's charts. I haven't had too much trouble with it so far, but I can only imagine the frustration of a floating chart when all you want to do is add a quick note.

Next week (holy crap, I can't believe it's already week 4) I'll be working on TPNs with Maria, the metabolic support pharmacist, spending a day in the OR (I asked my preceptor Missy for blood and guts), and giving my final presentations. My projects for this rotation included making a formulary review document for Exparel, updating chemotherapy drug info sheets, and my journal club topic.

I have really loved my time at Providence Park. The smaller hospital setting might not have the super crazy cases, but for an institutional rotation I have gotten to do a lot of different things. This has definitely been great practice leading up to my generalist rotation which I have next at UM. I also really like the camaraderie among the staff... a lot of the techs, pharmacists, doctors, etc have been with St. John Providence for a long time before moving to the new site; and having such a small staff means you really know everyone. The only thing I won't miss about PPH is the drive - curse you one lane roads!