Friday, July 27, 2012

Pediatric Emergency– A Generalist Approach

Posted by Anna at Friday, July 27, 2012

The end of the second rotation seems abrupt—how has it been 5 weeks already?! I had the privilege of working with the generalist pharmacists in the pediatric emergency department at U of M. I specifically requested a pediatric experience due to the lack of pediatric-focused care in my other rotations. It was an added bonus to be placed in the emergency setting, which is another area I would have had no experience in otherwise.

I was scheduled to be on rotation from 10am to 6pm but often went in from 1pm to 9pm in order to maximize my chances of being on-site when the ED was busy. Although there is no routine day in the ED, I did have some typical tasks I fit in throughout the day.

1.       Patient work-up. Upon arrival and throughout the day, I assessed the patients in the ED. When there were a good number of patients (>9 or so) or several patients with complicated conditions, I would spend time working up the patients and present them to my preceptor. The presentation included basic background information regarding the patient’s medical history and presenting complaint, with a more detailed discussion of what we have done so far regarding treatment, if that treatment was appropriate, and what else I anticipated the patient may require while in the ED. I found myself better able to anticipate the needs of the patient and make treatment choices as the rotation progressed. With the quick turnaround of patients speed was definitely a factor and is something I will continue to work on.
2.       Topic discussion. I was required to put together a brief (1-2 pages) handout for an ED topic discussion with my preceptor once to twice a week. These topics ranged from management of diabetic ketoacidosis to dealing with rabies or venomous bites. I also had the opportunity to meet with other P4 students on the pediatrics generalist rotation to participate in pharmacist-lead discussions about important topics in pediatrics.
3.       Journal clubs & case presentations. This activity also involved the other three fantastic P4 students on the pediatric generalist rotation. The topics were all pediatric-focused, and I learned a lot from my peers and the pharmacists in attendance. In case you’re dying to know, my journal club discussed the use of hypertonic saline in the ED in the management of acute wheezing in preschool children, and my case presentation pertained to a patient undergoing treatment for neutropenic fever in the ED.
4.       Discharge counseling & medication reconciliation. I was able to perform discharge counseling for patients being sent home with new medications—antibiotics being the most common. For patients requiring hospital admission I was responsible for obtaining a medication history and writing up a medication reconciliation note. Overall, these tasks granted me some face-to-face time with the patients and their caregivers and helped me to become more confident and comfortable in my knowledge and communication skills.
5.       Traumas. The pharmacist is responsible for responding to any traumas that come in—and that meant I got to tag along! I will 100% own up to the fact that I was very nervous about this aspect of the rotation due to my low tolerance for blood and such. However, I can happily report I had no fainting spells or other equally embarrassing reactions! This is likely due in part to the scarcity of traumas while I was on-site; I witnessed a trauma usually once to twice a week. Even so, I did have the chance to see the pharmacist in action and understand how her ability to accurately and quickly prepare medications for administration can impact patient care in this setting.

Overall, I believe this was a great rotation. Patients ranged from 2 days to 20 years old, which allowed me the chance to practice both pediatric and adult dosing. I learned a lot about pediatric-specific conditions and medications. I learned about emergency medicine and how to anticipate patient needs. I was forced to become faster at everything. I got to sleep in. I also worked with some fantastic pharmacists who really tried to maximize my learning experience.

Although I will miss the pediatric ED, I now must switch gears and prepare for my community rotation at Meijer!

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