Beejal
at
Thursday, July 19, 2012
Hi everyone!
Here's another long post on day-to-day activities with a little bit of
reflection! Grab yourself a fro-yo and sit yourself down for 20 mins!
:)
I’ve gotten
through 4 weeks at St. Joe's, and have gotten a pretty good handle on
things. This is not a stressful
rotation, but you really do learn a lot about the staff pharmacist’s role. You do a lot of multitasking and learn how to
be efficient (in case you’ve missed that somewhere along your pharmacy
experience)! I think this might be a
more difficult rotation if you haven’t seen the St. Joe’s system, but I had my
IPPE at St. Joe's Livingston so things were pretty familiar.
A
typical day…
There are
some baseline responsibilities that define a P4’s day: F8s, Ancillary carts, ADEs, Duplicates, and ALS
bags/boxes. Dr. West will put out a
schedule for which student is covering each responsibility each week (There are
usually 2 P4s in the same block). Some
days you could be assigned everything, other days you could have split
responsibilities, and a few days you could have no responsibilities.
F8s
are drugs to be checked first thing in the morning at 7:30am, so that the tech
can deliver them at 8am. My
understanding is that they are the drugs that a) don’t fit in the pyxis b) are
too expensive to stock in the pyxis and/or c) for patients who are day-to-day,
ie they could be leaving anytime. These
“Short-Stays” for example could be referring to someone who just delivered a
baby. Ancillary carts have drugs being refilled in the pyxis, and are
checked usually between 9 and 10am.
Sentri7 is
St. Joe's equivalent system for UofM’s Theradoc.
It has tabs for different drug alerts, and ADEs and Duplicates are
a couple of examples. ADEs are alerts that are triggered when
a renally-eliminated drug is prescribed.
The intern must check out the patient’s CrCl and determine if the dose
is appropriate. There are usually 5-7
pages of patients to go through so this can be tedious; but you learn which
drugs to look out for, where to find the information you need about the
patient, and common physician prescribing practices. I’ve seen a lot of these alerts for
famotidine, loratadine, gabapentin, allopurinol, certain antibiotics,
metoclopramide, and metronidazole. If
you are assigned this, it is your primary responsibility (besides F8s and
Ancillaries if you’re assigned to those too) before any other projects are
worked on. Usually the first day you’re
assigned this, you won’t even come close to finishing. You should get through all of them after a
few days, so it’s important to identify the poorest renal functions and the
highest risk drugs. Duplicates is also a tab on Sentri7. This alert is triggered when a patient is
prescribed two drugs that can be used for the same indication. The intern needs to go through the patient’s
notes to figure out if this is indeed duplicate therapy, or if the physician
intended to use both drugs. I usually
see these for asthma inhalers, MVIs, and famotadine/omeprazole. There are
usually no more than 10 duplicates daily, so this is one of the easier
responsibilities.
ALS bags
and boxes are emergency drug kits that are carried by EMTs. The technician restocks the boxes, and the
interns check for accuracy as the pharmacist.
These are to be checked by 4pm, so this is your last responsibility of
the day. Both P4s will do these every
day because it can get overwhelming. Our
record so far is 11 boxes and 12 bags in one day.
Other
projects...
There are
side projects/tasks that we get assigned on a week-by-week basis, as well as a
rotation-long project. My rotation-long
project is to look at a list of patients who are readmitted to determine if
poor med reconciliation could have caused the readmission. The patients on the list are those who were
taking anticoagulants, so the goal is to determine if pharmacy presence in
anticoagulation monitoring and dosing might prevent readmissions. This requires you to learn about both of the
patient’s admissions by reading through all of the notes. It can be really tedious especially if the
patient was admitted for a long time.
This is a project that one intern is assigned during each block, so
usually you’re continuing the work of one of your classmates.
We’ve also
learned how St. Joe’s monitors vancomycin
and warfarin. These are both tabs on the Sentri7
system. Guidelines are generally the
same as UofM (because we all follow CHEST), so you’re just getting more
comfortable taking on the PK responsibilities. We aren’t assigned these tasks
all of the time; only about a week each.
One of
the things I found unique to St. Joe's (though I haven’t been to many other
hospitals) is the “Huddle.” Once every
shift we have a team meeting where the pharmacy manager goes through
announcements, drug shortages, system outages for other locations where we’ll
need to help verify orders, and acknowledgements. During acknowledgements, different people
take the time to thank a coworker that has been really helpful lately, stayed
flexible to cover open shifts, etc. Even
when I was at St. Joe's Livingston, the general feel was very kind and
appreciative. Nobody’s hard work goes
unnoticed, and there are always open lines of communication.
Reflections…
Dr. West
wants you to see all parts of the hospital, so I’ve shadowed a technician, a
nurse, an IV room pharmacist, and a Medical ICU clinical pharmacist. The focus is to see the integration of
pharmacists in the hospital system. I
like that there is a focus on being independent; I get taught something once
and then I’m responsible for that task from that day forward. All of the pharmacists and technicians are
really nice and helpful. I like feeling
like I’m responsible and trusted, and relied upon. My role has meaning, and I am becoming more
confident in what I know (and realizing what I don’t know)!
It’s very
cool to see the difference between a big academic institute and a large
community teaching hospital. I would
definitely recommend this rotation to all students!
No comments:
Post a Comment