Long Term Care, a HomeTown Experience

Posted by Courtney K at Sunday, August 05, 2012

Hello!

It's been a busy week with the start of Rotation 3 last Monday, so I'm overdue for my Rotation 2 blog. I spent the last 5 weeks at a Long Term Care Pharmacy (associated with HomeTown Pharmacy), in Chelsea, MI. This was a very unique experience, and it served as my Non-Traditional rotation. Although this rotation was based out of Chelsea, I spent most of my days going to different nursing homes and assisted living centers all over the state with my preceptor. Some of the places they service are FAR away, so I chose to stay at home in Owosso a few nights to lessen the drive time. The biggest nursing home they service is in Ingham County, so we traveled there most often, but we also went to homes in St. Johns, Saginaw, and Southfield. So, what exactly did I do at these homes, you're probably wondering. My preceptor is a consultant pharmacist, so she reviews EVERY patient chart once a month and makes recommendations to the physicians, nursing, and pharmacy staff. Her work averages between 50 and 70 charts a day. That seems like a crazy amount to get done in a single day, but I was with her and sure enough she does it. It goes a lot faster for her because she is familiar with the patients and their medications, since she reviews them each month. For me, on the other hand, I was expected to review only 2 charts the first day (one in the morning and one in the afternoon) and I worked up to about 4-5 charts a day by the end of the rotation.

What are we looking for in the chart? and what kinds of recommendations are we making? are probably the next two questions. A lot of the recommendations we made involved Psych Meds, believe it or not. There are a lot of rules regulating the use of these medications in the elderly. Depression is very common in the elderly, so antidepressants are commonly prescribed. Antipsychotics are also used quite a bit for delusions and paranoia associated with dementia. Gradual dose reductions must be attempted for these medications to get patients at the lowest effective dose. Other types of recommendations include appropriate  renal dosing, optimizing the timing of medications, appropriate indications for therapy, PRN med use, and lab orders to monitor for efficacy and toxicity. The recommendations are all submitted at the end of the month in a single document, so unfortunately I didn't get to see if most of my recommendations were taken. However, since the rotation spanned over two months, so I did get to see when one of my first recommendations was taken by the physician and an ineffective antibiotic for UTI prophylaxis was discontinued. Exciting!

I spent 1-2 days a week in the pharmacy in Chelsea where they do all the dispensing from. Drivers make 1-2 trips a day to the different nursing homes to deliver the needed medications. In the pharmacy I got to make lots of IV's and do some compounding (ativan cream!). The rest of the time I worked on various projects, including a new drug article for the Pharmacy newsletter, a patient case presentation to the pharmacy staff, and a 30 minute presentation to assisted living residents about the management of Parkinson's Disease.

Overall, I really enjoyed this rotation and I would definitely recommend it! It was a good lead in to my current rotation, because both involve the management of diabetes, hypertension and hyperlipidemia. My next post will be all about AmbCare in Brighton with Dr. Wells. Enjoy the rest of the summer!