Monday, November 5, 2012

ID Stewardship and Drug Info

Posted by Katrina Karpowitsch at Monday, November 05, 2012

Like many of my co-bloggers, I feel that these rotations are quickly passing by without much time to reflect! Here's a quick summary of my last 2 rotation blocks:

Infectious Disease - Antibiotic Stewardship @ UMHS:

This rotation was divided into ~10 day blocks so that we could get experiences in both stewardship and rounding. Throughout the rotation, the mornings began with a topic discussion lead by a preceptor, resident, or student. This served as a comprehensive overview of all important ID topics that we were likely to encounter over the rotation (and was very useful in reinforcing spectrums of activity for the various classes of antibiotics!). My first block was spent with my preceptor on stewardship, where I would preform culture reviews for all patients on restricted antibiotics within the hospital system on a particular service. This helped me become more familiar with the guidelines for use in patients, and get a sense for assessing clinical need for restricted antibiotics that I hadn't learned much about in school. The following two blocks were spent with a pharmacy resident rounding with ID teams. These services ranged between 10-20 patients at any given time, for which I was responsible for working up and assessing their therapy. Mornings were generally spent reviewing charts and discussing possible interventions prior to rounds in the afternoon. Another notable activity on this rotation was helping to create an competency test for staff pharmacists on our guidelines for antibiotic used, based on case scenarios. Overall, I believe this rotation was very useful during my P4 year to reinforce and expand upon the ID we learned in class. I highly recommend ranking an ID rotation!

Drug Information - Medical Writing @ Lexi-Comp:

This rotation was a review in how to review primary literature for updating or creating new drug interaction monographs for Lexi. Even though a majority of work is done remotely, I found this rotation to be very busy! My preceptor would send drug inquiry emails throughout the day for us to look into, in addition to our workups for newly-approved drugs and revisions to existing monographs. This involved fine-tuning primary literature search skills, and working towards making succinct monographs that contained clinically applicable information. Interactions are graded based on the risk of a patient experiencing a clinically significant effect, which sometimes is hard to judge based on limited information available. I believe this was a good exercise in learning to become more decisive in clinical situations by evaluating primary data and extrapolating its meaning in a patient-specific manner. Another rotation-long assignment was to develop monographs for herbal medications, which are currently limited in Lexi. This involved extensive primary literature searches for each type of interaction (i.e. flaxseed and estrogens, flaxseed and hypoglycemics, etc.). Finally, we met with our preceptor to discuss pharmacokinetic and pharmacodynamic interactions for the monographs we were looking into, and also presented a journal club to our group. Again, this rotation was busy but useful in developing my primary literature search and review skills, and learning how to apply this information in the clinical setting.

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