Sunday, February 17, 2013

Institutionalized, hehe.

Posted by Michelle at Sunday, February 17, 2013

Hi all! I am woefully behind on blogging, so this entry is reaching back a bit to my block 4 rotation, which was institutional pharmacy at St Joseph Mercy in Ann Arbor. All my rotations have been great, so I don’t want to miss telling you about them! More entries to come in the future as my life craziness level falls just a bit. :)
So, back to St. Joe. Institutional rotation is a little bit less glamorous than some rotations like ID or transplant or critical care. Nevertheless, it is very important, because the activities you do on institutional rotation are building blocks and basics of much of the pharmacy world, the meat and potatoes if you will.

A typical day was as follows:

1. Arrive at 7:30 AM, check cartfill. “Cartfill” is essentially all of the unit dose medications needed by patients in the next 24 hours that are not available in on-floor medicine cabinets like Pyxis or Omnicell. While an overwhelming percentage of medication doses may be available in Pyxis, the 5% that are not can add up to a lot, especially in a large hospital. These all need to be hand-picked in the main pharmacy, checked by a pharmacist, and sent up to the floors.
2. Perform renal dose adjustments and resolve duplicate medications. St. Joe identifies renally dosed medications and potential duplicate medications by computer program. It was the task of fellow student Kristin Lee and I to make sure renally eliminated medications (mainly antibiotics, but a few others), were dosed correctly according to each patient’s calculated creatinine clearance. Duplicate medications mainly consisted of proton-pump-inhibitors with H2-blockers, and heparin with certain other anticoagulants. In many cases, especially in the first category, there is no reason for a patient to be using both PPIs and H2 blockers. By identifying which duplicate med should be discontinued, Kristin and I helped reduce unnecessary medication use.
3. Huddle: This was the daily pharmacy department meeting that occurred mid-morning. We went over important information for the day. Daily trivia questions were asked as a fun diversion; Kristin and I performed masterfully in this arena. ;)
4. Patient’s own meds: After lunch, we performed “Patient’s Own Meds”, which meant going up to the floors and barcoding medications that patients had brought in from home and were using in the hospital. This allows nursing able to scan the medications in and record their use in the MAR. It is also a patient safety measure; we needed to certify that the medications are what the patient says they are, and that they are not expired, adulterated etc.
5. Paramedic boxes: After completing Patient’s Own Meds, we had to check paramedic boxes. Each time a medication box is broken open for an ambulance visit, it must be refilled and checked by pharmacy before it can be sent out on another run. It was our responsibility to check the boxes filled by pharmacy techs; in a large hospital, this meant a lot of checking!
6. Other: There were many other activities that I participated in, although not necessarily on a daily basis. During this rotation I was responsible for completing a Medication Use Evaluation (IV midazolam) and a journal club. Kristin and I also spent a couple days in the IV room with the checking pharmacist and the TPN pharmacist, in addition to attending Grand Rounds lectures once per week. We shadowed a nurse, answered drug info questions, and occasionally did some compounding.

Finally, the best part of this rotation, you ask? If you are someone who *lives* for patient interaction, this rotation does not necessarily cater to you, simply due to the nature of the duties. But, dear reader, there is opportunity everywhere. On very last day of rotation, I went up to visit a patient for Patient’s Own Meds. When I walked into the room to ask about this particular woman’s seizure meds, she seemed rather upset, and I ended up talking to her for more than a half hour. She was pretty anxious and concerned about several things: some architectural components of the bathroom, the struggles she had with making sure she had her own specified generic brand of seizure drugs, problems with frequent reactions to drugs etc. I was able to talk to her and listen to her concerns, as well as explain some of the details of the difference between generic and branded medications and the differences between drug allergies and drug intolerances/side effects. When I left, her mood was much improved, and she said that while she still wanted to voice some concerns via our patient feedback pathway, she would be sure to note that PHARMACY DID A GREAT JOB! I was so proud to be part of this patient’s good experience at our hospital! Taking time to really listen to patients will always improve results for everyone. :) :)

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