Tuesday, February 19, 2013

Rotation 5: Pine Rest Christian Mental Health Services

Posted by Alison Van Kampen at Tuesday, February 19, 2013

So I am way behind, I know, but I hope to remedy that over the next week or so :)

General Info:
So this post is going to be about my rotation at Pine Rest Christian Mental Health Services with Dr. Kevin Furmaga.  First, this is a pretty unique experience and I would definitely recommend it.  This is an inpatient mental health hospital meaning all of the patients at this hospital are there for mental health issues. There are four adult units, and older adult unit, and a pediatircs unit so there are typically 60-70 patients staying there at a time. This is a very specialized and respected institution so there are people that come from long distances to receive treatment. 

Dr Furmaga is the only pharmacist on site (medications are dispensed by and delivered from St. Mary's Hospital in Grand Rapids), so he primarily acts as a consultant for particularly difficult patients to treat instead of following patients on a daily basis. He also attends the team meetings for each unit (except pediatrics) once weekly.  You go along with Dr Furmaga to team meetings (and sometimes alone near the end of the rotation) as well as looking at profiles for patients that require consultation.

Typical Day:
The typical day varies quite a bit.  There were several occasions where I spent most of the day shadowing the psychiatrists, PAs, or NPs while they talked with each patient on their unit to assess their progress.  I really developed a greater respect for these professionals as working with patients with mental health issues could be very difficult.  Some of them could be hostile and they can be difficult to read.  Deciphering patients thinking patterns and feelings just from talking with them is really a skill that I think needs to developed over a lot of time and with a lot of experience.

Other days I would work on projects, go to grand rounds, attend (or teach) medication education groups (more on that later), work up patients for consultation, or do topic discussions with Dr. Furmaga.

Topic discussions were really beneficial because it was almost like a mini lecture where Dr. Furmaga explained indication, mechanism of action, side effects, and unique characteristics of medication classes and individual medications within a class.  I found this to be really helpful when considering drug therapy selection.  Potential side effects especially played a big role when choosing therapy for a patient.  For example, the 2nd generation antipsychotics (olanzapine or quetiapine) that have more metabolic effects were often avoided in patients that had diabetes or were overweight because of there potential to increase weight or negatively impact diabetes.

The project that I was assigned was compiling a database of information on the effects that different psychiatric medications can have on pregnancy and breastfeeding.  For this I created a large table to easily look up a medication and evaluate the safety of a medication for pregnant or breastfeeding women.  This was assigned to me because Pine Rest was starting a new service for pregnant women with a history of mental health issues.

I also created a documents describing adverse drug events and how they were addressed in the past few months which was then used in the P&T committee in the drug safety evaluation.

Cool Things I Got to See:
First cool was getting to hear the stories from all of the patients.  Many of them have interesting and often very sad histories so it is important to be understanding.  I did not speak directly with them very often but giving them respect and sympathy was often very important.

I also got to see patients under going electro-convulsive therapy (ECT).  These patients are often the ones that are refractory to medication therapy and they can achieve really remarkable results from ECT.  Also, the therapy is much simpler than you would imagine.  It usually consists of giving the patient a short acting anesthetic and paralytic, the patient is given a shock for about 10 seconds (no physical convulsion usually just tightening of the face and legs), and they wake up (all within about 1-2 minutes).  It was interesting to observe.

Cool Things I Got to Do:
The coolest thing was getting to teach the medication education group to the patients.  The first few weeks I just observed Dr. Furmaga teach the group but the last few weeks he let me teach the group essentially on my own.  I followed his format and the class usually lasted about an hour (I know sounds scary, but the time actually passes pretty quickly and the patients usually ask a lot of good questions).  I also was able to answer questions from the patients as well.  Dr. Furmaga usually left me on my own for the majority of the hour but returned at the end to answer any questions that I was unsure about. It was a really neat and rewarding experience.

Take Away Points:
This is a really unique and rewarding experience.  I learned a ton and got to do some pretty cool things.  Keep in mind when considering this rotation that you will spend the majority of your rotation sitting in on patient interviews with psychiatrists, PAs, and NPs, or working on projects. You do not follow the same patients on a daily basis so you often do not give input on therapy unless some one on the unit asks for it directly. Overall, this is a great rotation and I would definitely recommend it.

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