Tuesday, October 1, 2013

Rotation 3 in the Children's Emergency Services Pharmacy

Posted by Mindy Prasad at Tuesday, October 01, 2013

Rotation 3 was my first “clinical” rotation. This was the “generalist inpatient A” experience and I completed it at the University of Michigan C.S. Mott Children's Hospital Emergency Department (CES). This rotation is a different version than most of the inpatient rotations. As you can imagine, there is no “rounding” in the CES, but pharmacists do provide medication information and recommendations. The main other differences between the traditional inpatient generalist rotation and this one was that I was able to learn MiChart. The emergency departments were part of the first phases in the roll-out of the new software. This had its advantages and disadvantages. It was great to learn the new system and feel a little ahead of the game, but for the pharmacists and other providers, this means working within up to 3 software programs to provide patient care. Sometimes it is tedious to keep everything straight when you are going between the systems (even though the systems “talk” to each other).

Fortunately for the children in the area, it was a relatively quiet time (aka very few traumas) while I was in the CES. This does not mean that the CES was not a busy place. A couple times we were even “on boarding” because there were no available beds in Mott for the children needing to be admitted. This just meant that care was given in the emergency department until a room did open up. It also meant antibiotic kinetics and dosing…but thankfully not too much!
I did help out in a few situations that required “trauma room” use. For the first couple experiences in there, the physician asked me to sit in the beginning – just in case…I was fine though. The pharmacist draws up the medication doses required in the trauma room. I had made a little book with all the doses for common drugs required for rapid sequence intubation (RSI) and other meds used in emergencies (thanks to my classmate for the idea!). That book was very handy. Pediatrics is all weight based dosing so a calculator was a must! Even if I did the math in my head, I always always double-checked (sometimes triple) checked the answers. In a high stress situation (most trauma room use is high stress!) it is too easy to make a mistake. 

A lot of my time was spent taking medication histories (aka med rec) and working up patients for presentation to my preceptor. Every patient that gets admitted through the CES required a med rec. I liked getting the chance to go into the rooms and talk to patients and families. Sometimes they would ask me questions about medications or even about what it takes to be a pharmacist. I was able to talk to a couple patients more than once over the course of the 5 weeks. As terrible as it is for them to be dealing with such complicated chronic conditions, they both had such a positive attitude and were so pleasant to talk to that you could almost forget they were fighting such difficult battles every day. In addition to the med recs, I was able to complete discharge medication counseling. I was able to spend about 45 minutes with one teenage patient that was newly diagnosed with Type 1 Diabetes. I taught him and his parents some basics about the disease and we practiced using the new lancet device and glucometer. I also found a good website that lists out all the apps for iPhones (he had an iPhone) that might be helpful or at least make tracking his glucose readings a little more fun. 
Each week there were 2-3 mini topic discussions in which I would prepare a 1-2 page “cheat sheet” for reference. The topics were all diseases and emergencies that we would see in children. There were also pediatric topic discussions given by the various preceptors for the Mott generalist students, and each student on the generalist service presented a patient case and a journal club article. Overall, this was a busy rotation and learned a lot about pediatrics and a lot about emergency medicine. I’m hoping it will help me when I have my Pediatric ICU rotation (#5)!

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