Thursday, October 31, 2013

Rotation 3: Pediatric General Medicine - C.S. Mott Children's Hospital, Ann Arbor, MI

Posted by Jennifer at Thursday, October 31, 2013

This rotation was different than my first two rotations in that all of my patients were pediatric patients.  Their ages ranged from only a few days old to late teens.  I did not have much previous experience with pediatrics, so I was very glad to have this rotation!

Daily routine:
0730-0830: I began the day with pre-rounding.  To me, the goal of pre-rounding is to understand the patient’s medical history and current status, think of recommendations to improve the patient’s medication regimen, and anticipate questions the team may have during rounds.  Recommended pediatric doses are often stated in mg/kg or mcg/kg, so it took some time to become accustomed to determining correct dosages for patients. 

Some questions I would be thinking about during this time:
What are the medications treating?
Are those the correct dosages, or do they need to be adjusted?
What should I be monitoring for (renal function, side effects, etc.)?
What changes to the medication regimen might the team be thinking about (IV to oral, increase or decrease in dosage, change to a different medication altogether)?
Can this medication be administered through a G-tube or J-tube?
Are there any home medications which are not listed on the inpatient medication list?

0830 - 0900: Present and discuss my patients with my preceptor and finalize recommendations for the team.  I actually worked with several different preceptors, and they all helped me to improve my therapeutic skills.
0900 - 1000/1100: Round with the team, which consisted of the attending physician, an intern, two residents, three medical students, the nurse, and myself.
1000/1100: Follow-up with any questions from rounds, complete medication reconciliations, track lab values for patients on total parenteral nutrition (TPN) and review the TPN orders. 
1330: Meet with my preceptor to verify TPN orders.
1400 - 1500: Finish medication reconciliations.
1500 - 1600: A variety of topic discussions, case presentations, and journal clubs would occur during this time.
1600: Complete any unfinished work.

It was quite a busy rotation, as you can see from the above daily schedule, but worth every minute of it!  The rounding team was very receptive to my recommendations and valued pharmacy contributions.  If treatment questions arose during rounds that required some research, I gladly would investigate and report back to the team.  I learned about many disease states that I had never heard of before and their recommended treatments!