Adam Loyson
at
Thursday, December 26, 2013
The last time I wrote to you I
described my rotation in critical care, where I provided medication management
to patients with a wide variety of medical conditions. I thoroughly enjoyed my
experience but little did I know, my rotation experiences were about to get
supercharged! In my next rotation, I found myself providing pharmacy services
to anyone and everyone who entered the emergency department (ED) doors in a
large academic teaching hospital.
It was time to grab the ropes
quickly for this APPE rotation because each second of faster patient care initiation
could very well be a second closer to saving a life. Shortly after this ED
rotation, I entered the world of nontraditional pharmacy practice with a
rotation at the FDA.
Breadth of learning opportunities
To my surprise, the
ED is comparable to a health care superhighway with patients continuously seen
and treated by multiple health care members. Patients are evaluated for the
imaginable (animal bites and dehydration) to the unimaginable (automobile accidents and occupational
hazards).With the American Heart Association’s adult cardiac arrest algorithms
committed to memory, I regularly participated with the emergency response team
of physicians and nurses by preparing necessary drug dosages before they were
needed and seamlessly relaying communications to the clinical pharmacist. With
airway control and adequate respiration a priority in the management of any
seriously ill or injured person, I also assisted in the proper selection and
use of paralytic and sedating drug agents to aid in tracheal intubation.
There is nothing like coming right
out of the gate on rotation and making an immediate impact in patient care. Staying
current with disease management practices, I performed daily appraisals of clinical
reviews and topic research on drug overdose/toxicology, trauma-burn, pain
management, infectious disease, and cardiology.
Sky is the limit
Although providing high levels of
care to patients in critical condition through a team-based approach was a
priority in the ED, I also created in-service nursing education on vaccinations,
an orientation manual for new ED pharmacists, and standardized the ED’s
medication supply chain.
Don’t let this fool
you though; there were also plentiful opportunities for patient interactions . In
a profession focused on advocacy and provider status, there is nothing better
than being one of the first professionals to enter a patient’s room, greeting
them, and letting them know that a pharmacist is there to help them.
Navigating the unknown
After an exciting experience in
emergency medicine, my next rotation brought me to the country’s heart of drug
regulation at the FDA in Washington, DC. I was responsible for reporting to the
Office of Compliance within the Center of Drug Evaluation and Research.
During my rotation, students were
invited to participate in an extensive daily seminar series to assist with
learning how the FDA works. Along with the 20 other students on rotation, I learned
about the FDA’s involvement in the revolving drug approval process; the FDA’s role
in adverse event review and analysis; and the presence of counterfeit drugs and
other supply chain risks. What makes the FDA unique is the combination of employed
civilian employees and United States Public Health Service (USPHS) personnel.
In working with USPHS staff at the FDA, I learned much more about federal pharmacy opportunities
post-graduation and was encouraged to apply.
Influential impact
My specific project at the FDA
focused on the review of inspections of compounding pharmacies. Currently,
the FDA does not know how many licensed community pharmacies are actually
engaged in activities that more closely resemble the manufacturing of drug
products. and has written warning
letters to firms whose practices appear to exceed the scope of pharmacy
compounding as outlined in the Federal Food, Drug, and Cosmetic Act of 1938., However,
many of these firms believe that their practices fall under the compounding and
drug product safety exemptions outlined in the Food and Drug Administration
Modernization Act of 1997.
With the recent New England
Compounding Center’s meningitis outbreak, the project I chose for my rotation
included the review of existing pharmacy compounding inspection documents and
recurrent citations (FDA Form 483). I believe the FDA could use my research in
the immediate future to support portions of a current U. S. Senate bill that
was recently passed by the U.S. House of Representatives, called the Drug
Quality and Security Act, which focuses on compounding pharmacy regulations.
Box of chocolates
Overall, I greatly appreciate the
vast hands-on involvement while working in emergency medicine and with the FDA. My
career goals for the future are slowly coming together with the increased knowledge
from these two rotations. Forrest Gump had it down when he said that life is
like a box of chocolates and that you never know what you’re going to get. Reflecting
on APPE rotations, you never know what great experiences will come your way.
Bring on the next rotation!
