Sunday, January 5, 2014

Institutional Rotation at Oakwood Annapolis Hospital

Posted by Patrick at Sunday, January 05, 2014

In many ways, the institutional rotation represents the nuts-and-bolts phase of our P4 inpatient experiences. Over the course of these five weeks, we learn the essentials of order verification and drug distribution. These two skills are important elements that define what pharmacy practice is all about: right drug, right patient, right time.
My particular experience at Oakwood Annapolis helped me to build a foundation in these skills, as well as expose to me to additional, unexpected, practice opportunities. The first week of the rotation was highly structured and centered on drug distribution. Each day focused on a different aspect of the drug delivery process. Days one and two were devoted to Pyxis delivery, packaging, staffing the IV room, and order fulfillment. The time spent in the IV room was a special treat. The sterile compounding conducted in 797 clean rooms at hospitals every day is a critical aspect of modern pharmacy practice and a skill that is very difficult to properly develop in a classroom setting. I was also fortunate to have an excellent teacher.
Most of the remainder of the week was spent with the inpatient pharmacists learning the basics of order verification. We talked about the criteria they examine when they verify “routine” orders as well as the more complex criteria that they use to evaluate more unusual orders. Each and every order is held up to the same high standard to ensure patient safety. I had a million questions and they were patient with each and every one. One of the most interesting takeaways was the magnitude of the differences between Epic based computer system and other software packages. Epic really does do things differently and I’m grateful that I had the chance to work intensely with Epic during this rotation (the University of Michigan Hospital will be making the transition some time in 2014).

The other major experience offered at Oakwood was the opportunity to spend two weeks rounding with the clinical pharmacist in the ICU. It is a quirk of my rotation schedule that I have not yet had the chance to work in a critical care environment and it was a welcome surprise to find that chance on my institutional rotation. The experience was very similar to what I experienced on rounds in my generalist rotation during the prior month, but given the setting, it was a very different set of medications we were working with. Of special note was a concern for dramatically changing renal functions, given the critical condition of these patients. A dose an antibiotic would be appropriate one day, and then way too high the next. Staying on top of the rapidly changing condition of these patients was one of the chief challenges and rewards of working and learning in this environment.

Outside of these primary learning experiences, Oakwood offered a great deal of flexibility to the student to pursue their own pharmacy interests within the context of the hospital. I built a strong relationship with the pharmacy director and we had the chance to have extensive discussions about the challenges facing the pharmacy and how it needs to grow in the coming years. I took on an additional project, communicating updated guidelines to the surgical staff, and I delivered an inservice on the atherosclerotic disease prevention guidelines (cholesterol guidelines) that I feel may have been one of the best presentation I’ve ever given. My five weeks at Oakwood Annapolis were well spent and I thank the staff for helping me to make the experience optimally fit my learning needs. 

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