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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