Wednesday, October 22, 2014

Community Pharmacy in St. Ignace, MI

Posted by Unknown at Wednesday, October 22, 2014

Growing up in Southeastern Michigan, my family and I made many trips over the Mackinac Bridge into Michigan’s Upper Peninsula for vacation, recreation and exploring “Pure Michigan”.  However, this time over the bridge into St. Ignace was different.  It was time to move away from Ann Arbor to develop an understanding of how pharmacy operates in the Public Health Service and to experience the culture of a unique population, the Sault Tribe of Chippewa Indians. 

I woke up just after sunrise to make it to my first day of Rotation 2 at Mackinac Straits Health System working in the Tribal Pharmacy.  When I arrived at my site, I took a few moments to take in the scenery and saw this gorgeous view:

Immediately, I thought, “I could get used to this!”

After orientation to the pharmacy, clinic providers and systems, I started counseling patients as they picked up new prescriptions or inquired with questions.  On the second day, I began meeting with patients prior to their provider appointments in the Tribal Health Clinic.  These patients presented with either acute conditions or for chronic disease management.  During my time with the patients, I assessed vitals, reviewed medications, discussed concerns and ultimately made recommendations to the doctors or nurse practitioner after discussions with my preceptor.  Over the next five weeks, I spent about half of my time working and interacting with patients in the pharmacy and the other half of my time with patients and providers in the clinic.  This is a very unique practice setting aside from the traditional community pharmacy.  Here, the pharmacy is directly connected with the clinic, allowing for significant interprofessional collaboration and access to the patient’s medical and medication history and pertinent lab results.  This rotation and practice model allows for a unique blend of community and ambulatory care pharmacy in order to provide exceptional patient care.

On the afternoon of my first day, one of the clinic doctors posed a question regarding hallucinations and acute mental status changes in an elderly woman.  When this discussion started, I immediately associated the symptoms with a urinary tract infection (UTI) and sought the lab results from the urinalysis (UA).  The patient had documentation of a UTI two weeks earlier and completed a course of empiric therapy with ciprofloxacin approximately one week before returning to clinic.  Upon review of the results with my preceptor, we determined that the bacteria causing the UTI was resistant to ciprofloxacin.  The prescriber planned on extending the course of therapy with ciprofloxacin, but after reviewing the culture and sensitivities and performing a repeat UA, I recommended changing to an agent that the bacteria was sensitive to, nitrofurantoin.  Fast forwarding through the rotation, the patient’s UTI and symptoms resolved over time with this treatment.  As a student pharmacist early on in my Advanced Pharmacy Practice Experiences, it was extremely exciting to make a significant intervention and to impact patient care from the start of the rotation!

This sunset is from one of the last few nights as my rotation grew to a close.  While I only had the pleasure of working and learning at Sault Tribal Health and Human Services for five weeks of my last year of pharmacy school, I would go back in an instant!  I am so grateful to have had this community pharmacy experience to develop personally and professionally. 

P.S. The excellent providers and co-workers that I had the opportunity to work with and the gorgeous scenery are just an added bonus! 

-Jessica Fennelly, PharmD Candidate 2015

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