Saturday, August 1, 2015

Rotation 2: I'll Take a General Kit, Please

Posted by Rebecca Racz at Saturday, August 01, 2015

My entire life I've been terrified of blood, so imagine my shock and horror when I found out I was assigned to the operating room pharmacy for my health system/hospital rotation!  In the first hour of my first day I was handed a syringe of morphine mixed with blood to empty, and thus began my 5-week journey of desensitization.

A typical day kept me constantly moving and looked something like this:

0600 - 0730: Pass out kits
The OR pharmacy had pre-made drug packs containing various narcotics that the CRNAs and doctors could sign out for their patients.  There were kits for ECT, codes, PACU, the medical procedures unit (MPU), and, most popular, kits for general surgery.  Doctors and CRNAs could ask for additional add-ons, such as ketamine or Dilaudid, as well as pick up non-controlled medications, such as Tylenol, Neurontin, and Precedex, and request infusions.  This time was particularly busy, as all 30 ORs had a shotgun start at 7:30.  During this time, we also received several kits that were used overnight, and had to reconcile those with the provider while he or she was standing there.

0730 - 1000: Verify, topic discussions, and LOTS of paperwork
The next 2.5 hours were spent talking about various topics related to anesthesia, opioids, or other OR drugs, verifying the pre-op medications for the next day, and reconciling and completing the returned kit paperwork.  The paperwork could be very tedious at times, as we could have as few as 2 kits returned or as many as 20 or more if there was a weekend or holiday! The paperwork had to be double checked against what was actually returned and against the Omnicell.  Anything returned in syringes had to be refracted to ensure that what was documented to be in the syringe was actually in there.

1030 - 1430: Pharmacy adventure!
Every day I went to a new place to learn about a new area of pharmacy.  On Mondays, I went to the main pharmacy in the children's hospital, where I was able to check prescriptions, participate in cart fill, learn about dosing children, and chemotherapy dosing.  On Tuesdays, I went to the OR in the children's hospital, where I performed very similar tasks to my responsibilities in the adult hospital.  On Wednesdays, I worked with the medication safety officer on a medication use project.  On Thursdays, I went to the Investigational Drug Service and learned how to verify a prescription for a study, how to read a protocol, and how to write guidelines for pharmacists dispensing based on the protocol.  On Fridays, I stayed in the OR and filled pre-op orders for the next day.

One of my favorite days in the OR was a day I never thought would happen: I spent four hours walking in and out of various surgeries and intently watching the procedures.  I walked around with an amazing anesthesiologist, who showed me how she uses all the drugs I had seen coming in and out of the pharmacy every day, which was fascinating.  I was also able to watch a kidney transplant, brain tumor biopsy, ear canal tumor removal, and a prostatectomy using the da Vinci robot.  Watching those surgeries showed me that I had come a long way in those five weeks with regards to my blood sensitivity!

Overall, this was a fantastic rotation and nothing like I expected it to be.  It was a lot of work, but well worth the effort!

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