Thursday, December 31, 2015

Getting psyched for Inpatient Psychiatry

Posted by H. Tran at Thursday, December 31, 2015

Rotation 6 for me was Inpatient Psychiatry in a small hospital. I wasn't too sure what to expect, as I've heard stories about the patient population from another classmate who had this rotation, frightening stories, and the lack of an electronic medical record and other technology that led to many medication errors. But as always, I just brought my "A-game" and let the rest unfold from there.

Upon arrival, I had an eerie feeling run through me. I had to press a button that apparently turned on a camera for the receptionist to see and open the door for entry into the building.  It was obvious that security here was a serious issue.

I introduced myself to the receptionist and asked for the pharmacist (my preceptor). While I was waiting, I observed some anxious adults, who appeared to be patients waiting for intake and admission, but my attention was suddenly drawn to a group of people coming out from the hospital hallways for discharge. A set of parents were eagerly waiting for their daughter, and the look of thrill and happiness of both parties after they were reunited was great to see.

My preceptor welcomed me in and introduced me to the facility. She gave me a set of keys that I was to use to get through every set of doors in the hospital, and explained the process needed in case of lost keys and the incident report required to be done. This is unlike hospital I've been trained at as a Wolverine, where we could use our ID badge and just scan in. Here, we use keys. Additionally as she gave me a tour of the facility, she instructed me to look through the small window on the door to the other side in case there was a patient waiting (or hiding) near the door for an opportunity to escape. "Wait 3." She explained to me to wait 3 seconds after the door shuts to ensure that the door has been securely locked before I proceed to my duties. There is a high elopement risk, and the necessary precautions were in place.

My first day already was a thriller. Towards the end of my day I was debriefing information with my preceptor, when suddenly, we hear loud noises as if there was an argument, a slam, and briefly see a shadow swiftly pass about 5 feet behind us as we turn our heads. A patient had just escaped from his unit. Code 5 was repeated throughout the intercom, alerting all staff to be wary and all trained staff to assist in the pursuit and tracking of this patient's AWOL. At this moment, I felt goosebumps rise throughout my arms and legs. (Note: the patient was eventually located, brought to safety and treated appropriately.)

This incident alone made me more aware and more cautious for the entire rotation. Although these patients are mostly on involuntary holds that would usually require pharmacotherapy, it's important to understand what they are going through and what they may be feeling to help them. Part of my role here was to go into the units and interview patients to assess pharmacotherapy. Beyond that, I tried to get an understanding of the patient, what they are going through, how they are feeling, and their perceptions of their medications. Not only did this allow me to develop a connection with the patients and choose the most appropriate agent for them, but it also served as a learning opportunity for me. I got a better understanding of patient's symptoms of psychiatric disorders such as bipolar, schizophrenia and depression, and a better understanding on how specifically their medications are treating their symptoms, and what it is doing for them. Learning from a textbook, PowerPoint lecture slides, and audio recordings from classrooms is different than hearing real stories and perceptions of patient experiences with not just the disorder, but the medication.

Another responsibility I had was to hold weekly groups at different units covering the topic of the week (i.e., depression, bipolar, schizophrenia, detox, etc.). This led to some great conversations, and allowed social workers to assess the progress of the patient. It also allowed me to have greater insight into how the patients felt about their medications and talk about the stigma involved. I also had wonderful opportunities to take their questions, and look up the ones I didn't know to get back to them. Some of the questions were very specific, such as "why does my SSRI cause weight gain?" and others were more general such as "what are the side effects of my risperidone? and "does my gabapentin affect GABA receptors?" Overall, this rotation was very interesting and the groups were informative for both ends.

Some other interesting incidents during this rotation include a code calling for assistance because a patient was actively cutting herself in the hallway (from wrist to elbow on both arms, leaving a very bloody hallway), and a physical altercation that included a person laughing hysterically into another person's face.

It was a very interesting rotation on a patient care standpoint. Another great learning experience was that given its limited resources, it has made me more appreciative of having an EMR and advanced technology to help prevent medication errors. At this site, we did not use a electronic medical records or Pyxis(R) machines. In a way I'm kind of glad to have completed the rotation, and now I'll use winter break and my off rotation to prepare for my next steps in pharmacy.

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