Rotation 7: Health System/ Hospital -- The Return of Med Rec

Posted by E. Caliman at Wednesday, February 17, 2016

This past rotation I spent at a local health system. While there, I mixed countless IVs all while trying to keep up with the IV batch fill. I also spent time dosing patients taking on warfarin or heparin. Later in the day, I'd start doing patient education for heart attacks and a antiarrhythmic drug that requires a lot of monitoring. After all this, I had to make notes in the patient chart, because "If you don't document it, it didn't happen". My preceptors frequently quizzed me, which is helpful when you start studying for the boards.

My main project was to medication reconciliation on patients from a specific unit. The pharmacy department wants to be sure all inpatients are started on the home meds that they need. I did this on the computer, comparing the meds, noting discrepancies, then reading the notes to see if  there was a reason a patient wasn't on certain meds. Obvious reasons included overdoses or a lack of a beta-blocker due to a low heart rate. If I couldn't find justification in the chart, I wrote an intervention.

This was a great rotation for this block, because it's interview season, and a rotation that doesn't require much of your outside time is ideal. The rotation is longer to accommodate your interviews. As long you get your work done, you'll be fine. I had to travel for a few interviews, so having that extra time as a buffer was welcome.

Rotation 7: Narcotic Kits and Pressor Drips

Posted by Emily at Thursday, February 11, 2016

My first rotation of 2016 fulfilled the “health system/hospital” aka “institutional” requirement.  I had no idea what this rotation type entailed until I got to experience it firsthand.  Essentially, the institutional rotation is designed to hone your staffing skills, with a focus on hospital medication distribution and order verification.  My home base was the cardiovascular center satellite pharmacy at UMHS, but this rotation was jam-packed with additional experiences that familiarized me with pharmacy operations throughout the health system.  Here’s what a normal day looked like:

0600-1000 – CVC satellite pharmacy

I reported to the CVC satellite bright and early at 0600 each day to help dispense narcotic kits and pressor drips to anesthesiologists for their morning surgeries.  Narcotic kit dispensing involved logging in to an online controlled substances tool that allowed me to scan the barcode on a narcotic kit, verify the contents, and hand it off to the anesthesiologist who would also confirm the contents and sign out the kit.  At the end of the case, kits were returned to the pharmacy and rescanned, and the controlled substances tool would indicate how much of each medication had been used, how many unopened vials were returning to the pharmacy, and how much waste in the form of partially full syringes should be returning as well.  I would confirm that the quantities in the computer matched those being returned, and the anesthesiologist would sign again, returning control of the drugs to the pharmacy.  In addition to requesting narcotic kits, anesthesiology providers could also place orders for drips they foresaw needing during their procedures (e.g. epinephrine, phenylephrine, nitroglycerin, esmolol, insulin, etc.).  Pharmacy techs would prepare the drips and I would assemble them into bags by OR for ease of pick-up.

Meanwhile, I would also help verify and fill pre-op antibiotic orders for the following day’s cases, provide the final check on medications that had been compounded in the IV hood, perform order verification, and answer the phone.  Depending on the day I might also spend some time in the hood making IVs, discussing the weekly adverse drug report with my preceptor, or shadowing other CVC providers like pharmacy techs and nurses.  Needless to say, I kept busy, and the mornings always went quickly!

1000-1030 – lunch

1030-1430 – time in other satellites/project time

I spent every afternoon in a different pharmacy satellite: Tuesdays in the infusion pharmacy or the Cancer Center, Wednesdays with the Investigational Drug Service, Thursdays in the narcotic vault, and Mondays working on projects.  During the middle week of the rotation, I also got to experience the other institutional rotation “home bases”: UH 6^th floor pharmacy, and the UH OR pharmacy.  CVC is a nice blend of both of these locations since we service the cardiovascular ORs as well as the cardiovascular inpatient floors.

Overall, this rotation totally exceeded my expectations.  My preceptor challenged me to improve every day, and by week four I was surprised by how comfortable I felt with pharmacy operations in the CVC – even verifying orders!  This is one of the first rotations where I have felt a true degree of autonomy, and I also enjoyed feeling like I was actually contributing something valuable to the pharmacy team rather than just slowing everyone down with my lack of knowledge.

Next up: drug information with Lexi-Comp.  After spending over two years as the UMHS drug information intern, I’m interested to learn more about the role of DI pharmacists in a different practice setting.  Stay tuned!