Saturday, July 30, 2016

Rotation 2: Health Systems, Day +25

Posted by Millie at Saturday, July 30, 2016

Hi again! 

My second rotation was health systems/hospital at a cancer research and treatment center affiliated with a medical campus full of other hospitals. I came into this rotation not really knowing what to expect, and I’m leaving it with such a good understanding of pharmacy operations, pharmacy services, and more about bone marrow transplant and hematology/oncology than I could have ever thought possible from only 5 weeks!

My first two weeks were spent in pharmacy operations, where I observed and participated in unit dose, narcotic control, order verification, and making IVs for non-chemotherapy and chemotherapy products. I learned about the inventory process, which was especially interesting considering the pharmacy at this site is responsible for ordering and managing thousands of dollars’ worth of oncology products. I also spent some time with the Investigational Drug Services and was able to witness pharmacists’ role in managing medications for patients participating in a drug study. Being one of the largest sites for phase 1 studies, you can imagine the IDS pharmacists were very busy.

Starting with week 3, I transitioned from pharmacy operations to participating in our pharmacy clinical services. I was so excited that this site was a mix of both inpatient (floor) and outpatient services (clinics) because I wanted to get exposure to a variety of patients. I spent some days with the pharmacist in the bone marrow transplant clinic, where I was able to see a few patient education or “chemotherapy teach” sessions. Before patients begin their transplants, they come to the clinic and are counseled by a pharmacist who goes over the medications, the transplant process, and answer any questions they may have. It’s a very collaborative process between everyone in the room, and it was so great to see how the patients really appreciated a pharmacist spending the time to go over each step with them. I also watched how pharmacists, physicians, and nurse practitioners work together to write and review chemotherapy orders. I was also able to round with the infusion center nurses, watch how they administered chemotherapy, and ask them questions. I gained a good appreciation for how nurses manage to juggle everything, and the importance of effective and constant communication between all staff on the floor. I even got the chance to sit down with a patient and explain to her how her pain regimen worked!

I spent a few days with each of the inpatient pharmacy clinical specialists in bone marrow transplant, oncology, and critical care. During these days, I was given some patients to work up, create an assessment and plan, and present the case to the pharmacist. The pharmacists would ask me questions and we would discuss things to consider when assessing patients. We went on rounds together, where I had the opportunity to interact with medical and nursing staff. I was impressed at the collaboration between all of the members on the team, and it was fascinating to see the thought process behind clinical decisions.

Towards the end of my rotation I gave an in-service presentation to the pharmacy staff on Graft-versus-Host Disease in Hematopoietic Stem Cell Transplant. GVHD is a very complex topic, and I spent a lot of time diving into the immunology and pathology of the condition, as well as reading about the background of HSCT and how it pertained to my site. From this presentation, I was able to gain more experience in ways to effectively present complex topics and scientific data. Over the 5 weeks, I even got to participate in some important events, including a pharmacy and therapeutics meeting, medication safety meeting, and an emergency preparedness exercise. 

Overall, I was fortunate to learn from patients with such complicated cases and understand the pharmacy department’s role in the hospital, and it was a great way to get ready for my future inpatient rotations! 

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