Tuesday, September 27, 2016

Rotation #3 - Ambulatory Care Oncology

Posted by Brock Jackson at Tuesday, September 27, 2016

On this particular rotation, it was certainly a mix of emotions. While there were certainly some low points, the high ones outweighed those by a wide margin.

This rotation was not nearly as complicated as the others and I was able to establish a routine from nearly the end of the first week. I’ll break down how my days generally went based on the day of the week.

Monday – Most of my time Monday was spent preparing for Tuesday-Thursday patient interactions. Working up patients, presenting them, and answering various drug information questions took up a majority of my time here.

Tuesday – In the morning, I would continue to work up patients, wrap up drug information questions, and work on special projects. In the afternoon, we had our biweekly chemotherapy teaching sessions. Myself and nurse would go through various IV chemotherapy regimens with patients that were going to receive them. We would go through what their regimen was, what days it was on, how it was administered, other medications that came with it, side effects that are common, side effects that are specific to their chemotherapy, and field a variety of other questions. These sessions typically had 10-16 people in them (family and friends could attend too) and lasted on average 3-4 hours.

Wednesday – In the morning, I had my oral chemotherapy patients come in for chemotherapy teaching. We typically had three, one-hour block sessions set in the morning. Patients typically came with one to two other people and we would sit in our library and go over their chemotherapy regimen. These regimens were a bit different than the IV ones. These were all taken at home, and aside from laboratory monitoring, they did not come in to see us again (barring side effects). These sessions typically did last the entire hour. We went a lot more in depth on how to manage side effects and what to do if they experience them in these sessions compared to the IV chemotherapy teaching sessions (in my opinion).

Thursday – This day was pretty much a clone of what I did on Tuesday. Often times, we would have patients rescheduled onto different days and this often led to last minute work up of patients on Thursdays, prior to our IV chemotherapy sessions.

Friday – If patients had been scheduled for next week, I would work them up first. Otherwise, I would be working on special projects, drug information questions, and patient education materials.

Random special events
-        Shadowing nursing during various procedures and administrations (IP chemotherapy (Fascinating), IV Iron, bone marrow draws, etc.)
-        Inspecting chemotherapy rooms for compliance
-        Journal clubs
-        P & T committee meetings

What I was doing when I was not working up patients or chemotherapy teaching:
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      Patient education materials – At the institution that I was at, we made up most of our patient education materials. These were tough to make because you often times had to go through the clinical trials of the oncology drug in question, look at the adverse events reported (and all the other information), and create them based off of that. I wish I could provide a sample here but they are institution-specific and I cannot. Sadly, words will not do justice to what goes into these but they were tough to create and took up quite a bit of time.
      
      Drug information questions – LOTS of drug information questions. They mostly centered around herbal medications and supplements. I cannot tell you how many of these I answered. Often times, patients would be on several of them at once. It became extremely difficult to manage drug-drug interactions and safety in general with patients being on numerous medications, oncology regimens, and anything else they were taking. I recall one patient being on over twenty different prescription + over-the-counter products, while taking ~7-8 different herbal medications and supplements. This did not include their oncology regimen.

      Overall, I had an absolutely wonderful experience on this rotation!

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