Unknown
at
Monday, October 31, 2016
I spent block four at the Cancer Center at St. Joseph Mercy
Hospital (SJMHS).
My preceptor is piloting a new program at SJMHS where each
person that is receiving any oral medication to treat cancer is required to
speak to a pharmacist about that medication. Oral chemotherapies—while often
much more tolerable than the usual intravenous option—are not benign by any
stretch of the imagination. More importantly, unlike the IV chemotherapy where
the patient is surrounded by healthcare professionals for the duration of their
infusion, the pills go home with them. For many of them, there are very real
risks associated with exposing other people to the drug and other
considerations like what you should/not eat or drink, warning signs for side
effects and other complications, and drug-drug interactions that could
compromise their treatment.
All of the same items apply for patients new to IV
chemotherapy, but the majority of the side effects and management have
significant overlap so that is done in a classroom setting. However, there are
always little things that a nurse practitioner and I would team up to address
afterwards.
These sessions would typically take about an hour (and
sometimes much longer!) and after three or four in a day I would try to avoid
talking for a while so I wouldn’t lose my voice!
Typical Day
I would typically arrive at SJMHS between 7 and 8 AM. First
things first: check in ARIA (the infusion center electronic medical record
system) to see if there were any new patients for the day. While most of these
were scheduled days or weeks in advance which would give us plenty of time to
prepare, there was the occasional last minute addition. The morning was usually
project work or counseling, depending on the day, and afternoons were the same
dependent on the IV chemotherapy teaching class schedule. Generally, I would be
in my car headed home between 4 and 5PM with a smile on my face.
The Work
Working up a patient is less focused on their specific
disease and more focused on the drug and the logistics of getting it to the
patient on time. A lot of things need to click in to place before the drug is
sent to them by the (usually specialty) pharmacy, and a big portion of what I
was responsible for was, on top of the usual pharmacist duties, ensuring that
our office had all of the information we needed and that all necessary testing
was done or scheduled. Based on the drug or drugs they were receiving
additional screening (such as hepatitis B, HIV viral load, or an
echocardiogram) might be required.
Next would be actually going to meet the patient and their
family. I often had groups as large as eight or nine people—and spend the hour
or more discussing the information that I had, answering their questions, and
if they wanted to continue, collecting their consent form. Most days these
counseling sessions would take 3-5 hours on 2-3 days a week.
These sessions have been some of the most fulfilling work
that I have done as a student pharmacist. Most of the people I was seeing have
only known that they have had cancer for one or two weeks. There is a lot of
apprehension and a lot of things are changing very fast—suddenly they need to
reevaluate their entire life plan and here I am talking about all the bad
things that could happen if they take this medication. I could relate to what
this was like—my father was diagnosed with cancer when I was in high-school—and
those experiences went a long way towards helping me understand what these
people were going through. The relief that each person experienced when they
were done speaking with me was something to behold. Many underestimate the
power of knowledge and what that can do when you have been preoccupied with so
many fear-filled unknowns. Pharmacists make this possible.
Projects
My preceptor more-or-less owns the responsibility for the
back-end management of ARIA and as such, we had access to a ton of data and
reporting tools for process improvement. I used my programming background to
streamline several reporting processes for each of the five clinic sites that
will probably save an analyst a full week of work each year (30-45 minutes per
report à
10 seconds per report). This is on top of literature searches for various
questions like “should we use cryotherapy with doxorubicin infusions” or “is
glucarpidase over dialysis cost-effective in managing methotrexate-induced
acute kidney injury?”
A major component of these counseling sessions is a set of
informational packets built for each drug. The Michigan Oncology Quality
Consortium (MOQC) has built a ton of these for the oral chemotherapies that we
enhanced for use in our clinic. Part of my job was building these for new drugs
and updating old drugs with new data.
Overall Thoughts
Year to date, this has been a blast of a rotation. I
sincerely left each day with a smile on my face and an excitement about the
next morning. I found the work fascinating, challenging (but manageable), and I
made a sincere, visible difference in the lives of so many people. Not to
mention, I got to program and use a bit of my technical background as well! You
can peer in to the world of specialty pharmacy billing, learn a whole lot about
various cancers and their treatments, and a ton of other interesting work
besides. I highly recommend this rotation!
No comments:
Post a Comment