Thursday, August 30, 2018

Rotation 1 and 2: Community and Nontraditional Informatics

Posted by Andrea at Thursday, August 30, 2018

Hi everyone! My name is Andrea Duong and I will be one of the P4s blogging about their APPEs this year. I’m excited to give you a glimpse into the life of P4. Hope you enjoy!

Rotation 1: Community Pharmacy
I was looking forward to this rotation, since I only had experience working in a big chain pharmacy. This rotation was at an independent pharmacy in a small town in Michigan. Typical hours for this rotation were 9am-5pm. My days were spent filling prescriptions, taking phone calls from patients and providers, and counseling patients. Later in the rotation, I became responsible for checking prescriptions (with preceptor supervision). I felt like a real pharmacist with this autonomy! When checking, this new responsibility changed my perspective- I realized that I would soon be working as an independent practitioner and no longer as an intern under the safety net of a preceptor or supervisor. I appreciated that my preceptor also did an extensive review of law with me, which reinforced what I had just learned in the P3 law class. Other activities included reviewing calculations, compounding some simple creams and solutions, reviewing OTC products, and doing one journal club per week.

The staff and patients were so welcoming here. I could tell that my preceptor was very passionate about community pharmacy and learning in a low volume store was the ideal setting for me.

Rotation 2: Nontraditional Pharmacy- Informatics
I was very excited for this rotation, since I am interested in pharmacy informatics. My rotation was at a community hospital in Michigan and my preceptor was responsible for managing the oncology electronic medical record (EMR) system. Oncology is a complex field with numerous types of cancers and constantly evolving drug therapies, so you can imagine keeping the EMR system up to date can be quite challenging! Managing the EMR system includes updating treatment regimens and building new ones, based on clinical studies and guidelines. Treatment regimens typically consist of multiple chemotherapy drugs and supportive care (e.g. antihistamines, anti-emetics, IV fluids, etc). Patients are on a certain number of “cycles”, which include days with drugs and days without. For example, one cycle can be 14 days, with only one day of chemotherapy and 13 days without. These were just some of the variables we had to keep in mind when building regimens in the EMR.

One major project I worked on was building treatment regimens for Rituxan Hycela (rituximab and hyaluronidase human), a subcutaneous formulation that could be used after the first dose of rituximab IV infusion. This would save the patient lots of time, since they would not need to be in the infusion chair for as long. I also evaluated and presented a comparison of the respiratory interleukin agents, wrote a case report, updated patient education for chemotherapy regimens, created an herbal supplement/vitamin reference sheet, and answered drug information questions. Every day was different, which was thrilling for me. It was a mix of meetings, project time, and discussions with my preceptor. Typical hours for this rotation were 8am-4pm. Most of my time was spent at my desk, but I worked in the cubicle next to my preceptor, so we were able to easily bounce ideas off each other.

In this rotation, I further developed written communication skills and analyzed primary literature. We often referred to the National Comprehensive Cancer Network (NCCN) guidelines and analyzed the clinical studies that were referenced. It’s free to make an account on the NCCN website, I recommend checking it out! Oncology was not an interest of mine prior to this rotation, but now I think it’s such an innovative field with a lot of opportunity for pharmacists to help physicians and patients understand the drugs.

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