Monday, September 17, 2018

Rotation 3: Infectious Diseases

Posted by Andrea at Monday, September 17, 2018

This rotation was a bit more busy for me, because I had my P4 seminar presentation. P4s are required to put together a 30-40 minute presentation for our class about our PharmD Investigations (longitudinal research project) or a pharmacy topic. The topic I presented about was the controversy of using steroids in septic shock. While this rotation did not require much outside work, most of my days after rotation were spent working on my slide deck or practicing my presentation. I was so glad to have finished this!

Rotation 3: Infectious Diseases
My third rotation was Infectious Diseases. This was my first clinical rotation and ID was a difficult topic for me in P3 Therapeutics, so I was nervous before starting this rotation. I had a variety of experiences on this rotation, including rounding with the ID team and antimicrobial stewardship. A typical day of rounding would start with working up patients (8AM-10:30AM), meeting with my preceptor to discuss patients (10:30AM-12PM), and end with rounding with the ID team which consisted of an attending, a fellow, a resident, and two med students (1PM-4 or 5PM). Rounds take a long time, because ID is a consult service so their patients are scattered all over the hospital. Days on antimicrobial stewardship were much different. The ID pharmacists share these responsibilities. There is disease-based stewardship, where antimicrobial therapy is reviewed and optimized for patients based on targeted disease states (e.g. HIV). There is also drug-based stewardship, where restricted drugs are reviewed for appropriateness (e.g. linezolid, daptomycin). These days were spent reviewing patient charts on the computer, followed by discussions with my preceptor. I also attended antimicrobial stewardship committee meetings (pharmacists and physicians discussed initiatives to optimize antimicrobial therapy), presented a topic discussion, and journal clubs. My preceptor would often send studies to read and discuss the next day.

Something I learned from this rotation was how to “work up” patients. We focused primarily on the ID problem. For each patient, we had to assess if the antimicrobial therapy was appropriate including drug, dose, frequency. To follow up, we assessed vanco and aminoglycoside drug levels and monitoring parameters.

Some questions I encountered on rounds were: Does this drug require renal/hepatic adjustment? Anyone know the patient’s creatinine clearance today? How do I dose this if the patient is getting dialysis? I also liked seeing how there was opportunity for pharmacists to develop wide-reaching initiatives through policy and guideline development. For example, they were trialing a pilot program for penicillin skin testing, creating guidelines for community acquired pneumonia treatment, and pediatric animal bite treatment guidelines. I really enjoyed this rotation!

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