Michael Tsai
at
Saturday, April 27, 2019
Hospital/Health-system
In a large academic medical center, I was specifically
assigned to the operating room pharmacies in the main hospital, eye center, and
children’s hospital throughout the week. In addition, I got to see the satellite
pharmacy, the general infusion center, and the cancer infusion center
pharmacies. Once a week, I attended meetings and worked on projects with a
pharmacist working on the management side.
It was insightful to see how operating room pharmacies
manage controlled substances and dispense kits for the anesthesia team. They
also verify and dispense certain orders for patients before their operation. In
the infusion center pharmacies, I saw the workflow of how pharmacists verified
orders, how pharmacy technicians prepared medications, and how pharmacist
checked preparations and noted stability of the medications. On the management
side, I saw how space and workflow could impact delivery of patient medications
throughout the hospital.
Since there were several pharmacists and pharmacy
technicians on this rotation, I worked with different teams and had to adapt to
different preferences and teaching styles. Also, while I was on this rotation,
I was also interviewing for residency positions. Traveling was intense and
time-consuming, but I’m grateful my preceptor was understanding and allowed me
to make up days missed through additional hours or projects. Overall, it was a
busy season for me, balancing rotations and interviews, but I am glad to have
the experience as it allowed me to see the bigger picture of how pharmacies
operate within the health-system.
Managed Care
I was placed at a large health plan for this rotation and
worked under a pharmacist who was a manager on the medical benefit, where drugs
managed needed to be administered by a healthcare professional. This was
different from my previous managed care rotation, which was a prescription drug
plan and focused on pharmacy benefits, where drugs managed were usually
self-administered medications.
This rotation was project- and office-based. My main assignments
included updating medical policies with support from literature and clinical
guidelines, providing summaries of therapeutic agents for hemophilia, and
analyzing medical oncology data to complete a report with charts and graphs. During
the rotation, I also had informational interviews with pharmacists working in
different departments of the company, including drug pipeline, formulary and
rebates, legislation and policy, operations, regulatory oversight, and sales
and marketing. These pharmacists played very interesting roles, bringing insight
to the variety of positions available within managed care pharmacy. I hope to
learn more and experience these different positions as I start a managed care
pharmacy residency in the coming months after graduation.
My preceptor during this rotation was working on a medical
oncology program, so I sat in on several internal meetings regarding the
logistics of implementation and external meetings with the vendor to ensure
responsibilities were carried out on both sides. Other meetings I attended
involved a quarterly drug pipeline update and internal sales and marketing
meetings and consultations. While I had previous experiences in managed care
through student organization involvement, internships, and a rotation, this
experience added on to that, exposing me to the medical benefit, different
pharmacist roles, and vendor relations. I am excited that there is still much
more to learn about managed care pharmacy.
General Medicine/Pediatrics
My final rotation was in a children’s’ hospital on the
mid-day shift. Here, I got to work under a pediatric generalist pharmacist, and
my role was to assist in verification of total parenteral nutrition (TPN) orders
and pharmacokinetic service of antibiotics. It was interesting to learn about
pediatrics and nutrition, since these topics are not widely covered in the
pharmacy curriculum. Pediatric patients should not be considered as smaller
adults since they differ greatly in distribution and clearance of medication compared
to adults. To verify nutrition orders, I navigated through a patient’s chart,
collecting weight, fluid goals, recent lab values, urine output, relevant medications,
and the order put in by the dietician. I would make sure that the volume of the
TPN was calculated correctly and that changes to macronutrients and
electrolytes within the TPN made sense. For the pharmacokinetic service, I was
responsible for interpreting vancomycin or aminoglycoside levels that resulted
during my shift. From these levels, I would make recommendations on whether to
continue therapy or change therapy, noting the dose and interval of the drug
regimen, and on when to check levels again.
The mid-day shift itself was different, but exposed me to
the endless work that pharmacists put in at the hospital. Additionally, as my
last pharmacy school practice experience, this rotation showed me that the
learning never stops. I was constantly looking up answers to my preceptor’s
questions and diving into the field of pediatrics. Even though my plans after
graduation have been set, I still very much appreciated seeing and experiencing
yet another perspective of pharmacy.
Now that my time at the University of Michigan College of
Pharmacy has come to an end, I hope that you have enjoyed following the journey
of my final year and gained insight into the practice experiences of a pharmacy
student.
“For today, goodbye. For tomorrow, good luck. And forever,
Go Blue!"
– Mary Sue Coleman
