Health System/Hospital - Rotation 1

Posted by Makenzie at Wednesday, July 10, 2019

For my first rotation I was back to where it all started.  I was able to go back to my hometown and complete my first APPE at the hospital I was born.  I work at a different hospital in the same city but I was surprised at how many common connections there were with pharmacists & techs across institutions (pharmacy is indeed a “small world”).

I also wasn’t lonely at this rotation - I was joined by 12 P4s from Ferris State who were completing all of their APPEs at this one institution.  Many of us would have lunch together, go to each other’s seminars, and bounce ideas off of each other.  For my first APPE, it was nice to have the safety net of a large group of students.

The rotation itself was great.  My preceptor took into account my previous work experience and personalized the rotation to my interests and gaps of knowledge.  For example, I am already experienced at sterile compounding but haven’t done TPNs before, so I was able to modify my schedule to spend more time on TPN verification and compounding.

This particular APPE also had the option of attending an open heart surgery with an anesthesiologist.  The procedure was a quadruple bypass & over 6.5 hours long.  The anesthesiologist placed me standing on a stool at the head of bed, with the heart only an arm’s reach away.  I was prepared for what it would look like but the smells (cauterization) and sounds (cartilage breaking) was not something I was prepared for.  Throughout the anesthesiologist taught me about what meds were put on cont IV vs bolus and how he monitors the patient while the surgeon explained the pathophysiology of the patient’s a-fib.

The next morning I followed the patient on CCU rounds & was astounded that he was already sitting in a chair & eating after such major surgery.  Attending the surgery helped me understand a patient’s cardiac journey and what role health care providers & medication management play throughout.

As amazing as open heart surgery is, it wasn’t apart of a “typical day”.  A typical day was divided into 2 parts.  The mornings were always scheduled.  I spent half of the mornings of the rotation doing staff pharmacist work.  Dosing, front counter, IV, med safety, etc.  The other half of the mornings I would do rounding in the PICU, ICU, or CCU and was able to spend additional days rounding in units based on my interests.

Afternoons were spent doing projects.  Daily, I did patient educations on post-AMI medications or anticoagulation teaching and had weekly audits for titratable medications.  The afternoons were also when students would do topic discussions, clinical questions, or present patient cases as final projects.  I found it helpful to attend these sessions as it kept ambulatory care, general medicine, ID, etc topics at the forefront of my mind.

For rotation 2 I am back in Ann Arbor for my gen med rotation in adult surgery & to present my PharmD seminar at the end of July.