AmbCare Cancer Style

Posted by mariarx at Wednesday, October 10, 2012

Hello everyone! We're almost at the half-way point of P4 year! Time is really flying by, and I am hitting my rotation groove full force now.

Rotation 4 placed me at St. Joseph Mercy Hospital for my ambulatory care practice experience. This is a unique site in that it is an oncology outpatient practice. I was slightly terrified of doing a cancer rotation, but my time with Dr. Carol Yarrington was been great.

My rotation duties were 3-fold: I spent time in the multidisciplinary clinic, the infusion center, and doing project/answering questions work.

Multidisciplinary clinic (MDC)

Recent COP grad, Eric Zhao, gave a really great breakdown of the MDC model during his time last year... so I'll let you read what he had to say about it HERE. To add my 2 cents, I enjoyed my time in the clinic. They aren't really used to having a pharmacist around, so it took a couple weeks for the oncologists to warm up to my presence and respond positively to my feedback about patients. There was one patient who did not really need much intervention on my part, just someone to sit with her while waiting for the doc and talk about her new diagnosis.

First Dose Follow-up

A pharmacy intervention that I was able to bring back to life while on rotation was first dose follow-up (FDFU). This is a service for all patients who are either new to the infusion center or are getting a new/different chemo regimen. I would find these new patients on my non-clinic days and arrange a time to meet with them during their visit in the infusion center in order to figure out the best time to call them the next day. My FDFU phone calls consisted primarily of symptom assessment, as well as being the middle person between the patient and the oncologist when their symptoms needed intervention in order to be managed. I had one patient who had been hiccuping for around 6 solid hours and did not think that it was related to his chemotherapy - definitely an intervention opportunity. A lot of patients really enjoyed talking about how much they enjoy the clinic and all the health care professionals they met with. Go St. Joes!

Project Work

During my non-clinic hours, I spent the majority of my time working on project stuff. Carol fields questions day in and day out, and she would occasionally throw some of them at me! Some of the other things I worked on included a formulary review update, doing research on herbal supplements and their drug interactions for patients interested in trying them, and other random stuff.

My big project for the rotation fit right into my management interests. On my first day, we had a patient coming into the clinic to undergo desensitization because her chemo drug was thought to have caused a massive rash during her previous cycle. The patient ended up having a skin test done first to confirm the nature of the reaction. The clinicians, oncologists, and Carol were able to come up with a test - however, this scenario also made it very clear that the health system does not have a policy in place for this. That's where I came in. Throughout the rotation I gathered literature about skin testing and desensitization, presented it to a multidisciplinary P&T committee, and finally wrote 2 protocols on the topics. I felt like this project was something actually relevant and useful to the department. I love that kind of work!

Overall, I liked my time at St. Joes. Carol was very open and receptive to my interests as well as getting any exposure I wanted to the oncology department, workflow, and staff. The people at St. Joes are wonderful, very patient, and willing to listen to students.