Monday, November 28, 2016

Rotation 5 - Pediatric Cardiology

Posted by Brock Jackson at Monday, November 28, 2016

Most likely this will go down as my hardest rotation of the year. It was an absolute change of pace from my previous rotation (Drug Information). On this rotation, I was at Mott’s Women and Children’s Hospital. It was a drastic change from working at a desk from 9-4.
I would describe my typical day as such:
Wake up around 5am, arrive at the hospital and be working up patients by 6:30am. Because I did not have much exposure to pediatric populations before, this portion was a struggle for me. 
Around 10am – noon, we would round on the pediatric cardiology floor.
Around noon-1, lunchtime 
From 1-4pm, I would have a bit of time to work on topic discussions, adjust my SOAP notes from what we did on rounds, and present topics/patients to my preceptor.
The types of patients that I primarily saw had congestive heart failure, atrial septal defects, ventral septal defects, patent ductus arterious, hypoplastic left heart syndrome, Ebstein’s anomaly, pulmonary hypertension, and other congenital heart defects. Our main goal was to help manage their cardiac conditions and prepare them for surgery or to be discharged.
Throughout my time on this rotation, I had to complete about 10 different topic discussions, which kept me quite busy outside of rotation. When I was presenting topics (such as hypoplastic left heart syndrome, plastic bronchitis, protein losing enteropathy), I would often be accompanied by a PG-Y1 or PG-Y2. I would often listen to them present their patients or topics, as well as they would listen to me. This was a great learning opportunity for me. In addition to that, my preceptor (which I enjoyed working with) often asked questions to failure. This method involved asked questions until the person answer them was unable to answer them. This often led to me having to look up many different questions afterwards and answering them the next day. It was certainly something that I was not used to and took time adjusting to not being able to have an answer for everything. As a side note, I do not believe I am a know-it-all or anything close to that. However, it is disheartening to not be able to leave one day with having answered all the questions about a patient or topic completely.
Highlights of the rotation:
Spending time with my preceptor after hours and talking pharmacy and life
Being on rotation during Halloween. We were able to dress up and round with the kids. The children and their parents APPRECIATED this A LOT. For the record, I was a piece of pizza and the team I was with were teenage mutant ninja turtles.
The food – pediatric rotations (from what I now understand) are laden with food. There is literally good food everywhere. My inner foodie was impressed!
The team – I loved working with all of the residents and medical students. These folks were great and were wonderful to spend long hours alongside.
The wins – Seeing sick children is extremely difficult to deal with…I do not think I need to elaborate on that. However, when we have a great outcome, the whole team is ecstatic. From the beginning, we had a patient that I followed who was in dire need of a heart transplant. They struggled with weight gain and adhering to a sodium and fluid restriction. It was a major struggle watching his condition worsen and worsen and the family try to cope with the reality that a new heart may not come. On my second to last day, the entire transplant team rounded with us (usually it is just one or two of them) and they announced that they had accepted a new heart for them! It was incredible!! The whole team rejoiced, the mother cried, the patient was stunned and it made the whole experience that much better. On my last day, I was able to watch the new heart be put in and the circle was complete.

Overall, the experience was grueling but I learned a lot and I made friendships that I treasure to this day!

Rotation 4 – Drug Information at the BIG House!

Posted by Brock Jackson at Monday, November 28, 2016

This rotation presented me with a whole different view of Pharmacy. It was quite unique from the previous rotations that I have had and most likely would experience in later rotations too. On this particular service, we would answer questions from various healthcare providers such as physicians, nurses, pharmacists, etc. The types of questions we answered varied IMMENSELY from one phone call to the next. Often times, we were the last line of help before it was deemed ‘unanswerable.’

My day-to-day on this rotation was extremely manageable. It was a 9-4 service with lunch from either 12-1 or 1-2, depending on when the classmate on rotation wanted to take lunch. Everything on the rotation was laid back. The several preceptors we worked alongside with were mostly familiar faces and all accommodated us well.

How our time was spent:
Everyday we alternated who answered the phone in the morning and afternoon. When you were on phone duty, you had to work up any questions that came through. If none came through, you were able to work on anything else that needed to be worked on. Occasionally, we would be slammed with phone calls (OR POWER OUTAGES!!!) and both my classmate and I would work up questions together.

When we were not working the phones, we were most likely doing the following:

Working on previous drug information questions that we were not able to be complete the day before.

Our drug monographs – This was the big project of the rotation. We each were assigned a specific drug and had to complete a drug monograph on it. I was assigned chloral hydrate. This particular drug is not really used anywhere anymore. It was a major project researching the studies behind this drug and the requested indications that were associated with it being placed on formulary.

Journal club – We each were assigned one day to present a journal article. During this time, we went through EBM concepts with our previous EBM professor.

Random events – side projects that came up, various drug information meetings, etc.

Overall, this rotation was an excellent one. Our main preceptor was ABSOLUTELY fantastic!

Sunday, November 20, 2016

Rotation 3: Pharmacy Administration: Transitioning to a New Perspective

Posted by Emily VanWieren at Sunday, November 20, 2016

First Impressions and a Day in the Life
What does a pharmacist in administration do?? Before this rotation, I had no idea what pharmacists do on a daily basis in this non-traditional role. I quickly learned that a job in administration felt similar to being in leadership for a student organization, something I was familiar with after being president of our chapter of APhA-ASP. My preceptor was in charge of the outpatient pharmacy as well as transitions of care initiatives at the hospital. We attended many meetings with various interdisciplinary professionals working at the hospital to brainstorm new ideas, create action plans, implement new projects, and track progress. Interpersonal and written communication was key in getting a message across and producing the best outcome. I helped interview technicians and pharmacists for positions that were open. I was also assigned various projects analyzing data and creating proposals for funding and restructuring of positions.


Transitions of Care
I became passionate about transitions of care over the course of this rotation. After two inpatient clinical rotations, I understood what happened while patients were in the hospital, but I had no idea what happened when they were discharged to go home. There are many medication errors that happen upon admission and discharge (transitions of care), and pharmacists can play a huge role in reducing these errors and creating a safer experience for patients throughout the whole health care continuum. I was heavily involved in counseling patients on their new medications during my organ transplant rotation, and there was some counseling on new anticoagulants during my internal medicine rotation, but a large majority of patients receive their discharge instructions via paperwork, and sometimes nurse education. One of my major projects was to create a proposal that would encourage more use of student resources to counsel patients being discharged on their medication changes so that patients and their caregivers understand exactly how, why, and when to take their medications. Pharmacists and student pharmacists can and should take ownership in transitions of care due to our vast knowledge of medications and our primary focus on medication use.


Reflections
I thoroughly enjoyed my administration rotation because I felt my skills of interpersonal communication, teamwork, and organization were in line with the day to day activities of a pharmacy administrator. I enjoyed hearing other's perspectives and brainstorming new ideas that would affect a large number of patients. Although I didn't have one-on-one interaction with patients on this rotation, I was surprised by how much I used my clinical knowledge and understanding of pharmacist workflow in order to problem solve and create ideas for large-scale solutions.

Saturday, November 12, 2016

Rotation 5: Community Pharmacy with a Twist

Posted by Millie at Saturday, November 12, 2016

Hey there,

Currently writing this entry on the train back to Ann Arbor from Chicago! Another P4 (Erika) and I just finished our rotation at a specialty community pharmacy that serves a health center with a patient population of primarily LGBTQ individuals and a focus on HIV/AIDS. As Jimmy, another P4 blogger on here, wrote about a few entries back, this rotation provided us with a lot of really great opportunities to practice our patient counseling skills and learn so much about a disease state we don’t really focus on during pharmacy school.

The past 5 weeks have basically been “HIV Bootcamp” where we learned EVERYTHING about the disease state and medications used in prevention and treatment. HIV medications have not only a trade name and generic name, but also a 3-letter code which – for some of the meds – is interestingly enough related to the medicinal chemistry of their mechanism. We discussed at length and were expected to understand the DHHS guidelines for HIV/AIDS and opportunistic infections, as well as the CDC guidelines for pertinent STDs (prevention and treatment). We were both amazed at how much we learned in the span of just 5 weeks!

Typical days at the pharmacy included making pillboxes for patients, utilizing the script processing software, calling patients to remind them of their refills, counseling patients, and of course administering vaccines. On our first day it all seemed unfamiliar and confusing to us, but by the end of the rotation we were able to better understand the workflow and even grow much more comfortable in verifying prescriptions! We spent two afternoons out of the week at an HIV clinic downtown where we were able to meet with patients, discuss their HIV regimens, and assess their other comorbidities. This rotation really helped improve my SOAP note writing and patient counseling skills.

During any time that we had available, we worked on multiple projects, including data for an MTM study, developing a patient case for continuing education, creating a poster for an HIV/STD conference, and giving a presentation on antidepressants in HIV positive patients to an interdisciplinary team. We were also actually able to attend that HIV/STD conference and my favorite seminar during the conference was one on transgender individuals and barriers they face in receiving good health care. If you want to hear about it, definitely contact me and I will tell you all about it!

Overall, this was definitely one of my favorite rotations. Since this rotation fell during the October/November months, Erika and I had additional challenges of not only keeping up with the large work load for this rotation but also completing our PharmD Investigations manuscripts and posters, completing P4 seminar quizzes, and preparing for post-graduate plans. However, I would not trade my experience for anything and I really enjoyed these last 5 weeks (though I am definitely ready for a nap now)! My advice would be to make sure you come into the rotation with a good mindset of working hard and trying to learn as much as you can.


P.S. We also happened to be in Chicago during a very exciting time of when the Cubs won the World Series (streets were packed!), as well as Michigan beating Michigan State in football! J