Thursday, August 30, 2018

Rotation 1 and 2: Community and Nontraditional Informatics

Posted by Andrea at Thursday, August 30, 2018

Hi everyone! My name is Andrea Duong and I will be one of the P4s blogging about their APPEs this year. I’m excited to give you a glimpse into the life of P4. Hope you enjoy!

Rotation 1: Community Pharmacy
I was looking forward to this rotation, since I only had experience working in a big chain pharmacy. This rotation was at an independent pharmacy in a small town in Michigan. Typical hours for this rotation were 9am-5pm. My days were spent filling prescriptions, taking phone calls from patients and providers, and counseling patients. Later in the rotation, I became responsible for checking prescriptions (with preceptor supervision). I felt like a real pharmacist with this autonomy! When checking, this new responsibility changed my perspective- I realized that I would soon be working as an independent practitioner and no longer as an intern under the safety net of a preceptor or supervisor. I appreciated that my preceptor also did an extensive review of law with me, which reinforced what I had just learned in the P3 law class. Other activities included reviewing calculations, compounding some simple creams and solutions, reviewing OTC products, and doing one journal club per week.

The staff and patients were so welcoming here. I could tell that my preceptor was very passionate about community pharmacy and learning in a low volume store was the ideal setting for me.

Rotation 2: Nontraditional Pharmacy- Informatics
I was very excited for this rotation, since I am interested in pharmacy informatics. My rotation was at a community hospital in Michigan and my preceptor was responsible for managing the oncology electronic medical record (EMR) system. Oncology is a complex field with numerous types of cancers and constantly evolving drug therapies, so you can imagine keeping the EMR system up to date can be quite challenging! Managing the EMR system includes updating treatment regimens and building new ones, based on clinical studies and guidelines. Treatment regimens typically consist of multiple chemotherapy drugs and supportive care (e.g. antihistamines, anti-emetics, IV fluids, etc). Patients are on a certain number of “cycles”, which include days with drugs and days without. For example, one cycle can be 14 days, with only one day of chemotherapy and 13 days without. These were just some of the variables we had to keep in mind when building regimens in the EMR.

One major project I worked on was building treatment regimens for Rituxan Hycela (rituximab and hyaluronidase human), a subcutaneous formulation that could be used after the first dose of rituximab IV infusion. This would save the patient lots of time, since they would not need to be in the infusion chair for as long. I also evaluated and presented a comparison of the respiratory interleukin agents, wrote a case report, updated patient education for chemotherapy regimens, created an herbal supplement/vitamin reference sheet, and answered drug information questions. Every day was different, which was thrilling for me. It was a mix of meetings, project time, and discussions with my preceptor. Typical hours for this rotation were 8am-4pm. Most of my time was spent at my desk, but I worked in the cubicle next to my preceptor, so we were able to easily bounce ideas off each other.

In this rotation, I further developed written communication skills and analyzed primary literature. We often referred to the National Comprehensive Cancer Network (NCCN) guidelines and analyzed the clinical studies that were referenced. It’s free to make an account on the NCCN website, I recommend checking it out! Oncology was not an interest of mine prior to this rotation, but now I think it’s such an innovative field with a lot of opportunity for pharmacists to help physicians and patients understand the drugs.

Rotation 2/3: Ambulatory Care in the Community

Posted by Unknown at Thursday, August 30, 2018

Hi everyone! My name is Laura Hayes and I am one of this year's P4 bloggers. I am excited to write about my experiences during fourth year and hope my reflections can help you in your pharmacy journey!

A little about me before I jump into my first reflection: 
I grew up in Rochester, MI and went to the University of Michigan for undergrad where I majored in Biomolecular Science and minored in Anthropology. I got married last summer and love being with friends/family and being outside. 

We just celebrated our one year wedding anniversary this August!
 My husband and I went to Europe for 2 weeks after P3 exams ended. This is me at the Cliffs of Moher. 

 We also had the opportunity to go to Denver, CO this summer and went hiking in the Rocky Mountains! It was so majestic!!

This is me on my birthday at Dom's Bakery in Ypsilanti. These apple fritters had just been taken out of the oven and were the BEST I've ever had! I would definitely recommend you check it out.

Now that you know a little about me, let me tell you about my last two rotations; Rotation 2 was Ambulatory Care and Rotation 3 was Community Pharmacy.

Ambulatory Care
For Ambulatory Care I had the privilege of being in two family medicine clinics 2.5 days a week and mostly managed diabetes, but also saw a lot of hypertension and hyperlipidemia. I met with patients in person for 40 minutes or talked to them on the phone for 20 minutes and discussed how their diet, exercise and medication regimens were going. I was able to build relationships and really connect with people to help them help themselves. While I absolutely loved this rotation, it was extremely busy. I worked up patients before clinic, finished notes after clinic and had to complete all the rotation requirements set for this rotation. This included a journal club, topic discussion, case presentation and Anticoagulation discussion. I learned a lot about time management and making sure I took time to relax in the midst of being very busy.
Of the three rotations I have completed, this one has been my favorite. I loved connecting with the patients and helping them with such important aspects of their lives. This experience was very encouraging as I had been interested in ambulatory care for about 1.5 years prior and after this rotation, I feel quite confident and excited to work in the ambulatory care setting.

Community Pharmacy
Community pharmacy was not a rotation I was very excited about. I had never worked in community pharmacy (I had an internship at UofM in the Cardiovascular Center inpatient pharmacy) and have heard a lot of horror stories about chain pharmacies. Needless to say, I was a little worried about how it would go.
I was placed in a grocery store/big box store pharmacy for this rotation. It was a slower store and had what I feel an independent pharmacy may feel like (based on what others have told me). The pharmacist has worked there for over 15 year and the patients deeply trust and respect him. Because we weren't running around crazily filling scripts, I had lots of time to engage in clinical services with patients. I did over 10 blood pressure screenings and made recommendations, counseled countless people on their medications and over the counter drugs, completed comprehensive medication reviews and had the opportunity to build relationships with patients who came back multiple times during my 5 weeks. These aspects felt so similar to my ambulatory care rotation and I was pleasantly surprised.
This experience helped break down some strongly held assumptions I had about community pharmacy,  has helped me realize just how important community pharmacist are and what roles they can play in patient's healthcare. Even though I do not plan on going into community pharmacy, it has become my 'Plan B', which feels like a big step from not even wanting to consider it before this rotation.

My advice to you, take every opportunity to learn and grow. Go into it with an open mind and learn all you can. I never thought I would enjoy being in the community pharmacy as much as I did, and I am so thankful I went in with a desire to learn and experience new things.