Saturday, April 27, 2019

Rotation 7, 8, 9: Farewell, and Be Kind

Posted by Michael Tsai at Saturday, April 27, 2019


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