Wednesday, July 31, 2019

Rotation 1 Nontraditional and Rotation 2 Psychiatric Pharmacy

Posted by Sarah Choi at Wednesday, July 31, 2019

School is hard, and pharmacy school is even harder. We’re constantly studying for the next quiz or exam. We don’t absolutely love every subject we learn about in Therapeutics. It is so easy to lose sight of why we wanted to become pharmacists, but I can honestly say that P4 APPE rotations are different (though I’ve only completed 2 rotations). It’s equally as difficult, but now you’re experiencing new things every day and learning from real-life examples. You get to apply all the knowledge you’ve built up in the past three years, and it’s far easier to remember why you decided to become a pharmacist in the first place.

Rotation 1: Nontraditional Pharmacy
            My nontraditional rotation was at a specialty pharmacy. This was a great rotation to have after my P3 school year ended, largely because it required a lot of self-directed learning and projects. Specialty pharmacy is unique because there are so many high-cost and high-touch medications that require more time investment from every party involved, such as insurance companies, pharmacists, patients. Specialty medications weren’t covered in depth during class, so this rotation really gave me a chance to delve into different disease states (like cystic fibrosis, multiple sclerosis, and plaque psoriasis) and their unique treatments. I also completed two journal clubs during this rotation about newer specialty medications like Risankizumab and Tafamidis. The most valuable part of this rotation was that I was allowed to be curious and look up disease states and drugs that I was interested in; this was a breath of fresh air after three years of school where the curriculum was set. It reminded me of one of the main reasons I decided to pursue pharmacy: I love researching and learning about different diseases and treatment options.

Rotation 2: Psychiatric Pharmacy
            My second rotation was completely different from my first. While the first showed me how much I loved learning about different disease states and unique drugs, the second showed me how much impact a pharmacist can have on a patient’s treatment course. I worked with a team to manage the psychiatric care of about 9 to 11 patients a day. My mornings on this rotation included working up new patients (focusing on their psychiatric problems), attending table rounds with the interprofessional team, and visiting patients daily with the medical residents and students. Having the opportunity to go to rounds and discuss patients with other health professionals was so valuable. After the first week, I had built up enough confidence to speak up during rounds and advocate for my patients. Seeing patients day after day really showed much how much he or she can improve, and this is magnified when you know that you made a recommendation that contributed to the patient’s improvement.

Overall my first two rotations only have me excited for the rest of my rotations. I’m ready to learn and experience more. Thanks for reading and coming along the journey with me! I’ll be back after my third rotation (infectious diseases) is done!

Wednesday, July 10, 2019

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.