Community Pharmacy in St. Ignace, MI

Posted by Unknown at Wednesday, October 22, 2014

Growing up in Southeastern Michigan, my family and I made many trips over the Mackinac Bridge into Michigan’s Upper Peninsula for vacation, recreation and exploring “Pure Michigan”.  However, this time over the bridge into St. Ignace was different.  It was time to move away from Ann Arbor to develop an understanding of how pharmacy operates in the Public Health Service and to experience the culture of a unique population, the Sault Tribe of Chippewa Indians. 

I woke up just after sunrise to make it to my first day of Rotation 2 at Mackinac Straits Health System working in the Tribal Pharmacy.  When I arrived at my site, I took a few moments to take in the scenery and saw this gorgeous view:

Immediately, I thought, “I could get used to this!”

After orientation to the pharmacy, clinic providers and systems, I started counseling patients as they picked up new prescriptions or inquired with questions.  On the second day, I began meeting with patients prior to their provider appointments in the Tribal Health Clinic.  These patients presented with either acute conditions or for chronic disease management.  During my time with the patients, I assessed vitals, reviewed medications, discussed concerns and ultimately made recommendations to the doctors or nurse practitioner after discussions with my preceptor.  Over the next five weeks, I spent about half of my time working and interacting with patients in the pharmacy and the other half of my time with patients and providers in the clinic.  This is a very unique practice setting aside from the traditional community pharmacy.  Here, the pharmacy is directly connected with the clinic, allowing for significant interprofessional collaboration and access to the patient’s medical and medication history and pertinent lab results.  This rotation and practice model allows for a unique blend of community and ambulatory care pharmacy in order to provide exceptional patient care.

On the afternoon of my first day, one of the clinic doctors posed a question regarding hallucinations and acute mental status changes in an elderly woman.  When this discussion started, I immediately associated the symptoms with a urinary tract infection (UTI) and sought the lab results from the urinalysis (UA).  The patient had documentation of a UTI two weeks earlier and completed a course of empiric therapy with ciprofloxacin approximately one week before returning to clinic.  Upon review of the results with my preceptor, we determined that the bacteria causing the UTI was resistant to ciprofloxacin.  The prescriber planned on extending the course of therapy with ciprofloxacin, but after reviewing the culture and sensitivities and performing a repeat UA, I recommended changing to an agent that the bacteria was sensitive to, nitrofurantoin.  Fast forwarding through the rotation, the patient’s UTI and symptoms resolved over time with this treatment.  As a student pharmacist early on in my Advanced Pharmacy Practice Experiences, it was extremely exciting to make a significant intervention and to impact patient care from the start of the rotation!

This sunset is from one of the last few nights as my rotation grew to a close.  While I only had the pleasure of working and learning at Sault Tribal Health and Human Services for five weeks of my last year of pharmacy school, I would go back in an instant!  I am so grateful to have had this community pharmacy experience to develop personally and professionally. 

P.S. The excellent providers and co-workers that I had the opportunity to work with and the gorgeous scenery are just an added bonus! 

-Jessica Fennelly, PharmD Candidate 2015

Improving Public Health through the Indian Health Service

Posted by Adam Loyson at Saturday, March 01, 2014

I hope you are enjoying a well-deserved spring break! Since last writing about my rotations in the emergency department and at the Food and Drug Administration, I found myself working in a more remote location with the U.S. Indian Health Service (IHS) located in Michigan's Upper Peninsula this past fall. Needless to say, providing health services to such a unique patient population has provided me with an experience that is unlike any of my other rotations!

Reversing health disparities

As an agency within the U.S. Department of Health and Human Services, the IHS provides health services to both American Indians and Alaskan Natives. The IHS was created to advocate for the American Indian people and to improve the access and delivery of their health care to the highest standard possible. Drawing from the past, American Indians and Alaskan Natives have historically experienced poorer health outcomes in comparison to other American populations. Remarkably, these native populations have a lower life expectancy and disproportional amounts of heart disease, pneumonia infection, and diabetes mellitus than individuals from other origins. The IHS is set up to specifically reverse these health discrepancies and focus on elevating the physical, mental, social, and spiritual health of American Indians and  Alaskan Natives.

Making an impact

There are 566 federally recognized American Indian Tribes, and I helped those affiliated with the Chippewa Indian Tribe. The health care services I provided during my rotation originate from an outpatient-like pharmacy that exists within a small tribal hospital. The hospital serves as a one stop shop for patients and includes clinics for mental health, dental, and ambulatory care services.

A day in the IHS outpatient setting consists of counseling patients in a manner similar to community pharmacy practice, interacting with health care providers, and engaging patients in medication therapy management to better understand their compliance and medication use in the outpatient clinics. I definitely considered this rotation to be fascinating based on the extraordinary plethora of opportunities available to make patient care interventions in the uniquely combined community-ambulatory care environment.

Patients who arrive at the clinic commonly cope with multiple disease states, including respiratory (asthma and chronic obstructive pulmonary disease) problems, diabetes, and chronic pain. These patients present great opportunities for pharmacists to determine whether the patients understand why they are taking their medication and know how to use their medical devices.   During my patient interactions, I frequently asked them if they were experiencing any medication-related side effects and if they were making appropriate lifestyle changes. I also evaluated patients for drug–drug interactions, drug diversion, and financial limitations to determine proper drug selection and dose escalation recommendations.

The pharmacists’ work in the outpatient world doesn’t go unnoticed. In my time with the IHS, completing such detailed patient assessments almost always led to improved patient outcomes and drug cost management. In addition, the IHS physicians were always delighted to have a pharmacist participate in interdisciplinary care and evaluate patients for medication-related problems before their primary assessment.

Learning automated pharmacy operations

Aside from the excellent opportunities for face-to-face patient interactions, my IHS site also featured integrated pharmacy automation and pharmacy robotics for drug selection and filling. Because this was my first time seeing these intelligent machines function up close, I was astonished by how much of the pharmacy workflow was simplified. Equipped with barcode technology and a comprehensive drug database, I learned how to partner with the robotic system to ensure the highest level of dispensing accuracy, efficiency, and patient safety. With robotic automation to the rescue, these mechanical systems also helped track drug use and accelerated prescription verification to free up significant time for additional patient interactions.

I was fortunate to have had this IHS rotation under my belt prior to the American Society of Health-System Pharmacists Midyear Clinical Meeting in December. I can confidently say that my counseling skills have improved drastically, as has my therapeutic knowledge set. After working with the American Indian population, I find myself even more curious about pharmacy careers in public health and the opportunities within the United States Public Health Service.

Only time will tell what the future holds for me!