Rotation 4, 5, 6: Drug Information, Critical Care, General Medicine

Posted by Andrea at Tuesday, February 05, 2019

Rotation 4: Drug Information

This rotation was with a drug information company and I was able to work remotely, as my preceptor also works remotely. We met two to three times a week for about one hour and communicated often during the week via email. My responsibilities were to write monographs for drug-drug interactions and drug-gene interactions (e.g. CYP2D6, CYP4A4, etc.). This consisted of reading lots of articles, learning how to scour PubMed for literature, and writing concise summaries.

Time management was incredibly important in this rotation. I had the freedom to create my own schedule each day, but this also allows for time to slack off. I had to hold myself accountable and ensure I completed my work. I learned a lot about what goes into writing the monographs when we search our drug information resource for quick answers about drugs and interactions. I always thought I would enjoy working by myself, so I was surprised that I missed interacting with co-workers and patients daily. Looking forward, I hope to find a position that balances independent work with teamwork or direct patient care.

Rotation 5: Critical Care

This rotation was in the surgical intensive care unit (SICU) at a local community teaching hospital. Going into this, I was nervous and intimidated by the complexity of critical care patients. My typical day started with working up patients (6AM-9AM), round with the team (9AM-11AM), eat lunch and finish working up patients (11AM-12PM), then meet with my preceptor (12PM-1PM). After this, I would work on assigned drug information questions or projects for the rest of the day. Working up patients in the ICU is based on the head to toe systems approach, rather than problem based like how we learned in class. This means problems were categorized by systems, which could include neurological, pulmonary, cardiovascular, GI/FEN (fluids, electrolytes, nutrition), I/O (ins and outs), ID, and heme. Patients were very sick and often had multiple problems within each system listed above.

I am very grateful to have had this rotation. I have a much better understanding of anatomy and how surgical changes can affect drug action/metabolism in the body. I also learned about weaning patients off pressors, opioid conversions, and nutrition. I had the opportunity to work with a large team, which consisted of an attending, fellow, residents, medical students, and dietitian. I also enjoyed working with my preceptor who was a great teacher and with another pharmacy student from a nearby school! Overall, this was a great learning experience and I am glad I was able to try it out.

Rotation 6: General Medicine (Adult Internal Medicine)

All P4 students are required to take the Gen Med rotation and I was placed on the Adult Internal Medicine service. This was a busy rotation, due to the patient load and weekly projects. My service capped at 11 patients and by the end of the rotation, I was managing the entire service. Patients had a variety of disease states, including pneumonia, UTIs, atrial fibrillation, and diabetes. The typical day started with working up patients (5AM-7:30AM), pre-round with my preceptor where I would present patients and run my recommendations by him (7:30AM-8AM), round with the team (8AM-11AM), and post-rounds with my preceptor where I would update him with any changes (11AM-11:30AM). The rest of the day was spent educating patients discharged on anticoagulation, meeting with my preceptor to go over patients or topics, and meeting with the other students also on Gen Med to present our projects. Time management and efficiency are key to this rotation and each student will develop their own schedule or system that works for them.

Pharmacists play an important role in antimicrobial stewardship and anticoagulation management on this service. I enjoyed the variety of patients and activities in this rotation. I was constantly learning and it made the long days fly by. My advice to students is to embrace this rotation and challenge yourself to learn as much as you can!

This rotation ended just before the holidays and I am currently on my off block. After this, only 2 more rotations until graduation!

Gen Med Block 6 students wearing our ugly Christmas sweaters!

Rotation 7 - General Medicine and Residency Interview Season

Posted by Jared at Thursday, February 16, 2017

Hello everyone! January and the first part of February have been a pretty busy time, but I'll update you with my latest rotation, along with my insights on residency interviews after going through the process!

Rotation 7: General Medicine

Like Millie, I was assigned to cover an adult internal medicine service for my general medicine rotation. During this rotation, you have the option of ranking between adult internal medicine, cardiology, surgery, pediatrics, or the NICU. Note that the NICU is typically an afternoon rotation, while the rest run from a normal 7-3:30 schedule. There are some blocks where the ED is an option for this rotation, but it wasn't during this block. Millie describes the rotation pretty well, but I'll quickly go over my time frame during the day.

6:00 - 7:00 AM: I would arrive at the hospital to work up patients for my service. On average, it would be about 10-12 patients a day.

7:00 - 8:15 AM: Talk over the patients with the resident I was on rotation with first, make
recommendations, then go over those recommendations with our main preceptor prior to rounds

8:15 - 11:00 AM: Round with the medical team

11:00 - 12:00 PM: Go over patients, discuss status/interventions, topic discussion

12:00 - 2:00 PM: Lunch, attend educational lectures (i.e. CE, resident on-call report), look up drug information questions, write warfarin/vancomycin notes, follow up on other medical issues for the team.
2:00 - 2:30 PM: Follow up with preceptor on issues, mini-topic discussion

2:30 - 3:30 PM: Student topic discussion. These consisted of either general topic discussions from preceptors, or student-led discussions that included new drug presentations, a topic discussion, journal club, and case presentation.

I enjoyed having internal medicine as my past rotations (ID and critical care), I felt I was only looking at certain aspects of the patient (i.e. antibiotics, renal dosing, etc.). However, on internal medicine, I could no longer ignore all the comorbidities a patient had. I really needed to make sure that a patient's medication was correct for not just the main problem, but even their home meds as well. It really taught me to look at the patient as a whole, and definitely helped solidify my knowledge. Also, my preceptor was great at going over a bunch of topics that helped me revisit a lot of areas from therapeutics. This definitely helped me out for residency interviews, which I'll go into next...

Residency Interviews

The month of December after Midyear is a frenzy. You're choosing where to apply, you're getting your letter of recommendations in order, and you're stressing out waiting to see the e-mail confirmation that they've been sent to PhORCAS, and that your transcripts are in. You spend days writing a letter of intent, and then you hit submit and play the waiting game.

Programs go about offering interviews very differently. There's no standard set of rules in terms of when they respond or how they will respond. Some programs will tell you when they'll get back to you by, others will just be silent until they send an interview offer or rejection. Some of my programs responded pretty quickly after the deadline, others took a few weeks. Some programs will either only give you one date to interview, some will have you fill out a list of preferences, or some will give you dates and you simply choose the one that works for your schedule. Finally, some programs will e-mail you, and some will call.

This process honestly requires you to both be extremely flexible and to have your calendar and phone at the ready. This is particularly true when some programs will call you and ask you to interview on a date, and you have to pick on the spot. Thankfully, I was able to have an hour or so to look at my calendar before responding back to them after the phone call, but I know of some students that weren't afforded that luxury for some of their programs. Sometimes, however, you will run into scheduling conflicts with interview dates if a program only offers certain dates or if you have rotation requirements. If you're unable to re-schedule the interview and can't accommodate it into your schedule for whatever reason, it's okay to decline as long you as explain your rationale and express your gratitude for being offered the interview in the first place. Programs would prefer you cancel prior to scheduling a spot. DO NOT schedule an interview and then cancel last minute. This causes bridges to be burned and looks extremely unprofessional on your part, and since pharmacy's a small world, you never know who they might tell...

As for the interview process, I would say Michigan prepares us extremely well. Most questions weren't out of the ordinary in terms of questions you would expect (why residency, why our institution, situational questions, tell me about a time when..., etc). At this point in time, I have completed the majority of my interviews, with just one more between now and when our rank list is due for the Match. Some tips I have below based on my experience:

• Know your CV inside and out, forwards and backwards. I studied my CV prior to interviews and took notes on all my presentations in case I got asked about any of them. The rule of "if it's on your CV, it's fair game" is extremely prevalent during residency interviews. Looking back, I've been asked about the majority of my presentations/projects, or have at least referred to them at one point during the interview process. It doesn't look good if you can't speak to at least what the project/presentation was about and what you did. For Michigan students, this is EXTREMELY true for your PDI. PDI becomes a default answer to a lot of questions (tell me about what you're most proud of, a time when you had to manage multiple deadlines, etc). Know your PDI, what you did, and what it found. I know I have been asked about it on multiple interviews.
• Try to group interviews together that are geographically close, especially if you know their dates ahead of time. This particularly applies to applicants going out of state for interviews. For example, I had some interviews out in the Pacific Northwest that I was thankfully able to coordinate in the same week, so I didn't have to travel back and forth between Michigan and Portland/Seattle. Some programs do release their interview dates ahead of time, so you can try and be strategic about choosing dates.
• Be nice to everyone you meet, including your fellow interviewees! The adage "you're being evaluated the whole time" honestly holds true. I had heard that programs evaluated how social you were with the other candidates you interviewed with, so this is something you want to keep in mind. While you're all interviewing for the same spot, note that these people could potentially be your co-residents! You don't want to appear stand-offish or anti-social, as program directors and preceptors will notice. 
• Eat breakfast and drink coffee/water if you need it! Interviews are a long day, and there are a lot of people you're going to be talking to. Make sure you're fully energized for the day, so your brain is at its sharpest.
• Be prepared for clinical cases. A number of programs have parts of the interview where you have to work through/present a clinical case. From my personal experience, I've experienced a lot of ID/anticoag, but generally a lot of these cases are types of situations you might experience on an internal medicine rotation. The main thing interviewers are assessing here is your thought process. Don't stress too much if you don't remember the exact dose of azithromycin you'd give for a patient with CAP or how long you would treat them. One thing to mention always is where you might go to look up that information (i.e. IDSA guidelines, institutional guidelines, etc.)
• Write down your interventions/disagreements as you go through your APPEs. You'll almost always get asked about your most meaningful clinical intervention, or about a time a doctor disagreed with you. Writing these down will help you to refer to it later during interviews.
• Remember you're interviewing them, too. Just getting to the interview is an accomplishment, especially with how competitive residencies are now. Honestly, just be yourself and try to get to know them, along with showing off your personality. You really want to know if you'll "fit" at the program, as you'll be spending the next 1-2 years there, and you don't want to hate your time there and be miserable. As always, prepare a number of questions for the different people you might meet (i.e. residency program director, preceptors, coordinators, residents). Finally, don't feel bad asking multiple people the same question. It's good to get different perspectives to help you better assess if the program is a fit for you.

I will say doing most of my interviews during the general medicine rotation was mildly hectic, but I'm glad most of them happened during this block. I felt really prepared for the clinical cases I came across and had various things I could speak to when interviewers asked me about clinical interventions/disagreements. Thankfully, I had most of my interviews during this block, as I'm currently in DC doing a rotation at the FDA. However, note that there are a lot of interview dates that occur during block 8, where you don't have an extra 5-6 days built in to go on interviews. Thankfully, my preceptors during both rotations have been really accommodating with me and have allowed me to go on interviews.

Hope that helps with a picture of residency interviews or the general medicine rotation. Feel free to e-mail me (jpborlag@med.umich.edu) with any questions. Thanks!

3-for-1 Special: Internal Medicine, Hospital/Health System, and Ambulatory Care

Posted by Silu at Sunday, September 01, 2013

Hello everyone! Silu here, blogging from the café at Plum Market in Ann Arbor. Like 95-100% of my fellow P4s will tell you, I cannot believe how fast this year is going by. In the spirit of Labor Day Weekend sales, this 3-for-1 special post includes my first 3 rotations. Please scroll to the headings you want to read if you don’t intent to read this lengthy post in one sitting. My apologies in advanced to the other bloggers whose posts I have probably displaced onto the next page x_x.

Rotation 1: Internal Medicine (Inpatient A), Mercy Memorial Health System
Preceptor: Dr. Tina Melanokos

Having only had experience in a large academic hospital so far, I was glad to have this opportunity to work in a Mercy Memorial Hospital, a small 200-some-bed community hospital in Monroe, MI. This was a unique opportunity to experience pharmaceutical care in different type of institution. Being a much smaller hospital, Mercy Memorial had a close-knit pharmacy staff, all of whom work together in order verification and clinical responsibilities including renal dosing, pharmacokinetic/antibiotic dosing, anticoagulation, TPNs, patient discharge counseling, and attending care coordination rounds. As students, my rotation partner Matt Allsbrook and I were responsible for these clinical duties on a daily basis. A typical day would include working up patients for any one of the clinical services offered and discussing recommendations with our preceptor in the morning, then project time in the afternoon. Beyond our clinical duties, we had special projects and additional responsibilities, including:
 

• Drug information consults – our preceptor had a strong relationship with many providers, and several would ask drug-related questions. We researched and prepared write-ups to answer the more in-depth queries.
•  IV Administration Guidelines – edited the hospital’s unit-specific IV push and IV infusion guidelines, compiling information about IV administration from several drug information sources. This was a huge undertaking, but was very much appreciated the nurse managers, who had been looking forward to a document like this to implement in their units.
• Drug use evaluations
  
  

In addition to our daily responsibilities and projects, we also were able to spend one week in the adult ICU, where we monitored all medication therapy for the patients in the main medical/surgical ICU.  We also attended weekly safety meetings and any administrative interdisciplinary meetings of any committee our preceptor was a part of.

Overall, this was a great rotation to start with. We able to learn about these basic clinical duties offered common to many hospital pharmacy departments at a comfortable pace and low-pressure environment. Tina was an excellent preceptor and provided teaching opportunities from our everyday duties. The best aspect of Mercy Memorial was the family environment of not only the pharmacy, but the whole health system. Located in a small town, nearly all staff were from local area, and patients were often familiar to those participating in their care, giving a true meaning to taking care of their own community.

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Rotation 2: Hospital/ Health System, William Beaumont Hospital (Troy Campus)
Preceptor: Dr. Scott DuFour

My second rotation was at Beaumont Hospital in Troy, MI. Slightly smaller than its main hospital campus counterpart at Royal Oak, Troy Beaumont is nonetheless a state-of the-art hospital with comprehensive inpatient and outpatient services. In addition, it’s one of the most beautiful facilities I have seen!

My rotation started off on an interesting note, where my preceptor, Dr. Scott Dufor, Director of Pharmacy, was on vacation the first week and half. Assistant Director, Dr. Dena Stout, and Clinical Coordinator, Dr. Jennifer Priziola, kindly adopted me and became my surrogate preceptors throughout this rotation.  I spent each day working with a different staff pharmacist on clinical services similar to those described in the previous rotation at Mercy Memorial. This was an interesting opportunity to see the differences in how similar duties were performed by different health systems. Besides working with the staff pharmacists, I was able to have a broad array of experiences in different areas of pharmacy operations, leadership, and clinical development, including:

• Working with specialist pharmacists in OR, emergency, oncology, and intensive care
• Weekly Family Medicine Rounds – an interdisciplinary group (nurses, pharmacist(s), attending physicians, residents, medical students, physical and occupational therapists, social workers, and case managers) lead by the family medicine team would gather weekly and discuss one patient, and use the expertise of each discipline to discuss treatment for the patient as a whole, even beyond the main concern for which they were hospitalized
• **This was my favorite part of the rotation. The family medicine team truly respected the internal medicine pharmacist and valued all of the input, even eliciting further information and asking additional questions as a teaching tool for the residents and students!
• Webinar series on pulmonary hypertension, a serious life-threatening disease requiring specialized intensive care
• Leadership meetings/seminars with leaders of the hospital
• Reporting adverse drug reactions and medication errors

I was also given several small projects, from writing an article about drug shortages for the hospital newsletter to developing a department procedure for splitting tablets to creating a comparison chart of antiplatelet drugs for nurses (and those of you who know me know my predilection for making tables/charts…).

Despite driving over 1 hour daily drive to and from Troy, I truly enjoyed this rotation. Some of the pharmacists I worked with were great teachers, and most allowed me the autonomy to perform tasks independently under their supervision (inputting orders, adjusting antibiotic doses, and suggesting changes for optimizing therapy). Other perks of Troy Beaumont? They have amazing home-made peanut butter granola bars and potato chips. If you’re there in the summer/fall, they have a farmer’s market by the parking lot too =). Get the kettle corn.

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Rotation 3: Ambulatory Care, UMHS Canton Health Center, Canton, MI
Preceptor: Dr. Stuart Rockafellow

Having been interested in ambulatory care pharmacy since P2 year, I was beyond excited for this rotation in U of M’s ambulatory care practice. I really hoped to sharpen my patient communication skills, gain a more in-depth understanding of chronic disease management, and decide if ambulatory care is the right career path for me.

My site was at the UMHS Canton Health Center in Canton, MI. Having spent the past 10 weeks driving 2 hours every day to and from rotation, I was thrilled this site was 4 miles away from my parent’s house, where I was staying at the time. This clinic was mostly composed of family/internal medicine physicians and pediatricians. Our patients are referred from the family medicine doctors for management of diabetes, hypertension, hyperlipidemia, and polypharmacy. Dr. Rockafellow has clinic 3 half days and 1 full day per week. Patients could be called for a phone visit for 15 minutes, or be seen in clinic for 30 minutes. New patients would always have a clinic visit first, then can be followed up by phone depending on their/the pharmacist’s comfort level.

On the first day, Dr. Rockafellow and I discussed my responsibilities and goals for this rotation. I imagined he might have standard expectations of how a student should progress in terms of autonomy in patient visits, but he very much individualizes the rotation to the skill and comfort level of the student. In the first few days, I  listened/sat in on phone/clinic visits and wrote SOAP notes for each in-clinic patient. I was surprised that by the end of the first week, I was taking medication histories by myself, and at the beginning of the second week, I was seeing patients independently.

The best (and perhaps most challenging aspect) of seeing patients is the holistic approach Dr. Rockafellow uses with his patients. Not only would we manage medication therapy, but discuss lifestyle factors that may contribute to disease management such as diet, exercise, stress, and sleep. I spent about as much time discussing medication changes and dose titrations as I did providing nutritional counseling and recommending exercise regimens.  (Yes, ask me about the sugar content of a Venti Caramel Frappuccino with whipped cream, I dare you).  The challenge was trying to fit all this into a 30 minute visit, especially with the more loquacious patients.  I also had some unique opportunities to discuss with a few physicians in the clinic about optimizing medication therapy for patients and answer drug information questions.

This was my favorite rotation so far, not only because I love the ambulatory care setting, but because of the impact of excellent patient care by a pharmacist. It was inspiring to see the trusting relationship patients had with Dr. Rockafellow, most of which see him as a provider similar to their doctor. Additionally, this rotation also challenged me to become more effective at balancing quality patient care with the constraints of time and patient volume. I self-titrated the number of patients I saw throughout the weeks, taking both phone and clinic patients, and met my personal goal of running an entire half-day of clinic on the last day. This site also had a diverse array of patients of different ethnic and socioeconomic backgrounds, offering opportunities in learning how to individualize therapy based on these factors.

That is all for now! I hope you’ve enjoyed this account of the past 15 weeks so far. Stay tuned for the next chapter: Pediatric Generalist at C&W Mott Children’s Hospital!

-Silu

March Madness with the Medicineheads

Posted by mariarx at Tuesday, March 26, 2013

Internal medicine - where specialists go to die. Ok, maybe not die, but definitely expand readily available therapeutic knowledge.

Rotation 8 had me back at UMHS for internal medicine with Dr. Regal. I know the saying is "jack of all trades and master of none" but this does not apply to Dr. Regal. He is more master of all trades. It's kind of scary sometimes. Internal medicine stretched my immediate memory of random bits of drug information, ways of getting the team to follow my recommendations, and not falling asleep on rounds after not having slept well.

Walking circles on rounds
My day usually started with working up patients. On a good day I only had 4-5 patients... bad days had me around 14-16 patients. I would check out doses, indications, labs, relevant drug levels, and their past medical history/reason for hospital stay.

The medical team (shout out Med Dock!) really utilized having a (future) pharmacist on hand to help with dosing and drug selection. I loved working with them, and I really felt useful and a major part of the team. I also felt like a butcher sometimes, chopping down options I knew weren't ideal before they got to Carelink. I'm looking at you, fluoroquinolones. I was also responsible for anticoagulation monitoring, teaching, and documenting. Any time a patient was started on warfarin, LMWH, or UFH we had to be on it. Warfarin INR monitoring is a fickle thing, especially with the bazillion drug interactions you have to look out for. We had a few interesting anticoagulation patients including someone with antiphospholipid antibody syndrome. Quite the tongue twister.

The Bench Test
One thing I heard about, and was scared of, coming in was the idea of the Bench Test. Dr. Regal wants to know how much we've crammed and retained through 5 weeks; and that comes in the form of a written and oral exam. The stack of articles looks pretty daunting, but it's not so scary once you find yourself actually using the information and giving references to justify recommendations to the team. I'd say the worst part was the oral exam - sitting at a table watching Dr. Regal scratch notes down while you're trying to recall a tiny detail from one article that is at the edge of your memory. But, I survived!

The End
On the first day Dr. Regal said that his rotation is built to prepare P4s for the intensity of residency training. As daunting as that was I'm grateful for it. I think I'm a bit less scared about the next 2 years knowing that I can do well in a clinical setting and that I have been prepared by a great clinical pharmacist.

To future P4s - Dr. Regal's rotation sounds scary, but isn't in the end. Start practicing your jokes!

My Levofair with Internal Med

Posted by David Plumley at Sunday, July 01, 2012

I knew that these five week rotations would go fast but I did not realize just how fast until I looked back a few days ago and I always already done with my first rotation.

To say I learned a lot on from Dr.Regal, Charles in charge, and the members of the Medicine Dock team would be an understatement.  Most of my learning came on the fly during rounds.  Once my team members became comfortable with me and confident in my pharmaceutical knowledge they would ask me questions about almost every patient.  Most of the time I would reply with my favorite phrase, "let me look into that and get back to you" and then do some research of my own, as well as discuss the topic with Dr.Regal, in order to come up with the best recommendation.  However sometimes thanks to the knowledge I acquired from therapeutics and the confidence I gained from this rotation I was able to make a recommendation on the spot.  Most of the recommendations I made involved antibiotics (dosing, optimization, duration, and toxicity), anticoag(warfarin dosing, Lovenox bridging, and the occasional Dabigatran), and optimizing chronic therapies.

The therapeutic and medical knowledge I acquired is very important, but maybe more importantly I learned confidence and how to operate with the medical team.  It took some time for me to understand how rounds work and how to best contribute but once I did I was able to participate in my own active learning even more.

The most valuable advice I can give to students getting ready for their clinical rotations would be to pay attention to every patient on rounds, learn from the discussion the team may be having even if you may not be responsible for that patient, look up everything you aren't sure about, and to work with your team.  We have all heard this before during orientation but it is most definitely true.  

One of the most difficult parts of having a clinical rotation first was my unfamiliarity with much of the medical terminology, but by writing everything down and looking it up later I was able to learn more than I thought.

It wasn't all work however.  Many of you might not know this but Dr.Regal is quite the wordsmith and poet.  He shared with us 2 poems he wrote about protecting fluoroquinolones (one of his favorite past times) and ending levofairs and ciproflections.  I will try to get copies of these so I can share them with the world.

Before I finish today I would also like to give you a quick intro to my next rotation.  I started this past Monday at Karmanos Cancer Center located in the Detroit Medical District.  This is an ambulatory care rotation focused on bone marrow transplant.  I am excited for this rotation since I have an interest in oncology/hematology.  My preceptor is Dr. Simon Cronin, the former preceptor of our very own Dr. David Frame, which makes me semi nervous.

So far in my first week I am getting accustomed to the work flow.  I spend most of my day doing med recs, some patient education, and have opportunities to shadow Simon as he works.  The clinic has approximately 2 MDs, 4 NPs, Simon.  The 2 Wayne State students I am partnered with and myself play an important role in searching out drug therapy issues and bringing them to the attention of the other clinicians.

I will update you on how this rotation goes in a few weeks.

Avoiding the Dogma House: Rotating with Dr. Regal

Posted by David Plumley at Tuesday, May 29, 2012

I have been looking forward to my Internal Medicine rotation since the day we found out our rotation schedules.  I had ranked Dr. Regal number 1, 3, and 5 for rotation preferences hoping I would get him.  I had heard many good things about his rotation and knew how hilarious he was from previous classes (I think he is the only professor to ever use a picture of Flavor Flav on one of his lecture slides).

One the first day of rotation Dr. Regal gave me and Chuck (my rotation buddy) a syllabus of what a normal day would be like for us, what the major focuses would be, and revealed a somewhat unexpected "bench test" that would be given at the end of the rotation to test the knowledge we would be accumulating over the next 5 weeks.

As far as what we would be doing on a day to day basis, each of us would be assigned to one medical team who we would round with and be responsible for all of the patients on that service.  My service is Med Dock; the team consists of an attending, a senior medical resident, 2 interns (1st year residents), and two med students.  Each morning rounds start at 8am and by that time I should have worked up all the patients and have a general idea of what issues may come up on rounds.  My major focuses are antibiotics (choice and dosing), anticoag (dosing, monitoring, education), overuse/misuse of PPIs (a Dr. Regal pet peeve), and other chronic condition therapies that are not being maximized.  Each morning after rounds we meet with Dr. Regal and discuss briefly questions that came up on rounds and recommendations we should make, we then follow up with our teams and make sure these recommendations are relied to them and either taken or have a reason why they are not.  After that we have some time for lunch and time to work up any new admits (each team is on call 2 days a week) or read any articles that were given to us.  Then in the afternoon we meet up with Dr. Regal to do some topic discussions about articles we have read or common themes that he has seen come up on rounds.

The most interesting this so far about this rotation has been the wide variety of cases I see on a day to day basis.  So far in my first 5 days I have seen your more common infections like pneumonia, cellulitis, many UTIs, and  several heart failure exacerbations, but I have also seen some rare conditions only seen in case studies like POTS (Postural orthostatic tachycardia syndrome), plastic bronchitis, and cardiogenic autonomic neuropathy.  These are conditions that most health care providers will never see; but because of this rotation I get to see these conditions and hear the medical team discuss their treatment.

I hope you enjoyed my first entry.  I will try to keep you up to date with some of the more interesting cases I see and give you an idea of what I do on a day to day basis over the next 4 weeks. 

 

Small Voice with a Big Impact

Posted by Jody at Wednesday, April 06, 2011

I am currently on my internal med rotation at Mercy Memorial Hospital. Mercy is a smaller community hospital located in Monroe, MI. There is one central pharmacy that dispenses for the entire hospital.

Mercy does not have the “traditional” rounds we think of when it comes to inpatient rotations. So, what do clinical pharmacists do at a smaller hospital?

My responsibilities on rotation:

- Anticoagulation

o Monitoring warfarin, lovenox, fondaparinux

- Renal Dosing

o Reviewing all medications for patients with renal insufficiency and recommending alternative treatment options to physicians

- Kinetics

o Dosing and monitoring antibiotics, ordering drug levels

- Drug Information

o Answering physician questions regarding medications and dosing since there is no drug info department

o Calling drug companies to determine stability and compatibility

- Administration

o Helped implement new programs and policy for the pharmacy department. Specifically, I assisted with the Fall Prevention and Safety Policy.

As you can see, the pharmacists have all the typical responsibilities that any pharmacist would have at any institution, plus a little more. At smaller hospitals, such as Mercy, the role of each pharmacist is a mix of responsibilities incorporating not just clinical but administrative roles as well as drug information tasks.