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!

Adventures in Babysitting -errr, Pediatrics!

Posted by mariarx at Tuesday, September 04, 2012

Oh man, I can't believe it's already rotation 4! The quiet summers of empty Ann Arbor are gone... soon we'll be entrenched in computer turf wars with the P3s on their direct care IPPEs. Before we get too far into rotation 4, I wanted to look back at my adventures in peds.

Our PY team. I like to think I'm the girl with the gold viking helmet hanging on for dear life.

The generalist rotation, new and required this year, gives you the option of working on the adult (UH) side or the pediatric (Mott) side. I decided to take the plunge and go with peds. Who doesn't love kids? Me. But I did like working with their meds. My mom would be so proud. 

My day on the generalist rotation started with rounds prep. On any given day we had between 2-6 patients admitted to the PY (pediatric gold) team. That isn't a lot of patients... until you realize the work that goes into peds dosing, indications, etc. For each patient I tried to get a good idea of their problems and what all their diagnoses meant (helloooo Google), their dosing regimens, weight based dosing, daily maxes for the medications, indications, and any alternatives that I may be asked about. Safe to say my monitoring form looked like a rainbow in trying to keep all the info divided. My preceptor, Jenny Hlubocky, was really good at giving pointers for keeping everything straight and reminding me to focus on the drugs and not get lost in the world of googling mowat-wilson disease.

One aspect of peds drugs and dosing that I didn't really think about before this rotation was the taste of oral meds. Unfortunately, tiny mouths and esophagi are not made for swallowing tablets - which is where solutions come into play. Doing the taste test with Dr. Streetman and the medical students was really fun, even if I did get a headache from all the random drugs we tasted. Note to the public: linezolid, clindamycin, MVIs, and iron taste GROSS; and chocolate syrup is Dr. Streetman's gift to little kids everywhere. 

After rounds my partner-in-crime Vince and I would go over our patients with Jenny, maybe work on orders for our services, and then have the afternoon to do individual work. Besides our general PY patients, we also worked up the rehab patients in Mott. These patients are usually in the hospital for a really long time (and have a really long MAR), so we would make sure that doses were appropriate and make recommendations for cleaning up the med list - such as getting rid of PRN meds that hadn't been used in a while. 

Our final patient interaction component was med reconciliation. I feel like I spent the majority of my afternoon work hours trying to find parents to speak with about their kids medications... the laws of not speaking to minors alone make medrecing quite the difficult task. 

Besides patient interactions and monitoring, we also had some mini-projects and 2 bigger presentations. Mini-projects consisted of topic discussions about things that may have come up in our talks about patients or just interesting topics in the world of peds. In the effort to bring my own interests into the pediatric world, I ended up presenting my journal club and larger topic discussion about pharmacy administration and its role in the inpatient stay and discharge. Dr. Brummond and Dr. Kelley would be proud (I think). 

Overall, I'm really glad I picked the pediatric side of the generalist rotation. I don't have any other peds rotations on the horizon so this was a good adventure to have. My 4th rotation is ambulatory care in oncology... you'll hear about that soon enough if I make it out alive. Till next time, keep saving lives fellow P4s! 

Putting healthcare on a diet: Toyota Production System

Posted by mariarx at Tuesday, June 12, 2012

Looking at the title you might be asking yourself "what in the hell do cars have to do with hospitals?" Our answer to you is - let's get lean.

Lean thinking is a concept derived from Toyota and how they work. The company has successfully integrated ideas such as worker responsibility, problem solving, just in time production, and inventory management to maximize quality and profits. The process of taking these concepts from car manufacturing to health systems was fairly simple - applying these will be the real battle. UMHS has committed to getting all of its health care providers thinking and acting lean. Assistant Directors Phil Brummond, Lindsey Kelley, fellow admin blogger Tom and I, attended the LEAN workshop in hopes of solving the pharmacy departments most perplexing problems. During the workshop we realized that every department has problems, and the lean problem solving process could really help give everyone a place to start and map out WHY problems are present.

The first 2 days of the lean workshop involved a highly technological simulation of emergency department workflow... we got to spend 4 rounds playing with lego patients, running around a conference room, and rolling dice. Each round, interspersed with lectures and discussion, added an extra layer of lean. We started with sheer chaos, with teams only finishing 3-4 patients in a 10 minute round. By the last round, our teams had finished 15 patients with time to spare. All of this was accomplished by implementing lean processes one round at a time.

Now you could be asking, "guys... how the heck do you take a lego and dice game and make it work in the real world?" I wish I had the answers. The lean workshop didn't give us a map to find the answers to all of our problems. But, it did give us the boyscout tools needed to navigate through the swamps, deserts, and forests of UMHS. By bringing these tools back to the pharmacy department and teaching others how to use them for themselves, we can (slowly) get to the root of a lot of the problems plaguing the department. Making people really examine every step of their routine and workflow - to look for how things should be done, and not how they've been done in the past - is the real goal of this workshop. One of the most profound things I learned was that you cannot MAKE people change, you need them to WANT to change. Given the power and opportunity, health care personnel will makes the changes needed to get more out of their job while also making it more fun, easier, and less stressful.

We learned a lot at the lean workshop and came back to the hospital with a lot to think about and consider. For now, we take it one step at a time and try and lay some groundwork in the last 2 weeks of rotation for the future. I want to be the person who writes their name in the wet cement of the future, even though I may not be around for it to dry.

Maria & -TV-

Meetings, meetings everyday...

Posted by mariarx at Saturday, May 26, 2012

Week one of rotation one is done. Woo!

If I've learned one thing in my first week on the UMHHC Administration rotation, it is how to eat on the go. Running around the hospital from 0800 - 1700 with no break on day 1 was pretty overwhelming. Nothing like learning to swim by being thrown right in the pool. Besides the long day, I got the opportunity to see a full range of administrative task meetings - RFP presentations, team meetings, pharmacy practice rollout and planning.  My second trial by fire happened on days 2-4 since my preceptor, Dr. Brummond, was in the land of Badgers and I was braving meetings on my own. Most meetings have consisted of taking notes (about medication safety, pharmacy operations, IT, drug shortages, Joint Commission) and then looking up all the terms that I'm not familiar with.

Besides meetings with my preceptor, other administrators, and various pharmacy teams; this rotation includes a 5-week (or more) long project. Thanks to fellow blogger, Andre Harvin, the admin team has a database of over 6.5 million points about medication dispensing in the hospital. My job will be to compile a workload analysis; one of many projects that will be done with the data. The past day has been spent fiddling around with Microsoft Access and googling tutorials. Thank the internet for "Access for Dummies." Also, it stinks that Access isn't available on macs. Boo!

I hope to also use the next 4 weeks to work on my leadership skills, hone in what I need to get done for residency applications, and maybe even create a hospital glossary. I think that's all I have for now.... I'm sure the next 4 weeks will be a great roller coaster, and I'll keep everyone posted!