Hey y’all! It’s been an amazing month in my Hospital IPPE rotation. I’m writing this blog post as an update about what I’ve been up to the past month! Enjoy.
Week 1: Learning about the medication dispensing/ order verifying process in a hospital pharmacy.
This week I learned a lot about how the typical hospital pharmacy might run on a day-to-day basis.
Monday/Tuesday/Wednesday: I spent these days shadowing a pharmacy technician to see what they did on a typical day. We filled orders using the automatic medication carousels, which are basically rotating carousels with bins of medications in them. When you scan an order’s label, the carousel moves to the place the medication should be located in and you just have to pick out how many tablets/capsules that you need and scan the barcode on the medication. Medications in the carousel are all already pre-packaged in unit-doses so that you can just pull out the exact amount of tablets/capsules that you need for a patient’s dose. We also spent some time delivering medications to the different nurses’ stations to put in patients’ bins and also replinished the “pyxis” on each floor. A pyxis is a computerized medication holding device that holdsthe nurses’ floor stock of medications. This allows the nurse to get medications that are used often more quickly than waiting for delivery from the pharmacy.
Thursday/Friday Morning: I spent these days learning about hospital pharmacy inventory. I spent time with the medication buyer, learning from how she ran things. We unpacked and checked in all of the totes that were delivered in the morning on both days. This took quite a bit of time. Our pharmacy is also the delivery site for some of the other departments of the hospital so we went and delivered those totes to the appropriate departments. We took calls from providers trying to get medications that were not on formulary and tried to see if it would be possible for us to purchase the medications. We also prepared the order at the end of each day and made sure that it was complete and ready to be delivered to us the next day.
Friday Afternoon: I spent a lot of this time watching my preceptor (the lead pharmacist and clinical coordinator) verify orders in the main pharmacy and check that IV preparations were made according to their order.
Week 2: Learning about IV preparation in a hospital pharmacy.
Monday/Tuesday: These days were not the most fun I’ve ever had in my life, but they needed to happen for me to be prepared enough to start making IV preparations. On these days, I garbed up in the appropriate PPE and watched the technician draw up and compound IVs.
Wednesday: We spent this day cleaning all of the clean room areas. We spent 4 hours cleaning the clean room, ante room, and chemotherapy room with the appropriate solution and then again with alcohol. When I say clean… I mean CLEAN. We cleaned the walls, floors, ceiling, chairs, etc. Anything that was in the room got cleaned. After I did that, I was actually able to help put “vial-mates” together. Those are devices that allow the IV bag and the medication vial to be attached so that the nurse can wait to mix it all together right before they are about to give the dose. They can be made in advance and we keep a stock of pre-made vial-mates in the pharmacy.
Thursday/Friday: On these days I was actually able to compound IV preparations. I actually drew up volumes of liquid and injected them into IV bags. This was actually really fun. I am super happy that I was able to actually have this experience during my rotation.
Week 3: Learning about medication reconciliation and taking medication histories from a patient (in the Emergency Department) and more IVs (YAY).
Monday/Tuesday: I spent these days learning how to take an appropriate medication history from a patient and how to follow up with the patient’s pharmacy or family members if I had any discrepencies. I had a lot of fun interacting with the patients and actually being able to talk to them about their medications. I probably saw about 15-20 patients on both days in the emergency department. I didn’t see anything crazy come through though like I was expecting when I heard that I would be in the ED.
Wednesday: I spent this day back in the IV room preparing IV preparations.
Thursday: July 4th! I didn’t have to go into the hospital this day… I spent it by the pool 🙂
Friday: I presented a presentation to the pharmacy staff on how to take an effective medication history. I also spent some time shadowing my preceptor on her rounds and how she looks at patient charts with a “clinical eye”. I was able to help her counsel a patient on a new diagnosis of heart failure and I was able to change a patient from an IV medication to an oral form by looking at the patient’s chart and seeing that they were already taking all of their other medications by mouth.
Week 4: Learning about clinical pharmacists and their roles in the hospital pharmacy setting.
Monday: On this day, I shadowed another pharmacist on his rounds and helped him prepare for a presentation that he had to present to a group of senior citizens on opioids for osteoarthritis and dependance on opioids.
Tuesday: On Tuesday, I shadowed the pharmacist that I shadowed on Monday. We looked through patient charts to see if there was anything that we could change. For example, there was a patient on IV azithromycin, but they were taking drugs by mouth… we changed their azithromycin to PO (by mouth).
Wednesday: On this day, I shadowed another pharmacist and focused on cardiac patients. I looked in patient charts and determined if they were on the correct anticoagulants and checked INRs, etc. I also gave a presentation on hospital formularies and P&T committees.
Thursday: I shadowed my preceptor, went with her on her rounds, and helped her counsel patients. We had 2 sets of patients to run through this day, so there wasn’t much free time.
Friday: My preceptor and I sat in the ED and verified orders that had been received from the ED. We also looked at culture results for recent ED patients to see if the antibiotics that they were discharged on were actually active against the colonies that grew in their cultures. I also had my evaluation on this day since it was my last day there.
I am truly going to miss the people that work at the pharmacy. I enjoyed my rotation a lot. I’m so happy that I had the opportunity to learn from all of those people.
I hope you all enjoy your rotations if you have some left, if not… I hope you enjoyed reading about my experience and learning about some of the things that pharmacists might do in the hospital setting.