APPE Reflection- Critical Care

I was very intimidated going into this rotation because it is only my 2nd APPE experience and the CCU is such a fast-paced environment. However, I have learned a lot over this rotation, and I had the best experience I could have imagined. My confidence in making recommendations to providers has increased significantly, and I was able to do a lot of independent learning.

During the first week, I had my first counseling experience of the month. I was able to counsel a patient on a new prescription for warfarin. It was a great experience because there are so many different things to consider when counseling on warfarin (diet, bleed risk, goal INR, etc).

I also had my first ED shift of the month this week and was able to complete several medication histories as well as make calls to pharmacies to gather information/cancel prescriptions that were sent to them by mistake. It is the job of the ED pharmacist to make calls for patients who tested negative for COVID and make sure that they no longer had a fever. I was able to practice with this on week 1.

I witnessed my first rapid sequence intubation during week 1 and was able to assist the pharmacist in drawing up medications to make sure it ran as smoothly as possible.

Week 1 was also where I began rounding every day on the CCU. Every day, I spent half of my shift sitting on the unit by myself and assisting with any medication related questions that the nurses/providers may have. Of course, being a student, I had to report to my preceptor with all of the recommendations that I had to make sure they were appropriate before recommending them to the provider.

Moving on to week 2, I was able to dose a new start vancomycin in a patient and adjust a heparin drip based on the patient’s aPTT level.

Week 2 was also where I had my weekend ED shifts. I completed 7 medication histories, 16 negative COVID callbacks, and another intubation.

The rest of the month was pretty chaotic. I attended 4 rapid responses, 2 codes, rounded on a total of 35 patients, dosed and prepared TPA, and made daily recommendations to providers. I pretty much handled the CCU patients on my own, with verification with my preceptor.

My big projects for the month were to present a case presentation on a COVID patient that had been in the CCU for most of my month long rotation and create a reference sheet on how to treat hypertensive crises.

I also had 1-2 topic discussions a week on critical care topics such as FASTHUGS, Sepsis, the ABCDEF bundle, RSI/NMBA, PADIS, and ACLS.

The hardest part of this rotation was experiencing codes and seeing how intense and emotionally draining they can be.

I have nothing but good experiences to report for this rotation, and I’m so sad to be leaving this hospital until January. I have really connected with the pharmacy staff here and really have started to feel like family. I hope to have as good of an experience during my Ambulatory Care and Community rotations that I have over the next few months.

I will continue to keep you all updated with all of my rotations!

Stay golden,

Emily

APPE Reflection: Advanced Hospital

First things first, I’d like to mention that I am extremely blessed to be granted permission to continue onto my APPE rotations even in the midst of COVID-19.

This was my first APPE rotation, and I can honestly say that I had an amazing experience. It was better than I could ever have expected. I was not only able to see how to complete orders in the pharmacy, I was able to complete a lot of clinical coursework and attend a lot of meetings.

Throughout my first week, I worked on improving my ability to work through the pharmacy system and find important information in the patient chart. I wrote several brief SOAP notes on the patients that I worked up. On Friday of the first week, I did a lot of research on remdesivir and its dosing because we had a COVID positive patient that we were going to start on remdesivir, and it was our first time gaining access to the drug. I helped one of our pharmacy residents put together a protocol on how we were going to administer it and store it, and even helped prepare a folder full of information on the drug to keep in the pharmacy for the pharmacy staff to refer to.

Then, on my second week, I worked in the main pharmacy for 3 of the days. I was able to assist the pharmacist in checking orders in patient charts, checking IV preparations, and checking cart fill to make sure everything was appropriate and given for the right patient. I really learned a lot during this time. Thursday and Friday I spent most of my time working up patient charts. I did some vancomycin kinetic dosing based on trough levels, warfarin dosing based on INR levels, and increasing/decreasing insulin regimens based on patient 24 hour BG levels. One of my biggest passions so far in pharmacy is diabetes management and education, so it was really exciting to actually be able to make recommendations on insulin regimens. I was actually able to document my intervention notes and discuss recommendations with providers.

On week 3, I was able to spend some time shadowing the pharmacy technicians. I really enjoyed this week because it is important to know exactly what the technicians are responsible for in the pharmacy, and the technicians at the hospital that I am doing rotations at are all really sweet and welcoming. I was also able to help compound oral liquids and a few IVs. On Friday, I spent my day in the Emergency Department. Our hospital is fortunate enough to have an ED pharmacist. I was able to help give recommendations to the physicians and research things that I was unsure of. I learned a lot down in the ED and was able to shadow some medication history reviews.

Week 4 involved more clinical work and a presentation. Monday was spent in the ED again doing similar things. I spent Tuesday up on the surgery floor working through new-start TPN dosing and making sure the post-surgery patients had all of their post-surgery medications on their profile. Wednesday-Thursday, I worked on the medical floor and learned a lot about my patients (because I was able to follow them for 2 days). I learned a lot about alcoholic cirrhosis and meningitis. I also gave a presentation on Malignant Hyperthermia on Wednesday afternoon to the pharmacy staff. Friday was my day off to attend my cousin Ben’s wedding.

Throughout the course of the month, I was also able to attend a lot of meetings with my preceptor and other pharmacists. This was very beneficial for me because I was able to see all of the responsibilities that pharmacists may have and the roles they play on a multidisciplinary team. I attended a meeting on the hospital’s metrics, a P&T committee meeting, and an antimicrobial stewardship meeting.

I can honestly say that I learned a lot from this rotation. I learned more than I ever thought would be possible in just 1 month.

I can’t believe I only have 8 more rotations to go! I’m super excited to begin my next APPE rotation, which is an inpatient elective in Critical Care. I’ll make sure to keep track of everything that I do so that I can keep y’all updated!

Until then…

Stay Golden,

Emily

Why Pharmacy?

Everyone thinks that I am crazy because I have wanted to be a pharmacist since I was in the 5th grade, but I have.

Everyone wonders how I came up with that as a career that early in life. How does a 12-year-old want to become a pharmacist? Why would you want to count pills all day? How does that sound appealing?

The truth is, I didn’t make the decision by myself. Honestly, it has always felt like God was leading me in this direction my whole life. All of the pieces of the puzzle have consistently been falling into place.

I have always looked up to my cousin, Laura, who is an amazing pharmacist. Growing up, I saw how much she was able to help her patients. I saw the passion that she had for helping the community, and I wanted that. My dad was always reminding me how much my study habits and personality reminded him of Laura, and that was another reason I felt like I would be perfect for the job.

Some people go through pharmacy school because they know that pharmacists can make a 6-figure salary, but that was never it for me. I am truly passionate about being able to help patients become the healthiest that they can be.

My end goal is to own my own independent pharmacy where I will be able to treat patients how I see fit without the oversight from a corporation. I want to host educational classes for patients and their families to be able to learn about their disease and how to best manage it with lifestyle modifications, not just medication. I want to get patients to their healthiest while making sure they are on the appropriate therapies and they are able to get taken off of therapies that are not working for them or are unnecessary.

I am constantly told that this is a pipe dream and that independent pharmacies are going out of business, but I truly believe that once patients see how I’m willing to treat them, they’ll be excited to start their healthcare journey with me and my team.

I am willing to do whatever it takes to get to this goal because I know that God has called me to this career and to make the community a better place for everyone in it.

No matter how big or small your dream is, it will succeed if it is what you are truly called to do.

Never forget to dream and to shoot for the stars.

Stay Golden,

Emily

Thoughts on COVID-19

Hey y’all! I hope everyone is doing the best to stay safe in this pandemic that we find ourselves in. 2020 has not been kind to us. I am writing this blog post to put into words how I feel about the Coronavirus.

The panic that has ensued in our beloved country is partially reasonable, however, we have become fearful of things that could have been avoided if the media would not blow things out of proportion. Here is what we (rather I) DO know about the virus:

  1. “Coronavirus” is not a new term for us. We, as a society, have seen many strains of this virus through the years. HOWEVER, this is a new, seemingly more deadly, strain of the virus.
  2. Everyone can get infected, but the virus seems to be most deadly for individuals >60 years old or with decreased immune system function (i.e. smokers, cancer patients, HIV/AIDS patients, etc.) If you know any of these people, volunteer your time to go to the store and get them what they need so that they can avoid exposure as much as possible.
  3. The most important things that you can do to avoid getting COVID-19 is wash your hands (if nothing else, make sure you wash your hands before eating ANYTHING), avoid crowded areas, and cover your mouth when you cough/sneeze (by using your elbow, a tissue, or the inside of your shirt).
  4. Healthcare workers and emergency personnel are not immune but have to continue to work to keep everyone safe. Keep that in mind.
  5. Stockpiling excess supplies does not do you any good and takes them away from others who may desperately need them. By the way, if you buy up all of the hand sanitizer/soap, how are people going to wash their hands and prevent the spread? Only keep what you will need.
  6. Cancelling classes, requiring work from home, and cancelling large events may seem like a drastic measure, but the goal is to stop the spread of the virus so that the country can get a better handle on the situation and prevent healthcare system over-saturation.
  7. Most of the information about the life-cycle of the virus is still unknown to the general public. This is an unknown strain, but that doesn’t mean that we cannot do anything about it.

Here are the websites from the CDC and WHO about COVID-19, strategies to prevent transmission, and updates on confirmed cases: https://www.cdc.gov/coronavirus/2019-ncov/index.html https://www.who.int/health-topics/coronavirus

Stay Safe and Stay Golden,

Emily

You Will Prevail.

I don’t know about y’all, but I have been having a rough time maintaining my motivation this semester. I’ve been feeling an increasing amount of stress, and it’s been harder to manage than it normally is.

I’m writing this blog post because I’m sure that I’m not the only one who feels like this sometimes.

I want you to know that you’re not alone in this.

It is OKAY to admit that you get overwhelmed sometimes.

It is OKAY to admit that you are exhausted sometimes.

It is OKAY to be unmotivated sometimes.

It is OKAY to want to give up sometimes.

We all go through times when we feel that we can’t handle any more stress or work put on us. There is nothing wrong with you.

When you go through these times, think about why you put yourself into the situation that you are in. For example, when Pharmacy School gets overwhelming, I try to remember the reasons that I’m here. My passion is helping people. I’ve been on this path since I was 12 years old. This is what I have always wanted. I LOVE my profession. Those are the reasons that I’m in this profession. That is why I’m in school. If I keep these motivations in the forefront of my mind, it’s easier to get back to work and focus on what I need to do.

What is it that gets you up in the morning? What is it that motivates you? Try to bring that to the forefront of your mind.

And when in doubt…

Breathe.

You’ve got this!

Stay Golden,

Emily

Preparing for Rotations

Hey guys! I’m writing today to list out how to best prepare to be on your A-Game when you start APPE rotations. Note: This is just what has helped me feel prepared as I go into rotations in May. Other things may work better for different people.

1. First things first, during the first 3 years of pharmacy school, study hard and study well. It is beneficial to work hard to get short-term memory into long-term memory so that you remember all the important stuff for all of the years ahead of you in your career. One of the ways that I do this is to make Quick Disease Fact Sheets after each disease state (or set of disease states) tackled in pharmacy school. I have discussed these before and the link to that blog post is here. You can also do the same thing with specific medications or classes of medications to make sure you remember the BIG, IMPORTANT points.

2. Second, it is important to continue studying, even when you begin rotations. What has been beneficial to me is to buy an RxPrep book (several years old) that was relatively cheap on Amazon. I am going through these topics nightly so that I’m well versed in what I need to know. We do not receive our RxPrep book for the current year until around September/October, so having the older model around before that comes will prove worthwhile.

3. Stay organized. It is very important to remain organized as APPEs are approaching. You should know which rotation is coming up when so you know where to focus your energy in the week or so leading up to that rotation. For example, if your first rotation is a cardiology rotation, it would be a good idea to brush up on the cardiology disease states before heading into that rotation.

4. Be prepared to be wrong or to not know an answer. It is important to be okay with not knowing everything. As pharmacy students, a lot of us are worried about being seen as ignorant. However, the preceptors on rotations understand that it is impossible for us to know everything about the world of pharmacy. A lot of that comes with being in the career field itself. A lot of the time, they aren’t testing our knowledge, but are testing our ability to admit when we don’t know something and our ability to look it up in a reputable source. This is not to say that they don’t expect us to know something… I mean, if they ask you what the brand/generic name or indication is of something… you NEED TO KNOW that.

5. And last but not least, the most important way to prepare for APPE rotations is to just trust yourself and breathe. It will all be okay. You’ve got this. WE’VE GOT THIS. I’m right there with you. If you ever need anything, feel free to reach out.

And as always…

Stay Golden,

Emily

Study Tips: Final Exams in Pharmacy School

In order to best study for final exams, I start studying ~3-4 days BEFORE I EVEN THINK THAT I NEED TO STUDY for an exam. It is critical to give yourself enough time. Here are some tips that I have to make that happen:

Make “Quick Disease Fact Sheets” or “Quick Medication Fact Sheets”

Example Quick Disease Fact Sheets That I’ve Created

I suggest for Disease States to focus on Key Features of the Disease, Pathophysiology, Risk Factors, Medication Management, and Non-Pharmacological Interventions. For Medications, I suggest focusing on Indication, Generic and Brand Names, Side Effects, and Therapeutic Class. It might be helpful to include pictures and charts.

Create a Rough Schedule for Studying

By this, I mean plan out which days leading up to exams that you are going to spend on each subject. For example: Monday: Pharmacotherapy 1, Tuesday: Research and Design, Wednesday: Integrated Pharmaceutical Sciences 1, etc.

Listen to Study Music

Here, I’ve attached a Study Music Playlist that I listen to on Spotify! It may be helpful to create your own.

Avoid Distractions

Put that phone down. Turn off that TV. Go somewhere quiet. Anything to help you avoid distractions.

Use a Timer!

There are lots of Study Timers online. I like the Pomodoro Method of Studying where you have 25 minutes of studying and then a 5 minute break. After an hour, you get a 15 minute break. Here is a useful online timer!

TAKE BREAKS

Going along with the last one, remember to take breaks! Your brain will stop absorbing information after about 20-25 minutes without a break because, as humans, we have a short attention span.

Avoid Cramming

This kinda goes without saying, but I feel like I still have to say it. Don’t wait until the last minute to study.

Make Quizlets or Practice Tests

This one has worked really well for me over the year. Being able to create my own questions with the material gets me thinking about it in different ways. I’ve even been able to anticipate almost the exact question that a professor is going to ask.

Focus on What You Don’t Remember!

If you spend most of your time going over the stuff that you got right on previous tests, you are going to neglect the stuff that you had a hard time with. The point of studying is to get a better grasp on the things that you don’t know or have a hard time remembering.

Get some SLEEP.

It is extremely important to sleep, especially during this time. It allows you to better retain information and leads to increased performance.

Good luck on your exams!!

Stay Golden,

Emily

It’s Not the Stress That Kills Us, It’s Our Reaction to It.

To be 100% honest with you guys, this semester hasn’t really been too stressful for me. I’ve been able to do a lot of things that I never would have thought I could during pharmacy school.

However, this week hit me like a ton of bricks. I’m sure a lot of you know exactly where I’m coming from… everything is going well and all of the projects and exams are spaced out and life is good and then all of a sudden it’s like your world was flipped on it’s head.

I know that sounds kinda dramatic, but that’s how I feel. How do you go from one or maybe two things a week to everything being due all at once?

This week I have a pharmacotherapy exam, an NDU (New Drug Utilization) presentation, a Business Plan Proposal, and a SOAP note due. On top of that, I have to read 100 pages for one of my classes and do other little homework assignments along the way.

But the thing is that, I know everything will be okay. I can see the light at the end of the tunnel, and for the first time in my life, I’m handling the stress in a productive way. I’m staying positive, taking deep breaths when I feel overwhelmed, and remembering how blessed I am to be able to have this mess of a life and be in pharmacy school so that I can graduate and do what I love.

One of the biggest things that has helped me deal with my stress is to take time and grow my relationship with God. I try to do a section out of my devotional every night no matter what is going on. This helps me reel in all of the negative feelings and remember all that I have to be thankful for.

We all get a little overwhelmed sometimes, but it will be okay. Everything will work out the way it should, and God’s got this!

Feel free to reach out if you’re feeling overwhelmed, or if you just want to talk. I’m here!

You’re not alone in this crazy thing we call life.

Stay strong and Stay Golden,

Emily

A Day in the Life of a Student Pharmacist (Pharmacy Student)

Generally, it’s expected that pharmacy students will never have it ‘easy.’ Some of us even work in a pharmacy or otherwise during what little free time we have. But for me, it’s stressful enough to just study and go to class all the time.

Here’s a glimpse into what a day in my life currently consists of:

Hit snooze on the alarm for the 3rd time. It’s 6:30 AM; you always set your alarms for 5:00 AM with high hopes that you’ll wake up and do something productive, but you never do.

A feeling of fatigue comes over you as you open your eyes and blink at the alarm on your bedside table a few times. Wow. Is that really the time? You feel as if you have only slept for 2 hours (even if it has been more). You rub your eyes and beg your body to get out of bed because you can’t afford to miss a class.

When you finally get the energy to get up and sluggishly walk into the kitchen to fix your coffee, you try to recall why you’re feeling so tired. You were up late every day this weekend studying for your exams. This is going to be rough. You try to shake the feeling that it’s going to be a long day when you hear your coffee finish brewing.

You finish fixing your coffee, and you start getting ready for the day. Again, you think that today is going to be a long day. It’s Tuesday. You have a Physiology exam at 7:45 and then you are stuck in that same class for 2 hours. Then after that, you have a brief lunch break and then it’s off to Case Recitation. It’s hard to imagine a world where your day doesn’t start at 7:45 AM and end at 4:00 PM, but it seems to be nowhere in sight.

After finishing off your cup of coffee, you try to make sense of the mess that is your hair. You run a brush through it and hope it will look decent enough. If you have time, you fix your makeup, and you’re on your way.

You make it to your exam with a few minutes to spare, but then you realize that you didn’t eat breakfast. You start digging around in your bag in hopes that you packed something that will hold you over. You pull out something totally unhealthy and nibble on it until your professor comes in to begin the exam.

After your exam is over, you walk down the hall and set your stuff out to begin studying for whatever exam is next on the agenda before class starts. It is a neverending cycle. Study for one exam, take it, study for another.

Finally, it’s time to start class. You pack up your things and head back into the room, where someone has taken the seat you’ve been sitting in since the beginning of the year. Go figure. You plant yourself in a seat closer to the back of the room and prepare yourself for the longest 2 hours of your life.

After class, you heat up your lunch and eat it with your friends. Lunch goes by so fast (as it always does) and it’s time to start the last class of the day. You try to pay attention, but all you can think about is the nap you so desperately need but cannot afford to take after class.

You get out of class and head back to your apartment. There, one of two things happens. You either start studying again, or you lay down in hopes of taking a quick nap and it turns into a 2-hour nap which you instantly regret.

After your nap, you try to study some more, but you get distracted by the hunger in your belly. Time to go get dinner. You meet some friends for dinner, but you have to rush off because you have to actually be productive and study.

You tell yourself you’re going to get to bed early, but it rarely happens. You either find yourself studying into the wee hours of the night, or you find that this is the only free time you have, so you have to use it to relax and spend some time on yourself.

Finally, you shower, pack up your bag for the next day, and pick out your outfit. You brush your teeth. You lay down in bed.

And finally, you set your alarm for 5:30 again…knowing it’s already 12AM or 2AM… knowing you won’t wake up that early, but still hoping you can get an early start.

You shut your eyes and dream of the days when you are an active pharmacist… happy, healthy, free.

You’re always trying to thrive, but honestly, it’s okay as long as you just survive.

Try to Stay Golden,

Emily

Maintaining My Sanity in Pharmacy School

Who would have thought that I would be in my first year of Pharmacy School at 20 years old. It’s a little tricky to juggle being a graduate student with still living the life a 20-year old wants to be living, but I’m doing it.

Going to graduate school at the same university that I completed my undergrad career is very difficult at times. I still have so many friends that are still completing their undergraduate studies, and sometimes it’s hard for them to understand how hard I have to work. This provides one of the major challenges in my life. You have to learn when its essential to say yes and when its essential to say no.

You can’t do everything. I’m slowly learning that I cannot stretch myself too thin. I was put in the position where I had to go alumna in my sorority and leave that part of my college career behind because I’ve decided to run for president of my P1 (pharmacy year 1) class, and I really think that it is an amazing opportunity to grow as an individual and as a leader. I love all of my Phi Mu sisters; I know that I will always have them in my life, but at this point in my life I have to contribute to the sorority as an alumna. And that’s okay! It’s okay to figure out what is most important in your life and focus on everything that gets you to your dreams.

However, you have to do things that make you happy. You can’t focus only on school. So, I make sure to save some free time every day to do things that help me stay happy, healthy, and sane in the midst of all of the stress. I’ve been attending group workout classes once or twice a week, watching a little bit of Netflix, hanging out with my friends/roommates, and getting more in touch with my faith.

I know its only been a few weeks, but I feel as if I’m managing my time well. I’ve been extremely happy in these first few weeks of school, and I hope I continue to maintain my good attitude about all of it.

I just keep reminding myself that this is the dream I’ve had since 5th grade and that I’m going to make a fantastic pharmacist as long as I push myself to be the best I can be in all aspects of my life.

Stay Golden,

Emily