Un día normal para un residente

Cardiovascular Intensive Care Unit

My day begins with pre-rounding on patients and assessing pertinent changes to orders and clinical lab findings. We have a “TPN per pharmacy” protocol in the CVICU, so I pay close attention to medications and other interventions that affect fluid and electrolyte balance. During rounds, I participate in clinical decision making with the interdisciplinary team and make recommendations or answer any medication-related questions. After rounds, I write TPN orders and monitoring notes, follow-up on patient care items, and lead topic discussions with my preceptor. In emergencies, I respond to Code Blue events and prepare patient-specific medications at bedside. Overall, I have enjoyed the opportunity to be directly involved in patient care while working closely with members of the medical team to contribute to the healing of complex, critically ill patients.

Neonatal Intensive Care Unit

A typical day in the NICU begins by reviewing patients and assessing necessary changes to orders for both medications and nutrition. Many neonates that we take care of are born premature and may require parenteral nutrition in the first days to weeks of life to support their growth. As the pharmacist on the team, we coordinate with dieticians to ensure our patients are receiving the best nutrition possible, including both macronutrients and micronutrients. During rounds, I participate in patient care discussions and make recommendations on medication changes, medication dosing, vaccinations, and more. After rounds, I help the team order TPN, follow-up on patient care items and drug-information questions, and lead topic discussions with my preceptor. I also attend any high-risk deliveries to support the neonatology team in managing critically ill newborns. The NICU provides a fulfilling environment in which the pharmacist is an integrated member of the interdisciplinary care team and I look forward to going to rotation each day to care for the smallest and youngest patients in our hospital.

Antimicrobial Stewardship Program

Our goal as antimicrobial stewards is to ensure the safe and effective use of antimicrobial therapies in other to reduce resistance and prolong longevity of all antimicrobials in our society. A typical day in ASP begins with prospective audit reviews and feedback. Depending on my workload for the day, and the day of the week, I typically arrive around 6 AM to ensure that I have enough time to review my patients’ antimicrobial therapies in order to identify, discuss and relay any recommendations to the primary team all before 9 AM.  My afternoons are often filled with recommendation follow-ups, journal articles and guidelines reviews, ASP meetings, mini-project work, presentation preparation, and topic discussions. Additionally, I also attend weekly clinics on Fridays as a longitudinal experience, where I get to observe physician-based ambulatory care and interact with patients to gain exposure to the outpatient infectious diseases.  The ASP learning experience allowed me to stay connected with interdisciplinary team and to build on my clinical foundation in infectious diseases.  I have thoroughly enjoyed this experience as I get to expand my knowledge base and make an impact one antimicrobial at a time.

Specialty Pharmacy Management

My typical day begins with a daily specialty pharmacy huddle where we debrief on how the previous day went, address any issues and concerns, and prepare for the day. Next, I attended pharmacy Gemba rounds with pharmacy administrators, where we visited different areas of the pharmacy to address any concerns or questions from the staff. The rest of the day was spent working on my major project involving the URAC re-accreditation process such as conducting hazardous risk assessments for all hazardous drugs on our formulary and hazardous materials carried in our specialty pharmacy. I had the opportunity to meet everyone in specialty pharmacy to understand their workflow and how the hazardous drugs are received, stored, and handled. I collaborated with the staff on ideas on how to appropriately store hazardous drugs in specialty pharmacy and implemented process improvement strategies. From this experience, I learned about the regulatory aspects of the specialty pharmacy and how specialty pharmacy is involved with other key stakeholders to help address any barriers that would prevent our specialty pharmacy from becoming compliant with our institutional policy and USP 800 guidelines.

Pediatric Cardiology

My typical morning involves pre-rounding on patients and communicating with case managers to determine potential discharges for the day. Following that, I would discuss patients and recommendations with my preceptor prior to heading to rounds. While on rounds, I participate in clinical decision making with the interdisciplinary team, especially pertaining to management of diuretics, anticoagulation, and whether prophylactic medication is indicated for patients. After rounds and patient follow ups, my afternoons can vary between coordinating patient discharge medications, patient medication teachings, medication reconciliations, topic discussions, or medication/clinical pearl presentations to the interdisciplinary team. Overall, I have enjoyed the opportunity to be directly involved in patient care and to work with a multidisciplinary team to ensure that our patients receive optimal care.

Oncology

My mornings involved a chart review of my patient list prior to rounding with the liquid tumor service at 9:00 AM. I also used this time to identify any new patients that would need an admission medication reconciliation as well as potential discharges that would require discharge medication teaching. While on rounds I would make recommendations for opportunistic infection prophylaxis, febrile neutropenia, chemotherapy-induced nausea and vomiting, tumor lysis syndrome, pain, and mucositis. I would use my time in the afternoon to follow-up on any medication changes that were discussed on rounds, perform admit med recs, and write monitoring notes for vancomycin or high-dose methotrexate. I would also meet with my preceptor to discuss Treatment Plans, write chemotherapy orders, and have topic discussions. Additionally, I also had an opportunity to attend weekly Leukemia/Lymphoma Board meetings.

Pediatric Intensive Care Unit

A typical day in the PICU starts with pre-rounding on patients to assess pertinent clinical findings and identify any therapeutic interventions. I then go to rounds where I participate in making clinical decisions on patients with an interdisciplinary team, answer any medication related questions, and make medication adjustment recommendations. After rounds, I catch up on monitoring notes, such as vancomycin per pharmacy, follow-up on patient care plans, lead a topic discussion with my preceptor, and follow-up on any drug information questions from my preceptor and/or the medical team. In emergencies, I would attend Code Blue events with my preceptor to help prepare patient specific medications as necessary. Overall, I find the critical care environment fast-paced and very interesting. There are many complex patients and pharmacy is an integral part of the patient care team, so being involved in many clinical decisions is very fulfilling to me.

Administration

There is not really a typical day during Admin rotation, but you can generally expect to be in at least a few meetings and to have some time to work on various projects. There are, however, a few regular duties that I help the department with. One of them is to help disseminate issues and their solutions within our department. I attend the daily inpatient huddles, where any issues involving workflow, patient safety, and other announcements are voiced by both managers and staff. I will then compile the issues and their solutions to be sent out to the department so that it is communicated to everyone. Another activity that I help with on a weekly basis is to review any reported situations regarding patient or workplace safety. This is done with a small, close-knit, interdisciplinary team, which allows us to discuss errors from a wholistic perspective. This in turn allows us to better understand areas that we need to improve upon, whether it pertains to modifying a workflow process, adding a safeguard, or providing enough education and support to our hospital staff so that we can avoid future errors of a similar nature. It is definitely interesting to see from a high-level perspective all that goes on not just within the pharmacy department, but within the hospital as a whole.

Solid Organ Transplant

My day in the solid organ transplant rotation begins with reviewing patients’ profiles and assessing their medications to identify pharmacological interventions. The solid organ transplant learning experience is unique in its diversity of the patient population, which includes patients with a fresh solid organ transplant, those awaiting a transplant, and those readmitted for complications following a previous transplant. This has allowed me to round in various patient care areas, such as the intensive care unit and acute care unit. After rounds, I present patient updates to my preceptor and write monitoring notes for patients’ immunosuppression therapies. During the remainder of the afternoon, I perform other patient care items, such as collecting medication histories for patients upon admission and providing medication teaching for patients upon discharge. Overall, solid organ transplant has been a rewarding learning experience that has exposed me to a highly specialized patient population and enabled me to play a role in patients’ transitions of care.