Working in a pharmacy with no medications...

This summer I am interning at the Mayo Clinic in Rochester, MN. I am an outpatient pharmacy intern and will be rotating through six different outpatient pharmacies during the duration of my program. As a Minnesota native, I have grown up hearing about the Mayo Clinic practically every day but for some of you who aren’t as familiar with this hospital system, here are a few basic facts. The Mayo Clinic is the largest integrated medical center in the world and serves more than 350,000 patients per year. More specifically, the outpatient pharmacies see about 1,000 patients per day and process approximately 4,000 prescriptions daily.

Because of the huge volume of patients seen at the various outpatient pharmacies, the Mayo Clinic utilizes a separate medication filling center, allowing for two of its six outpatient pharmacies to focus their efforts on patient counseling and worry less about the actual counting of prescriptions because there isn’t actually any filling of medications at these two locations.

Let me explain a little bit more about how this process works. Basically, a patient brings a new or refill prescription to our pharmacy where a technician enters it into the computer system. While the prescription is being entered, the pharmacist counsels the patient on their medications and answers any questions they may have. All of the pharmacists I have worked with so far utilize the three question approach we learned in PCare (What did the doctor tell you this medication was for? How did the doctor tell you to take this medication? What side effects did the doctor tell you to expect with this medication?). After the prescription is entered into the computer, it is scanned, verified by a pharmacist, and sent off to the filling center. There, the prescription is filled, checked by a pharmacist, and sent back to our pharmacy through a tube system where the patient can pick it up roughly 30 minutes after dropping it off.

I was very surprised when I first learned that they did not have any medications in the pharmacy but so far the process seems to run very smoothly. It’s great to see the pharmacists spending the majority of their time counseling patients on their medications and less time counting pills and checking orders. It was also very encouraging to see some of the exact same patient counseling techniques we learned in PCare put into practice in the real world and how effective they can be when communicating with patients. Looks like we really will use some of the things we learn in school!

Playing Catch Up

So I will preface this blog by saying that I am not a blogger. I actually had to google blog for some examples and I am still a bit confused if I should write it as 'blog' or 'blogg', still trying to work that out. Anyways since I came home to Maryland I was sick as a dog and had a car accident, so uh yeah great. Luckily the accident wasn't too bad my back hurt for a while, but everything is working fine.

Now to what you all came here for, my internship with Johns Hopkins Medical Center. Well there isn't much to contribute just yet, I will be working with the Director of Pharmacy Nathan Thompson. For now I am floating to each of the outpatient pharmacies throughout the hospital shadowing the pharmacists and technicians to get a perspective on their work flow. Each pharmacy in the hospital caters to a slightly different patient population and therefore have a slightly different work flow. Once I have visited all the pharmacies I will meet with Nathan to design a research project for the summer. Throughout the summer I will accompany him to various meetings and even have the opportunity to take his place in certain committees. The summer looks exciting and I will update as things develop.

Clinical: Not Always the Hospital Setting

So this is my first week at Prime Therapeutics in Bloomington, Minnesota. I am doing the AMCP/FMCP/Pfizer Managed Care Summer Internship and am already learning a wealth of information. Currently I am rotating through the Drug Formulary Development department, and seriously putting my evidence based medicine skills to use.

Updating/maintaining the drug formulary is a year long process. Each pharmacist is responsible for a few therapeutic topics, and have to make sure their respective chapters are complete and up to date. What does this involve? Looking at the literature, clinical guidelines, FDA reviews, etc. and applying their clinical knowledge to evaluate the value of a medication in therapy. The pharmacists also review new drug products as they are approved by the FDA and released. My preceptor asked if I knew Ampyra, and I quickly ran through my mind all the meds I learned in therapeutics. When I couldn't recall it, he said it was just released 2 months ago. I find it really cool that the pharmacists know about the drug products as they are released. They are on top of the information because they need to evaluate the safety, efficacy and uniqueness of new medications to see if such medications should be placed on formulary.

When talking to pharmacists within the department, they each emphasized to me how their job is very clinical. Before starting this internship, I did not realize that managed care is very clinical. When I hear the word "clinical" I used to think of the pharmacist working in the hospital setting, and I am sure many students think this as well. At Prime, the pharmacists definitely use their clinical skills in evaluating medical literature and making judgment to ensure that patients' drug therapy is safe, efficacious and cost efficient.