Shadowing an Internal Med resident

Royal Oak Beaumont pharmacy has PGY-1 and PGY-2 programs available, and I had the fortune to see a "day-in-the-life" of PGY-1 resident on their Internal Medicine rotation. 

The day started at 8:00am with us looking up patient profiles for about 10 patients, varying from those in the intensive care unit to patients awaiting discharge. Since the resident had been tracking the patients for a few days, she reviewed each profile for medication changes and lab results that were previously pending. We were able to cover a few medication profiles of the patients in depth, discussing why antibiotic changes were necessary, or what pertinent lab results would warrant a change in therapy. 

When it was time for rounds, the resident paged the resident doctors and attending physician. Rounds started with the resident doctors presenting the case to the attending physician, and with the pharmacy resident offering suggestions to change medications. With each patient visit, the pharmacy resident was able to interact with the patient directly, counseling them on proper medication use (patient questions included what the difference between rescue and maintenance inhalers, why a whole course of medication was necessary to complete, what side effects were normal to experience, and how to time taking medications in relation to food). Once a patient was counseled, the team moved to the next patient, discussing the following case while walking to the floor. This experience made me realize that it is essential to have a comprehensive work up readily available on hand for each patient, since it can often be difficult to remember all the details when on the floors.

After rounding, the pharmacy resident made a plan of action for the following day, noting which patients required closer monitoring. The rest of the day was devoted to working other residency tasks, such as making handouts for the physicians on medication dosing, creating presentations for the pharmacy department, and manuscript editing. 

Residents are certainly busy with a variety of activities to complete before they are done, but according the resident I shadowed, the experience of a residency is invaluable and truly rewarding!

In the End

Seeing that I was working in retail for the first time, and it was an internship, I took away some thoughts on retail pharmacy. The first was customer service. I learned you always have to be on your game in front of people. There is this expectation of always having a smile, quick in acknowledging the person, and speaking in simple terms. Even though pharmacy is a complex and time consuming topic, it is placed in a setting with people who have busy lives and simple medical knowledge. One time, a customer asked me about the difference between lisinopril and Dyazide. I started out describing the molecular differences then I realized this explanation is not helping her. I summed it up as they targeted two different sites in the body.

Secondly, I became experienced at being accurate and multiple tasking. At times in the pharmacy it is crazy: phones going off, customers lining up, and running out of drugs. One has to be quick, but more importantly accurate in times of stress. When counting Vicodin, we have to double count because it is a control medication. I want to quickly and accurately count the Vicodin then move onto my next task like serving the drive thru. If I am not accurate, the customer will come back saying that we shorted him. This causes more time to deal with the situation and takes away from filling today’s prescriptions. I learned to do things right the first time because it will save me time later if issues arise.

Retail taught me to be fast and to prioritize. One area I haven’t mastered just yet is drop off. I know how to work drop off but I do not have the speed for it at peak hours. One needs to prioritize when prescriptions are due then start typing them right away. And it is just not the prescriptions from walk-ins. It is ones from the drive thru, computer system, fax, and phone calls that add to the volume at drop off. One minute I am doing fine with my prescription level then five pop up on the computer, a person walks in with two and my pharmacist gives me three from phone calls. I am quick at typing but it still takes a thorough knowledge of the inventory and solving insurance problems not to be slowed down and keep up with the volume.

I realized learning and re-learning is the key to being on top of the game. Since pharmaceutics are always evolving and adding new drugs to the market, the pharmacy has to keep up with the times. Fast movers change from time to time. Brands become generics. One can get use to certain drugs and know everything about them until a customer asks you about a new drug. If I want to be great at my job, I have to look to improve myself and test my knowledge. It is easy to get in a comfort zone and think you are doing a good job when actually you can do better.

My final thought is the people I worked with this summer. They were the number one reason I enjoyed my time in the pharmacy. For being friendly, caring, and helpful, it was easy to enjoy the good and get through the crazy times in the busy retail world. I had several co-workers my age to talk about college stuff and enjoy going to the bar after a long day at work. When I leave this week for school, I won’t miss the customers, but you guys!

UMHS Patient Triage

Hello readers!

I am writing this last summer post about my experience as the pharmacy employee responsible for patient triage at the University of Michigan hospital. To start, working patient triage entails serving in one of the hospital’s inpatient unit pharmacies. The position involves completing nurse requests that originate from the pharmacy window, answering incoming phone calls into the pharmacy, responding to requests made through the University of Michigan’s medical record software called CareLink, and disseminating patient medication orders to other staff working in the unit pharmacy. These aforementioned responsibilities require good communication, team building, and leadership skills. First, fulfilling requests involves beginning, continuing, or refilling a medication in a patient’s CareLink drug regiment. This means printing out patient drug labels for compounding technicians to fill and pharmacists to check. Second, phone calls are directed to the appropriate hospital department, transferred to an available pharmacist, or are answered and provided with accurate clinical knowledge within the scope of a pharmacy technician’s role. Third, hospital staff requests through CareLink are completed in much of the same manner as phone calls are handled. Fourth, dissemination of information among unit pharmacy staff is based upon the fact that drugs are to be administered at different time periods. Since the unit pharmacy staff want to provide patients and hospital staff with medications that are new and have long hang-by and expiration timing, the technicians will usually wait until an hour before the medication is due to start compounding it or will wait for a nurse phone call to confirm if the drug is still actually needed if the medication is expensive. It is up to the employee working patient triage to accurately relay this kind of information. As always, patient triage also requires workers to pneumatically tube finished medications directly to the patient’s unit location if they are required STAT (Sooner Than Already There)!

To conclude, I want to say it has been very fun this summer. I hope that my blogs have provided you with insight on how the University of Michigan unit pharmacies inner-workings operate and the processes involved in the central pharmacy department. I hope you have enjoyed reading my blog as much as I have enjoyed writing it. I wish the rest of your summer is enjoyable and that you have success in all of your future pharmacy endeavors!

-Adam Loyson