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!

Pediatric Satellite Pharmacy

Whenever I get a chance to work some overtime, I often spend time in Beaumont's pediatric pharmacy. This satellite is located in the Children's hospital, which features pediatric inpatient beds, neonatal and pediatric ICUs, and a surgical center.

Understandably, a major difference between this pharmacy satellite and others is that there is a daily "batch" of liquid medication doses to be syringed up for the patients. This task can test really test your attention to detail- doses range from 0.05ml to over 10ml, so its important to check yourself with each syringe (especially when drawing them up at the end of a 10-hour shift!). Another layer of detail  includes noting the number of syringes required for a set of twins (or even triplets). It can be less than straightforward, especially when BabyBoyA requires 1 dose at 1.36ml and BabyBoyB requires 2 daily doses at 0.645ml, for example.

In addition to the liquid medications, there are typical stat orders and IV compound mixtures to be made throughout the day. Other unique responsibilities involve drawing up propofol syringes for procedures, making IV Remicaide, weighing out PEG powder, and compounding starter TPN bags.

Generally, its imperative to appreciate the different dosing required for pediatric patients, as this becomes readily apparent after spending most workdays filling adult doses.

Intro to EC Pharmacy

Hello everyone! My name is Katrina, and I am an incoming P3 student currently interning at Royal Oak Beaumont Hospital. I've been a pharmacy intern there for a year, working alternating weekends during school and full-time in the summer. As a pharmacy intern at Beaumont, there are several practice areas where I been trained to work, namely in the central inpatient pharmacy, satellite pharmacies (general and pediatrics), IV clean room, and in the emergency center (EC).

During the summer, I am frequently scheduled to work in the EC. Working in this setting as an intern is definitely an interesting experience in the unexpected- no day is the same. Royal Oak Beaumont has a Level I Trauma center, which translates into receiving a variety of critical patients from around Michigan in addition to local cases.

Typical daily tasks include: refilling the EMS boxes and bike packs, restocking the pharmacy, filling and delivering doses to 1 of the 8 areas of the EC, and crediting unused patient medications. Compounding IVs quickly and accurately in the EC is essential, especially for medications like TPA and amiodarone. All of the EC pharmacists that supervise my work are truly knowledgable, and are more than happy to both teach and test me on drug information and dosing while I work.

When the EC pharmacist is paged to attend the trauma bay, I usually get to tag along and help out with whatever case presenting. Most often, pharmacist involvement in traumas features intubation sequences and the provision of syringes for cardiac arrest codes. For example, during a code, the EC pharmacist is responsible for providing the nursing staff and physicians with specific medications at defined intervals of time, all depending on the patient's status. At the discretion of the EC pharmacist, interns are permitted to draw up doses on the spot for the traumas, which are immediately used after verification by the pharmacist. The pressure can be on when those around you are depending on a syringe in a few moments!

Overall, it has been rewarding to be able to experience this different side of inpatient pharmacy as a student, and I look forward to more times in the EC!

The Middle

You know those days when you are just so tired from running (some days literally) around at work all day that you don't want to really do anything that requires much thought? Well I'm like frequently, hence my lack in blogs. However, I have tomorrow off so I will start my 24 hours of productivity (hopefully) with a blog post.

I am still a glorified technician at the UM hospital but I have had some new opportunities and some realizations that I would like to share!

1. I.D. is not for me: I had the opportunity to shadow one of the infectious disease pharmacists at the university. While the job I'm sure is quite interesting for some, it was not particularly interesting for me that day. We listened to medical students give updates on the patients and as a group we (I didn't say a peep) discussed them. The pharmacist we were with also didn't have anything to say regarding these patients. Maybe it was just an off day...I hope. Either way, when we went to see the patients after the discussion, they were mainly in the ICU's and we weren't really involved in speaking to them or even listening to them. I need some interaction! I am grateful for this opportunity, and the pharmacist was very nice and informational...but it's like the book He's just not that into you, except it's me and deals with an area of pharmacy...hmm...

2. Cancer is sad: Well duh Margo! I actually really enjoyed this shadowing experience and I think that if I had chosen to go on it after I had actually learned about medications used in cancer it would have been 10x more interesting. If I could do it over I would have waited but you have to take pie while pie's passing. This shadow allowed me to see all types of patients from those just beginning radiation to those that have been treated for some time. The problem was that my heart just ached the entire time. Maybe I'm just a big baby, but to see those people worried about if they can make it to their daughter's wedding or asking when they can get out of the hospital just made me so sad. Overall, it was interesting and touching. The pharmacist also had a lot of input and the staff really looked to her for help and suggestions. I found that promising because I feel like the role of a pharmacist can be up in the air sometimes.

3. Old to new, new to old: On my psych shadow today I heard two different statements. The first from the patient that she wanted to return to her old self. The second from the pharmacist that she liked her position because over the course of the patients stay, she is able to see them leave a completely new person. Very interesting! This was probably my favorite shadow so far (although I might have to sleep on it). I enjoyed it because I actually had an idea of the medications that were discussed (thank goodness I actually remembered some of them), and there was more interaction with the patients. When rounding we actually discussed their feelings instead of just what hurt and what other tests they had to get done. The pharmacist I was with said that she could have as much interaction as time would allow with the patients and once a week (when possible) she has her own session with a group of patients to talk about their medications and they get to ask her questions about them. How cool is that? A controlled setting, no phones ringing or other patients waiting, not stepping on nursing toes... sounds like a pharmacy dream.

4. You down with TOD? Yeah you know me: TOD = Tech on Demand = pretty sweet spot unless there are call-ins. Too bad there are always call-ins. When the interns are TOD we are allowed to work on "projects." These range from counseling transplant patients (lucky bum P4's), to writing up a training document for new hires (me). So far this year I have completed two projects. The first was the training document for new hires, this document is to standardize the processes for technicians in the satellite pharmacies. It includes everything from getting into the omnicell (machine that contains drugs) to expiration dates on oral syringes (yes, that somehow varied). It was a good project for the beginning of the summer because it brought me up to speed (for the most part) on anything that had changed and reminded me how to do things I had forgotten. My second project was actually like a part 2 of the first. Hold onto your hats ladies and gents, I typed and checked over our desensitization protocols. This is for when a patient is allergic to a medication but needs to be used so we titrated the dose little by little until they are at the therapeutic dose. Many of these documents were previously hand-written and those that were typed were in different styles, so being the twit that I am sometimes, I made sure that they now matched. Yep, very exciting. I'm officially a part of the "Michigan Difference" with these.

5. Wait, Wait...Don't Tell Me: Nope, I was not featured on the NPR program but I'm going to play a "Bluff the Listener" with those of you who are actually still reading to part number 5 (Good for you by the way, come see me and I'll get you a prize).
Here goes, You choose the correct project that I will be starting on this week. Is it....?
a. Margo will be going through all of the policies, starting with 85.00 (Smallpox Standing Orders) and re-numbering them through 400.07 (Investigational Drugs used in Compassionate Cases) because one of the policies had since been deleted.
b. Margo will be meeting with waste management vendors in order to decide the new colors and types of bins used for various recycling, glass, trash, and sharps.
c. Margo will be taking apart the bottom of shelving units in the satellites to collect and record all of the drugs that have fallen through the cracks or were swept under the shelves.

Answer to follow.

Dear Pharmacy Phriends and Phamily, I hope this long (probably too long) blog makes up for my lack of previous blogs.

Well Carl Kasell, what's the correct answer? You guessed it, the answer was b (If you got it right some see me and you'll get two prizes...as long as supplies last). I will fill you in on all of the gory details of waste management as soon as I get them...and am willing/able to write about them.

Oh yeah, that changed too...

When starting my second year as an intern at the University of Michigan inpatient pharmacies I figured everything would come back quickly and I wouldn't have any problems. Well I remembered how to do everything, but the old way. The phrase "Oh yeah, that changed," has been a common one since starting back.


At the hospital I work in the inpatient satellite pharmacies as a technician with benefits. The benefits being once weekly intern meetings where I get to interact with my supervisors and learn more about the hospital. My work includes making IVs and filling unit dose orders to be sent out to each of the nursing units every hour on the hour. This was the same work that I did all last summer except now there are some new procedures to get used to. For example, UMHS changed their narcotic protocol so that we have a better idea of where all of our narcotics go and who has them in their possession each step of way. This isn't very difficult but takes time to get used to. The delivery is my favorite part because the hospital is so large it takes 15 minutes sometimes to complete a run so it's like killing two birds with one stone because I get to exercise while working.


Overall, the position has not been too exciting thus far. Without the H1N1 patients, things have been a little slow. I suppose this is good so I have the time to get use to the changes made while I was at school. Soon I will be shadowing some pharmacists and starting on some projects. Once those come up I'll keep you updated on the fun facts I learn.