Allegiance Health

My name is Kristen Tedders and I am a proud member of the COP Class of 2012, also known as a P4-elect (with the current P4 class still not graduated, I think it’s only fair to think of myself with this title). I am returning to Allegiance Health, a hospital in Jackson, MI (formerly known as Foote Hospital) for my second summer in a row. After working in the IV room and OR pharmacy satellite last year, I am currently being trained in the Emergency Room pharmacy.

Working down here can either be incredibly hectic or pretty laid back, you never know what the day will bring. The pharmacist and technician (or in my case, intern) will service the ER by making IVs throughout the shift as they are needed for the patient and delivering them and medications directly to the room (as most are needed STAT). They must also be prepared for emergency angios, strokes, codes, and a number of other situations that can happen at any time. Along with these inpatient services, I also deal with outpatient ER patients and their prescriptions. Throughout my 8-hour afternoon shift, we can fill anywhere from 20-60 prescriptions. While this may not seem like much, patients always seem to come in bulks of 5-10 at a time, so that when you are filling prescriptions for one, there is always a line behind them. Add to this the constant need for IVs to be made and delivered, things can easily get pretty busy!

Throughout the last 4 days I have been training (with the aid of a very knowledgeable technician!) and everything has been pretty laid back. I will soon be working my own, with a pharmacist also in the pharmacy with me, in a couple days and I am fully expecting to experience my first wildedly busy day when I am all on my own. Not to worry though, just remember: the needs of patients in the ER come first. Don’t be afraid to politely tell those waiting for prescriptions to be filled that it may be a little bit of a wait if there is a lot going on! And always remember, remaining calm under high stress situations will make things go by much smoother.

Hello from Singapore!

My name is Grace Chen and I'm an incoming P4. I'm currently working in Singapore at the National Healthcare Group Polyclinics (NHG) in Choa Chu Kang (CCK).

These polyclinics are government subsidized clinics where patients get treated for minor acute ailments and chronic conditions. Physician offices, labs, nursing stations, pharmacy are all located in one 3-story building. Because it's subsidized (read: cheap), our pharmacy serves 700-800 patients in a DAY alone. Needless to say, it's super busy every day.

Here are my observations so far on working in Singapore:

Technician role. at NHG, there's this advanced version of the tech-check-tech system. In fact it's more like tech-check-tech-check-tech-check-tech, and then it gets to the patient....without a pharmacist check. Technicians here can do every step of the process and are usually the ones doing the patient counseling before giving the meds to patients.

Pharmacist role. Definitely not as developed as in the United States. Because pharmacists do not have to be the final check in the dispensing progress, they help out with filling, typing, or dispensing whenever it's busy. There are, however, "pharmacy only medicines" (e.g. famotidine) that only pharmacists can dispense, so a pharmacist duty include triaging patients who ask for those medications.

Pharmacists also run anti-coagulation and hypertension/diabetes/lipid clinics but it's still in a nascent stage and the demand for pharmacist interventions is low. Pharmacists have no prescribing rights, so for every warfarin dosing change the pharmacist must first call the patient's doctor to get approval. This gets very inconvenient when the patient is sitting next to you and the doctor cannot be reached.

Languages. People here are so incredibly fluent in multiple languages and dialects. Bilingual (usually English and Chinese) is the norm, but someone like my pharmacy manager can effortlessly switch between English, Mandarin, Cantonese, Hokkien, and Malay. I'm currently learning to do inhaler and warfarin counseling in Cantonese, my goal is to do one anti-coagulation clinic session entirely in Chinese. Haha we'll see about that....

Work ethics. I am constantly amazed by how hard everyone works. At NHG pharmacies, the average work week is 42 hours (which means working on Saturdays!). The staff stay late and some are on their feet constantly but they rarely complain (contrary to my work experience in the US!)

The picture I have above is of the staff practicing their dance for "Family Day," a corporate-sponsored team-building day. It's definitely fun working with these people!

Anyways, today I have the day off because it's Vesak Day (Buddha's birthday)...so I'm off to the Singapore zoo and night safari!

Intern in the ‘ship part 2

One word: busy. Retail is busy at least at my store. I did expect to be busy, but it is always different when you are actually in the flow of work. I have been doing pick-up, production, and drive thru for my first couple of days. I am starting to learn how to work the computer system for looking up customer’s information and refill requests. There is a ton of little things customers want like knowing when their next refill is to wanting to pick up a prescription with new insurance which takes time to enter and process. The pharmacist and techs have been great to work with. They help me out whenever I have trouble and they love making the work day enjoyable. One day I actually knocked over some food on the floor but the pharmacist wasn’t too mad. He actually helped me clean it up when he got a moment of freedom.

One thing I have not mastered yet is insurance problems. Once we get prescriptions we type them into the computer and run it through the insurance system. The system will shoot back a response with a green or red light. We like seeing GREEN lights. When a red light pops up, we have to see why it is rejected to see if we can adjust anything to make it work. The more experience technicians are quick with the computer system and can determine if anything can be done. No one wants to be the person who says to the customer “your insurance did not cover this prescription.” Even though we do not control the payment, people still vent. Luckily, I haven’t experienced someone blowing up on me. Most people are annoyed but sensible. Next week, I will be working the drop off station and some new experiences!

AmCare at the VA

Hello, all,
My name is Garret Smith an incoming P4 student and I am an intern at the VA Medical Center in Battle Creek Michigan. The Medical Center has around 235 inpatient beds most of which are filled with psychiatric patients as well as substance abuse and post traumatic stress disorder patients. Being a Veteran's Affairs hospital the patient population is fairly limited, however it is a population that is needing and deserving of our services.
This summer I will be working with the clinical team in the pharmacist-run ambulatory care clinics. The clinical pharmacists at the VA are in a fairly unique position in that they have prescriptive authority for their patients! Clinics are offered in anticoagulation, hypertension, dyslipidemia, and diabetes. If a veteran has one or more of the aforementioned conditions their physician can refer them to our clinic where we the pharmacists are in charge of all their medications related to those conditions.
Using this team approach much of the patient load is shifted off of the primary care physician and patient care is greatly improved since we can see patients much more frequently than 3 to 6 month wait to see the doc.
Today was my first day, so stay tuned for more info on our clinics as I delve deeper into the VA system!
-Garret

"You probably don't know what you don't know."

One of the pharmacists expressed this quote to my fellow interns and I at orientation, and after my first week in in-patient pharmacy I have a feeling this will be the theme of my summer!

Hello Readers! My name is Kari Horn and I am a P2 at the University of Michigan College of Pharmacy. My internship this summer is right here in Ann Arbor at the University of Michigan Hospital in the In-Patient Pharmacy. Specifically, I will be working in the C.S. Mott Children's Hospital. I hope to give readers a unique insight into the world of hospital pharmacy from the perspective of a pharmacy student.

After a very relaxing week off after final exams, we officially started our internship Monday May 9. The time off was nice, but I actually found myself getting bored with the abundant amount of free time I had, so I was definitely excited to get back to Ann Arbor and start my new position.

Our group of new interns started on Monday with a Michigan Traditions and Values (MTV) Orientation for all new Health Systems employees. It was nice to interact with employees in other areas of the UM Health System, and we learned a lot about the mission, values, and policies to abide by at the hospital. One idea that was stressed in this orientation is doing our best to assist patients and their families. If we see someone who looks lost or confused, we should go out of our way to help them find where they are going. This becomes critical in a hospital system the size of Michigans. Our group of interns determined that in the first few days we might be the ones needing help navigating!

Tuesday and Wednesday, the group of interns went through department-specific orientation with pharmacy services. These days were filled with lots of introductions and information. One thing that our group was very excited about was being about to wear scrubs. I've attached a picture of me and a fellow intern/P2 Erin Dukarski in our new scrubs and pharmacist intern badges.

Thursday and Friday, our group of new interns split up to train in our respective areas. Mine was being the "runner" in Mott Children's Hospital. Mott is connected to University Hospital (as is the Cardiovascular Center and the Cancer Center), so it was easy to find and get acclimated to. The day shift starts promptly at 7am with many tasks to get done right away. The runner first checks the messages. Messages are sent from the different floors to the pharmacy to order IV's and other medications. The runner checks these and relays them to the rest of the pharmacy to fill the order and get it out to the patient. Then, we quickly go on a "run". This happens at the beginning of every hour. "Runs" consist of taking all of the medications to the floors (NICU, 7, 6, 5) and getting them to the proper place. Depending on the floor, the medications might go to different places. One thing I am still in awe of are the giant Omnicells in each of the units. Omnicells are Medication Dispensing Systems that hold a variety of medications. Controlled medications are always kept in Omnicells, and depending on the floor other medications are placed in here too. The Omnicells require a password to unlock and keep a very careful inventory of medications, so there are no mix ups or lost medications. This is critical to reduce medication errors and lost inventory. If medications are not delivered to Omnicells, they might go to patient bins in the medication rooms on the floors, or in the refridgerator if needed.

With the help of my trainer, I quickly developed a system for each run to make the process more efficient. One thing I really enjoy is because we do a run every hour, we get to see the familiar faces of the other healthcare professionals and patients and families.

In between runs, we fill prescriptions that come into the pharmacy. Being a children's hospital, Mott has a lot of unique dosing and dosage forms. The dosage of a diuretic will be infinitely smaller for a neonate than the dosage for a regular 150 pound adult. Many of the doses are also drawn up from oral bulk solutions, so I got to put my compounding skills to the test and make some solutions! I also found out that taste is a factor, so flavoring is also routinely added to oral solutions.

One thing that is very apparent is you are always busy when working in the hospital pharmacy. There was never a time when I had nothing to do! I really enjoy the fast-paced atmosphere of the pharmacy. Before I knew it, my shift was over and it was time to go home. I also really enjoy the fellow technicians and pharmacists working in Mott, which makes coming to work fun.

I learned so much from my first few days of training, and I am excited to continue on Monday. Stay tuned for more updates!

The ABC's of Managed Care

Hello everyone! My name is Bernie Marini, and I am an incoming P4 who will be doing an internship in managed care this summer at Blue Care Network (BCN). Yesterday was actually my first day, and it was definitely a change of pace from working retail. Managed care is a new world for me, and every day I am surprised by how attractive a career in Managed care might be. Since I (and you, maybe) are new to managed care, we'll start with the ABC's. Prepare to be Kindergartner-ized (I'm an author of a blog now, so I can make up words):

A: Acronyms - Managed care is FULL of acronyms. It's like learning a new language. At first, during meetings, I was pretty lost - terms like ERISA, ECRI, HEDIS, MAC, CFI, PREFALT, PCOT, AGL, FAIR, FACETS, and NCQA just flew over my head. It's made for a difficult start, but I'm starting to get the hang of it. I now know that PREFALT letters are those that are sent to providers when a PA is denied, letting them know what the preferred alternatives are. If I'm feeling ambitious, I might make a glossary for future interns by the end of the year.

B: Boring? Not so much. Every day is completely different. There are a lot of meetings in managed care, but they vary greatly from day to day. Today I attended my first webinar on a successful safety initiative in the Philadelphia area known as the Partnership for Patient Care. I had another meeting about compounding fraud, and another one discussing branching logic built for certain medication prior authorizations (more on this later...). I also am being assigned a different project just about every single day. I'm currently working on several short informational stories and brochures regarding COPD guidelines for both providers and patients, to improve compliance with NCQA guidelines. Next I'll be working on a presentation for the members of the Chrysler Automotive group on their medication use within the health plan compared to all other BCN members.

C: Clinical - One cool part about this internship is that I have my very own cubicle, and I get to work right next to the clinical pharmacists there....wait... whaaaat? Clinical Pharmacists? In managed care? That's right, BCN employs many clinical pharmacists, and much of the work done at BCN is very clinically based. The pharmacists have to create the branching logic for prior authorizations and other formulary rules regarding medication selection by members of the HMO. For example, let's take the hypothetical example where a doctor writes a prescription for tizanidine (Zanaflex), a muscle relaxant. Because of safety concerns with tizanidine, this would require a prior authorization, and the form that the doctors fill out asking questions such as "has the patient tried cyclobenzaprine (Flexeril)? (Y/N)..." is created by clinical pharmacists. The answers to these questions determine whether or not the prior authorization is approved. These safety and efficacy decisions concerning formulary rules and prior authorizations are one of the the many responsibilities of clinical pharmacists at BCN.

I think that's enough ABC's for today. Stay tuned for more adventures in managed care!

Next week: D, E, and F - get excited.

-Bernie

Abbott Laboratories

Hello World. This is Eric Zhao (incoming P4) checking into the Summer Experiences blog. I'll be interning at Abbott Laboratories in the Regulatory Affairs Department this summer, and I'll do my best to give you a taste of what the pharmaceutical industry has to offer.

Quick Note: Due to Abbott's new social media policies, I have to wait for clearance before I begin posting any details, so stay tuned.

Abbott: A Promise For Life
Abbott Park, IL

-Eric Zhao