"So will you be getting your master's next?"

I'll get to how my current rotation is going, and all the wonderful things I'm learning. But first, I wanted to take a second to explain the title of this post! Last week, we had a huge dinner party at my parent's house - aunties and uncles I hadn't seen in a long time were there, and we were all catching up. They were asking questions about my life..."Soo, when are you getting married?!" (umm, not quite even engaged yet)..."Are you working now?" (nope, still a student)..."So, will you bet getting your master's next?" (....WHAAT?!). This last question was what really got to me. But only for a second. I realized that the older generation (actually, the majority of people) know a pharmacist as an RPh (which I believe is a bachelor's degree). They don't know that a Pharm.D. degree is what current pharmacy students are getting...a doctor of pharmacy degree, and includes more clinically oriented courses. Anyway, instead of actually blurting out the initial "WHAAT?!" I explained that there would be no more schooling after this (yay!), because it is a doctorate degree, and that I'll be doing a residency because I'm passionate about a clinical career. The transition to pharmacists being seen as clinicians will take time, which is why it's so important to educate anyone and everyone around you about what it means to be a pharmacist.

Anyway, enough preaching. So my current rotation site is great! The clinic rotation was relaxing, since I wasn't busy all the time. Now that I'm back in the hospital, and the rotation site is custom to having pharmacy students, it's been nonstop. My preceptor is SO smart, and she's literally a super star on rounds. She just graduated from pharmacy school 2 years ago, and is already the trauma pharmacist at the hospital I'm at. Very impressive. I have a few tasks to do everyday:

1. Dialysis patients - I print out the list of patients on dialysis at the hospital, and make sure their medications are all renally dosed - the major ones I look for are the antibiotics. I've taken it upon myself to make sure there aren't any drug-drug interactions too - and I catch them fairly often. The major ones I keep finding are simvastatin with amlodipine and diltiazem. Since the guidelines changed, the max dose of simvastatin with amlodipine is 20mg, and with diltiazem is 10mg. There are others, but these are the most common ones that keep coming up.
2. Epidemiology reports - This is a print out of completed culture and sensitivitie reports for patients in the hospital. My job is to look at the clinical picture of the patient, and make sure they're on antibiotics/antifungals if needed, and if they're already on something, then to make sure they cover the bugs that grew out. I've made many interventions doing this so far. For example, we had a patient who was on day 18 of cefepime and day 12 of vancomycin. The patient had not had a fever in days, and did not have a white count. So I went to the chart, and looked at progress notes - and the plan was to discontinue the antibiotics on a certain day, but it was never done. So, finally...10 days later, they were discontinued. It bothers me when patients are getting medications when they're not getting any benefit from them - then it just becomes unnecessary chemicals in the body. Another intervention was when I identified a patient with MDR Enterobacter and a Staph haemolyticus wound infection who was on the wrong abx. I was able to talk to the physician and change the patient to the correct antibiotics. Today, one of my patients' C.dif result came back negative. She was on prophylactic Flagyl, but was never discontinued - so I made sure it was gone before the end of my work day!
3. Coumadin teachings - we get a print out of all the patients on coumadin in the hospital. The students are responsible for doing these coumadin teachings, since it is such a serious medication. They're very redundant, but it's been fun talking to patients. 
4. Vent rounds - Every Wednesday, the pulmonary doctor volunteers to come in and go through her patients on vents with the respiratory therapist and the pharmacist. I tag along too, since my preceptor is this pharmacist. So far, I've presented patients at two vent rounds - I make sure there's DVT and stress ulcer prophylaxis, PRN sedation and pain medications, make sure they're on the correct abx, etc. 
5. Go on rounds - I around on trauma rounds every Monday and Thursday. It's a sad hour in my opinion, since a lot of these patients are young. However, it's a great learning experience - I listen to see what kinds of issues my preceptor brings up, and 9/10 times, her suggestions are followed through. Everyone on the team, including the head trauma surgeon, is always interested to hear my preceptor's opinion, which makes me happy :D. 


By the time I've gotten through all my patients, dealt with the issues that I found while going through the charts, and finish my teachings...it's time to go home!