H-IPPE: Remaining Rotations

With classes starting tomorrow, I have run out of time going over my month-long rotations.  These sites were just as interesting and I enjoyed them as well.

Pharmacy Administration
On this day, I followed my Resident to all of her meetings.  UNC offers a two-year Pharmacy Administration residency with a Master's degree and a teaching certificate.  The wonderful ladies in charge of our month were both at the end of their second years.  My Wednesday morning started with a huddle with the Investigational Drug Service followed by a meeting about where the money goes.  IDS is not expected to make money, but somewhere the money that researchers pay for the service had been lumped in with other pharmacy accounts.  After that, we went to the opposite side of the hospital to observe an interview and a meeting about transitioning into a management role.  My favorite part about the last meeting was the source of her ideas - The Carolina Way by Dean Smith.

Central Inpatient Pharmacy
I was excited about the inpatient day because at the end of the month I would start working there.  This was a great introduction to where I would be spending every third weekend.  I won't say much here because I have a much greater experience in the department now that I am employed.  My rotation day started with a trip through the hospital filling Pyxis machines with patient-specific medications- take out expired meds and put in new.  Fairly simple.  When we returned I worked with the pharmacist checking medications that were being dispensed.

Controlled Substances
Also in the CIP, the controlled substances people deal exclusively with the list of drugs that require special supervision - opiates, benzodiazepines and viagra.  This day began with a trip around the hospital filling Pyxis machines with controlled substances = take out expired meds and put in new (sounds familiar).  We restocked the locked cabinets after a trip to the supply room.  The main difference here is that the numbers are taken very seriously.  If there is ever a situation in which there are less of a drug than expected, they have to contact the hospital police who investigate the missing med.  The Pyxis machines keep track of who signs in and the number of medication recorded in the machines.  When the number is off they contact the person before and the person after the number changes.  Usually it is just an accident, but it can have serious consequences - termination and criminal charges.  They take this area seriously.

Infectious Disease Consult
My second residency day was a short time with the Infectious Diseases consult.  In a hospital infections are incredibly serious.  A lot of those infections begin in the hospital - surgery opens up your first line of defense.  The consult group double checks the patients with an infection.  They help with diagnosis and identify the correct antibiotic or antiviral to treat.  There were some interesting cases-  HIV-patients starting chemotherapy or someone coming back from overseas with a case of malaria.  I am really interested in microbial stewardship.  The pharmacist can play a huge role in the hospital managing antibiotics.

Pediatric Satellite
Pediatric pharmacy scares a lot of potential pharmacists.  People seem distressed by the additional math involved in calculated doses for a wide range of patients.  They could be 3-kg newborn or an obese 16-year old.  The dose must be accurate in every case which means calculation.  Also, kids have a different metabolism and that can mean different standards from adults.  Working in Peds generally requires two-years of residency.  Kids also present another problem - they don't like taking pills.  The Peds satellite fills a ton of oral syringes.  In this case, you have to consider the taste.  I tasted several of the medications for an iron supplement that felt like a bloody mouth to cherry- or bubble gum-flavored meds.  I also went on rounds with the respiratory group in the Children's Hospital.  They have a large population of kids with Cystic Fibrosis.  Having taught about CF for many years, I was interested in meeting some of the kids and seeing how they are treated.

Oncology Satellite
My afternoon in the Cancer Hospital was similar to my day in the Sterile Products Area.   Primarily, the technicians fill IV bags for the Infusion Clinics.  In this case though, everything is hazardous.  They work in a sterile room but they don't use open needles.  They have a special needle system to prevent sticks.  I was most interested in the names of the drugs - it was essentially a list of Biochem presentations.

With that, I believe I have finished all of the rotations through the Hospital-IPPE.  Tomorrow, PY2 begins with Drug Literature and Pharmacotherapy.  Then I have to give up my short lab coat of rotations for the long, OSHA-approved lab coat of the PCL.  The first year was great, and I only expect more for the second.