APPE Reflection: Advanced Community & Enhanced Clinical Services

As with any new rotation, I was very nervous going into this one. However, I had an amazing experience. I got to do things during my community rotation that I feel like a lot of people don’t get the chance to do.

What were those things? Lots of clinical services! I worked with several of our Chronic Care Management (CCM) patients and was able to call and check in on them and see how they were doing with their chronic conditions and how they were dealing with COVID. This is a task that I feel not many people relate to pharmacists, but we are in the perfect position to do these types of services! It’s important to check in on these patients and make sure that they do not have  any pressing issues with regards to their medications or their health in general. Pharmacists partner with physicians to provide these services to their patients. Another important clinical service that I was a part of was Medication Therapy Management (MTM). This involves calling patients and making sure their medication regimen is up to date, they are adherent to their medications, and they are not having any unwanted side effects. It’s important to make sure patients are taking the medications as they are prescribed to them. 

I also participated in 4 flu shot clinic days where I was able to give ~200 flu shots to teachers and other government employees. 

Aside from the clinics, I also gave flu shots, shingles shots, pneumonia shots, and tetanus/diphtheria shots in the pharmacy. 

I also did a lot of blister packaging. For those of you who may not know what that is, it’s where the pharmacy packs all of a patients medications in a weekly or monthly pack with the foil backing to so that the patient can see that they did or did not take their medications on a certain day. Not only did I pack them, I was able to check a few that my preceptor packed (to get experience actually acting as the pharmacist) and looked through patient charts to make sure that their medication regimen made sense. I was able to find some areas where the packs could be improved and was able to prevent some medication errors.

I was able to also check a few prescriptions (with my preceptor) to make sure I understand what it’s like to actually be the pharmacist.

Here’s a couple pie charts that show some of the things that I was able to do over this rotation!

August Patient Care Tasks
September Patient Care Tasks

I really, really enjoyed my time at this rotation site, and I’m so excited for my Ambulatory Care rotation next month! 

Stay Golden,

Emily

APPE Reflection: Critical Care

I was very intimidated going into this rotation because it is only my 2nd APPE experience and the CCU is such a fast-paced environment. However, I have learned a lot over this rotation, and I had the best experience I could have imagined. My confidence in making recommendations to providers has increased significantly, and I was able to do a lot of independent learning.

During the first week, I had my first counseling experience of the month. I was able to counsel a patient on a new prescription for warfarin. It was a great experience because there are so many different things to consider when counseling on warfarin (diet, bleed risk, goal INR, etc).

I also had my first ED shift of the month this week and was able to complete several medication histories as well as make calls to pharmacies to gather information/cancel prescriptions that were sent to them by mistake. It is the job of the ED pharmacist to make calls for patients who tested negative for COVID and make sure that they no longer had a fever. I was able to practice with this on week 1.

I witnessed my first rapid sequence intubation during week 1 and was able to assist the pharmacist in drawing up medications to make sure it ran as smoothly as possible.

Week 1 was also where I began rounding every day on the CCU. Every day, I spent half of my shift sitting on the unit by myself and assisting with any medication related questions that the nurses/providers may have. Of course, being a student, I had to report to my preceptor with all of the recommendations that I had to make sure they were appropriate before recommending them to the provider.

Moving on to week 2, I was able to dose a new start vancomycin in a patient and adjust a heparin drip based on the patient’s aPTT level.

Week 2 was also where I had my weekend ED shifts. I completed 7 medication histories, 16 negative COVID callbacks, and another intubation.

The rest of the month was pretty chaotic. I attended 4 rapid responses, 2 codes, rounded on a total of 35 patients, dosed and prepared TPA, and made daily recommendations to providers. I pretty much handled the CCU patients on my own, with verification with my preceptor.

My big projects for the month were to present a case presentation on a COVID patient that had been in the CCU for most of my month long rotation and create a reference sheet on how to treat hypertensive crises.

I also had 1-2 topic discussions a week on critical care topics such as FASTHUGS, Sepsis, the ABCDEF bundle, RSI/NMBA, PADIS, and ACLS.

The hardest part of this rotation was experiencing codes and seeing how intense and emotionally draining they can be.

I have nothing but good experiences to report for this rotation, and I’m so sad to be leaving this hospital until January. I have really connected with the pharmacy staff here and really have started to feel like family. I hope to have as good of an experience during my Ambulatory Care and Community rotations that I have over the next few months.

I will continue to keep you all updated with all of my rotations!

Stay golden,

Emily

Preparing for Rotations

Hey guys! I’m writing today to list out how to best prepare to be on your A-Game when you start APPE rotations. Note: This is just what has helped me feel prepared as I go into rotations in May. Other things may work better for different people.

1. First things first, during the first 3 years of pharmacy school, study hard and study well. It is beneficial to work hard to get short-term memory into long-term memory so that you remember all the important stuff for all of the years ahead of you in your career. One of the ways that I do this is to make Quick Disease Fact Sheets after each disease state (or set of disease states) tackled in pharmacy school. I have discussed these before and the link to that blog post is here. You can also do the same thing with specific medications or classes of medications to make sure you remember the BIG, IMPORTANT points.

2. Second, it is important to continue studying, even when you begin rotations. What has been beneficial to me is to buy an RxPrep book (several years old) that was relatively cheap on Amazon. I am going through these topics nightly so that I’m well versed in what I need to know. We do not receive our RxPrep book for the current year until around September/October, so having the older model around before that comes will prove worthwhile.

3. Stay organized. It is very important to remain organized as APPEs are approaching. You should know which rotation is coming up when so you know where to focus your energy in the week or so leading up to that rotation. For example, if your first rotation is a cardiology rotation, it would be a good idea to brush up on the cardiology disease states before heading into that rotation.

4. Be prepared to be wrong or to not know an answer. It is important to be okay with not knowing everything. As pharmacy students, a lot of us are worried about being seen as ignorant. However, the preceptors on rotations understand that it is impossible for us to know everything about the world of pharmacy. A lot of that comes with being in the career field itself. A lot of the time, they aren’t testing our knowledge, but are testing our ability to admit when we don’t know something and our ability to look it up in a reputable source. This is not to say that they don’t expect us to know something… I mean, if they ask you what the brand/generic name or indication is of something… you NEED TO KNOW that.

5. And last but not least, the most important way to prepare for APPE rotations is to just trust yourself and breathe. It will all be okay. You’ve got this. WE’VE GOT THIS. I’m right there with you. If you ever need anything, feel free to reach out.

And as always…

Stay Golden,

Emily