APPE Reflection- Surgery

Wow. I’m finally done with my APPE rotations. All that stands between me and my PharmD is a 1-month NAPLEX review course. This rotation was a really good experience. I feel like I learned a lot and was able to help improve patient outcomes.

You might be wondering what in the world a pharmacist or pharmacy student would be doing during a surgery rotation, so let me give you a little insight into what I was doing.

My preceptor and I sat on the surgical floor (near the nurses) and worked through our patients. We dealt with any pre or post-op medication issues or issues relating to a patient’s home medications. We made sure the patients got their antibiotics on time and didn’t get them if they were not needed. We also worked directly with the nursing staff to make sure the patient’s pain was well controlled. The main reason we sit with the nurses and not down in the main pharmacy is so that we can hear everything that goes on and can act fast when something happens.

Every day this month, I looked at about 7-10 patients, went through their medical chart, and completed a whole workup on them. A “whole workup” includes their background, the reason that they were in the hospital, any pertinent lab values, drug allergies, home medication list, current inpatient medication list, etc.

Along with working the patient up, I went to speak with them after their surgeries to make sure that their medication list that we have was correct (i.e. a medication reconciliation) or ask them any questions that we had about their medications.

I also spent a lot of time talking to the nursing staff and the providers to try and get antibiotics corrected or stopped on time or change doses of a patient’s medications.

Overall, this month I have become more confident making recommendations to the providers and talking to patients. I was able to get patients sent home on appropriate antibiotics and stop antibiotics when they were no longer necessary. I feel like I was truly able to make an impact on the care of the patients that I interacted with.

Over the course of the month, I also had 4 topic discussions with my preceptor (Post-operative Nausea and Vomiting, TPN management, Appendicitis, and Septic Joint Infections) and a presentation to the pharmacy staff on Post-Operative Ileus Prevention and Management.

Of course I also helped in several COVID vaccine clinics as well.

I cannot believe that it has already been a year since I started this journey.

I cannot believe that I’m almost a pharmacist. If you know me, you know that I’ve wanted this for as long as I can remember and now its ~6 weeks away (well.. I guess a few months until I’m licensed to practice).

I hope you’ve enjoyed walking through this journey with me.

I’ll keep you all updated on my post-graduate plans, and I’ll continue to blog as a practicing pharmacist.

Once I pass the board exams, be on the lookout for a blog post on helpful study tips!

Stay Golden,

Emily

APPE Reflection: Oncology

Let’s start this post on a high note… I absolutely loved this rotation! One of my favorites, but honestly, all of my experiences have been amazing. Also, I received both doses of the Pfizer-BioNTech COVID-19 vaccine during this month, so I will briefly be going over that experience.

On this rotation, I spent the month in the Oncology Clinic Pharmacy, where I assisted the pharmacist as well as nurse navigators and providers to ensure exceptional care for our patients. Oncology, if you don’t know, is a fancy word for cancer… or rather oncology is the study of cancer.

I spent some time helping the nurse navigator with educating patients about their new chemotherapy regimen.

On the very first one, I met a patient who I was able to help more than I knew that I could. She was a patient with newly diagnosed breast cancer and had already received surgical intervention and radiation. Through our conversation, I was able to get to know her better and learned that she was really interested in meeting the president of my university, Nido Qubein. She kept mentioning it, and at the end of our discussion, she mentioned it one more time stating “tell Nido I’m here.” After contemplating whether or not it was appropriate to contact him on her behalf and discussing it with my preceptor as well as the nurse navigator that was in the room when the conversation took place, I decided to email him. After he put me in touch with the appropriate person, we were able to get flowers sent to her on his behalf when she was there for her first treatment the next week.

She told me that she was so thankful and that it really made her day.

That is the first time that I felt like I had the opportunity to go above and beyond what is asked of a GOOD pharmacist or pharmacy student and give her something that she would likely not forget.

Some other things that I was able to do is sit in on some of one of the provider’s new patient visits. I got to learn a lot about ways to break bad news to a patient in a way that shows how compassionate you are and how you are truly there to help them the whole way.

I also researched and got answers for questions that providers had for me. I was able to teach them something new. This was a very rewarding process for me.

I spent a lot of my time in the clinic’s pharmacy assisting the pharmacist in being a part of a 2-check verification system. This was a way for the pharmacist to have someone check their calculations, requirements of diluting/mixing the product, and other pertinent patient information to insure that the patient was safe to get their medication that day and that it was made properly.

Another important aspect of my rotation was going through the concise treatment plans of all new patients to insure the therapy was both appropriate and safe and verifying those things with resources available to us.

Also, I participated in a mass COVID-19 vaccination clinic where we vaccinated >1000 patients. Along with that, I occasionally helped the hospital provide vaccinations at their smaller clinics (Here’s an article detailing the mass vaccination clinic).

Overall, I feel like I learned a lot over the course of the month, and I feel much more confident in my ability to understand oncology and various chemotherapeutic regimens.

Moving on, I’d like to talk a bit about my experience with the Pfizer-BioNTech COVID-19 vaccine. I received the 1st dose on January 5th. I didn’t have any side effects from that one. The injection site was a little sore, but it was less than I typically get with my annual influenza vaccine, so it really didn’t bother me at all. I got my 2nd dose on January 22nd (I know that was only 17 days after the first one, but it’s the only day I was able to get it). It is recommended to get the 2nd dose 21 days after the first. Anyways, the side effects that I had with the 2nd dose were severe pain at the injection site and swollen and severely painful axillary/armpit lymph nodes (on the same side) for ~3 days. I also had a mild headache and felt a little nauseous. I understand that my experience was a lot milder than some people, but I just figured I would explain what happened to me.

Anyways… I only have 2 more months of APPE clinical rotations and then I’ll be in my NAPLEX review class for 1 month and then graduation!

Also, I got a job offer!! I’m still waiting for a community residency to get back to me so I haven’t accepted yet, but it really seems like a great opportunity!

I’ll keep you all updated on that process.

Stay Golden,

Emily

APPE Reflection: Entrepreneurship

Originally, my November rotation was supposed to be a medical mission trip to Jamaica. However, because of COVID, the whole thing got cancelled. While I was disappointed at first that I was not able to go on that trip, this rotation was amazing, and I really learned a lot about myself.

This rotation was designed for us to be as independent as possible. We were tasked with creating a new pharmacy product or service. Throughout the whole rotation, we worked on this project and presented it on the last day of rotation. I’d give you my idea, but then you may steal it, and I actually might act on it in the future.

We were also tasked with choosing a book on innovation to read throughout the rotation and come together weekly to discuss what we learned from the book with the other students and our preceptor. I chose “The Innovation Stack” by Jim McKelvey (co-founder of Square credit card readers). This book was a great read and made me think a lot about what it means to be truly innovative in a world where we are trained to copy.

We also each watched an episode of Shark Tank and summarized it to the group. I think this was critical to the process in that we could see how people were really able to sell their products just based on their pitches and how some flopped for the same reason.

Overall, this experience was great and something that I definitely needed since I would like to own my own independent pharmacy in the future. It opened my eyes to the possibilities of creating a new product, business, or service and rolling it out.

I’m excited to finally have a month off of rotations, and I know I’ll be well rested and ready for my Oncology rotation that starts in January.

Stay Safe and 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

APPE Reflection: Advanced Hospital

First things first, I’d like to mention that I am extremely blessed to be granted permission to continue onto my APPE rotations even in the midst of COVID-19.

This was my first APPE rotation, and I can honestly say that I had an amazing experience. It was better than I could ever have expected. I was not only able to see how to complete orders in the pharmacy, I was able to complete a lot of clinical coursework and attend a lot of meetings.

Throughout my first week, I worked on improving my ability to work through the pharmacy system and find important information in the patient chart. I wrote several brief SOAP notes on the patients that I worked up. On Friday of the first week, I did a lot of research on remdesivir and its dosing because we had a COVID positive patient that we were going to start on remdesivir, and it was our first time gaining access to the drug. I helped one of our pharmacy residents put together a protocol on how we were going to administer it and store it, and even helped prepare a folder full of information on the drug to keep in the pharmacy for the pharmacy staff to refer to.

Then, on my second week, I worked in the main pharmacy for 3 of the days. I was able to assist the pharmacist in checking orders in patient charts, checking IV preparations, and checking cart fill to make sure everything was appropriate and given for the right patient. I really learned a lot during this time. Thursday and Friday I spent most of my time working up patient charts. I did some vancomycin kinetic dosing based on trough levels, warfarin dosing based on INR levels, and increasing/decreasing insulin regimens based on patient 24 hour BG levels. One of my biggest passions so far in pharmacy is diabetes management and education, so it was really exciting to actually be able to make recommendations on insulin regimens. I was actually able to document my intervention notes and discuss recommendations with providers.

On week 3, I was able to spend some time shadowing the pharmacy technicians. I really enjoyed this week because it is important to know exactly what the technicians are responsible for in the pharmacy, and the technicians at the hospital that I am doing rotations at are all really sweet and welcoming. I was also able to help compound oral liquids and a few IVs. On Friday, I spent my day in the Emergency Department. Our hospital is fortunate enough to have an ED pharmacist. I was able to help give recommendations to the physicians and research things that I was unsure of. I learned a lot down in the ED and was able to shadow some medication history reviews.

Week 4 involved more clinical work and a presentation. Monday was spent in the ED again doing similar things. I spent Tuesday up on the surgery floor working through new-start TPN dosing and making sure the post-surgery patients had all of their post-surgery medications on their profile. Wednesday-Thursday, I worked on the medical floor and learned a lot about my patients (because I was able to follow them for 2 days). I learned a lot about alcoholic cirrhosis and meningitis. I also gave a presentation on Malignant Hyperthermia on Wednesday afternoon to the pharmacy staff. Friday was my day off to attend my cousin Ben’s wedding.

Throughout the course of the month, I was also able to attend a lot of meetings with my preceptor and other pharmacists. This was very beneficial for me because I was able to see all of the responsibilities that pharmacists may have and the roles they play on a multidisciplinary team. I attended a meeting on the hospital’s metrics, a P&T committee meeting, and an antimicrobial stewardship meeting.

I can honestly say that I learned a lot from this rotation. I learned more than I ever thought would be possible in just 1 month.

I can’t believe I only have 8 more rotations to go! I’m super excited to begin my next APPE rotation, which is an inpatient elective in Critical Care. I’ll make sure to keep track of everything that I do so that I can keep y’all updated!

Until then…

Stay Golden,

Emily

You Will Prevail.

I don’t know about y’all, but I have been having a rough time maintaining my motivation this semester. I’ve been feeling an increasing amount of stress, and it’s been harder to manage than it normally is.

I’m writing this blog post because I’m sure that I’m not the only one who feels like this sometimes.

I want you to know that you’re not alone in this.

It is OKAY to admit that you get overwhelmed sometimes.

It is OKAY to admit that you are exhausted sometimes.

It is OKAY to be unmotivated sometimes.

It is OKAY to want to give up sometimes.

We all go through times when we feel that we can’t handle any more stress or work put on us. There is nothing wrong with you.

When you go through these times, think about why you put yourself into the situation that you are in. For example, when Pharmacy School gets overwhelming, I try to remember the reasons that I’m here. My passion is helping people. I’ve been on this path since I was 12 years old. This is what I have always wanted. I LOVE my profession. Those are the reasons that I’m in this profession. That is why I’m in school. If I keep these motivations in the forefront of my mind, it’s easier to get back to work and focus on what I need to do.

What is it that gets you up in the morning? What is it that motivates you? Try to bring that to the forefront of your mind.

And when in doubt…

Breathe.

You’ve got this!

Stay Golden,

Emily

Study Tips: Final Exams in Pharmacy School

In order to best study for final exams, I start studying ~3-4 days BEFORE I EVEN THINK THAT I NEED TO STUDY for an exam. It is critical to give yourself enough time. Here are some tips that I have to make that happen:

Make “Quick Disease Fact Sheets” or “Quick Medication Fact Sheets”

Example Quick Disease Fact Sheets That I’ve Created

I suggest for Disease States to focus on Key Features of the Disease, Pathophysiology, Risk Factors, Medication Management, and Non-Pharmacological Interventions. For Medications, I suggest focusing on Indication, Generic and Brand Names, Side Effects, and Therapeutic Class. It might be helpful to include pictures and charts.

Create a Rough Schedule for Studying

By this, I mean plan out which days leading up to exams that you are going to spend on each subject. For example: Monday: Pharmacotherapy 1, Tuesday: Research and Design, Wednesday: Integrated Pharmaceutical Sciences 1, etc.

Listen to Study Music

Here, I’ve attached a Study Music Playlist that I listen to on Spotify! It may be helpful to create your own.

Avoid Distractions

Put that phone down. Turn off that TV. Go somewhere quiet. Anything to help you avoid distractions.

Use a Timer!

There are lots of Study Timers online. I like the Pomodoro Method of Studying where you have 25 minutes of studying and then a 5 minute break. After an hour, you get a 15 minute break. Here is a useful online timer!

TAKE BREAKS

Going along with the last one, remember to take breaks! Your brain will stop absorbing information after about 20-25 minutes without a break because, as humans, we have a short attention span.

Avoid Cramming

This kinda goes without saying, but I feel like I still have to say it. Don’t wait until the last minute to study.

Make Quizlets or Practice Tests

This one has worked really well for me over the year. Being able to create my own questions with the material gets me thinking about it in different ways. I’ve even been able to anticipate almost the exact question that a professor is going to ask.

Focus on What You Don’t Remember!

If you spend most of your time going over the stuff that you got right on previous tests, you are going to neglect the stuff that you had a hard time with. The point of studying is to get a better grasp on the things that you don’t know or have a hard time remembering.

Get some SLEEP.

It is extremely important to sleep, especially during this time. It allows you to better retain information and leads to increased performance.

Good luck on your exams!!

Stay Golden,

Emily