It certainly feels good to have the 1st rotation under my belt…although it seems like the calm before the storm. All in all, I feel that I got more out of my drug distribution rotation than I had preconceived. Apart from doing the various drug distribution-y things such as “prepare and dispense medications safely and accurately according to institutional policies and procedures” and “accurately transcribe orders onto the patient’s medical record”, I had the opportunity to branch out a bit too. So one does not have to go back to the original post, here were my goals:
1. Develop an efficient process to processing and verifying drug orders – I think I have developed a flow for doing this. Name, 2nd identifier, allergies… then the rest is clinical. Screen the order – and NESA each order.
2. Become familiar with preparation and distribution procedures for parenteral medications in the hospital setting – which ones come premade from PDDC? Which ones need to be mixed? IVP, MED, or MEDM? Doesn’t only apply to parenterals…but I’ve been told it comes from experience.
3. Appreciate the role of pharmacy technicians and the impact of their scope of practice in the hospital pharmacy dispensary – see below.
4. Become familiar with reporting medication incidents from the hospital pharmacy dispensary – see procedure log. Reporting a PSLS was an interesting exercise.
And here were my objectives to meet those goals. Were they met?
– Prepare and dispense 3 medications safely and accurately according to institutional policies and procedures: ACHIEVED. See procedure logs. I got to be with a technician in various steps of preparing medications.
– Accurately transcribe 3 medication orders onto the medication profile of an inpatient: ACHIEVED. See procedure logs. Reflecting on my experiences, I think one week of order entry is way too short to have a working competency given the various idiosyncrasies of individual hospitals, but I can safely say that I have achieved this.
– Clarify 3 orders with physicians and other prescribers: I did not fully achieve this objective but it highlighted the difficulty in making completely informed clinical decisions from the dispensary. At least it encouraged me to be mindful of what I should find out in order to make a decision!
– Demonstrate the safe preparation of 1 IV medication: ACHIEVED (sort of?). I observed the preparation of various IV medications, including a few chemotherapy agents during my visitation to Burnaby Hospital. I do have some tissue culture (asceptic) technique experience in the past, but my muscle memory must be terrible and the technicians do it so quickly…that dexterity! Everything was very protocol based, and all your calculations, prep work, etc was done OUTSIDE of the hood. HOWEVER, if for some reason I was the only pharmacist on call who could do it and it was 2am…I think I could plug through it.
– Name 3 logistical barriers to providing clinical pharmacy care when pertaining to drug distribution: Only 3?? ACHIEVED. Not to say that it isn’t an efficient system. The hospital dispensary is like a well-oiled machine. However, things do happen. Unclear orders, porter delivery times, pass medications and the requirement for 24 hours notice, patient’s own medication ambiguities, incomplete/incorrectly filled out MedRecs… there are many things to keep in mind.
– Name 3 unique roles that the hospital pharmacy technician assumes to expedite safe and effective drug distribution: ACHIEVED. More like, “name a role the hospital pharmacy technician does NOT assume in the dispensary”. Ward stock, inventory, IV prep, you name it, they do it. My preceptor was mentioning that Fraser Health was moving towards centralized order entry. Not sure how that would work out, as it comes with the advantage of standardized order entry procedures, but some drawbacks as well. The techs or pharmacists who would be entering orders would not be following the patient, would not be screening for more subtle DTPs given the Hx of the patient, etc. However, the technicians basically run the show. They do the product check, preparation, most of the order entry (at least at ERH)…the pharmacists mainly deal with order verification in the dispensary, and most pharmacists are on the ward.
Project week (with an interesting ADS coming up on one of my interests… infectious diseases!)…then UBC summer didactic week…then clinical orientation.