Clinical Community Pharmacy

This month I am at Kerr Drug here in Asheville. I am on my Advance Community rotation, which for most people is just another retail experience counting to 30 and all that jazz. Not for me. I am doing Clinical Community which to me is really a lot more like ambulatory care.

The pharmacists I am working with this month, Anthony and J.J., are there to do more than fill prescriptions. They spend the day doing medication reviews in multiple fashions. Patients that have Medicaid get "locked in" to a pharmacy when they get more than 11 prescriptions filled in one month. Once these patients are locked in, a pharmacist has to review all their medications every 3 months. Also. Medicare patients qualify to meet with a pharmacist once a year face to face to review all their medications. Anthony and J.J. also see City of Asheville and Mission Hospitals employees on a semi-annual basis to review their diseases states and medications as part of employee sponsored Wellness Programs.

After reviewing medications and disease management with the patients, we also contact the doctors. We fax them a note of what we talked about and make any recommendations we see. Usually we are trying to find cost savings alternatives for medications to reduce spending on the part of the patient and reduce healthcare dollars. And shots! LOTS of shots. Today, alone, we gave 9 Shingles vaccines, 6 H1N1, and 2 seasonal flu vaccines.

And there's follow up and billing. We also call the patients a few days or a week or so after our meeting or after their doctor has made changes to their medications to check up on them. We see how they're doing, how they like their medications, and have a way to hold them accountable to the goals they set with us for managing their disease. The best part is we can bill for these services. It has been a challenge for community pharmacists to show they know more than how to check pills and that they can make a difference in the lives of their patients. The federal government has acknowledged, to some degree anyways, that these are valuable services provided by pharmacists and they should be reimbursed for their time. Pharmacists know a lot more than they get credit for a lot of times, so remember to ask your friendly neighborhood pharmacist for help and advice next time you have a question about your health.

Rotation Switch-a-roo

I realized last night that I hadn't told you all about my rotation changes. The hospital I was scheduled to go to in February cancelled my rotation (and another student's January rotation) due to "staffing loss." One of my roommates was there in October and saw the drama brewing -- it apparently got worse after her rotation. I'm glad the hospital told the school "hey we don't have time to teach students, they won't have a good experience, please find them something else" because I hate being in people's way and wasting everyone's time, but it really screwed up my schedule for a bit.

Things got moved and cancelled and moved again. They thought there was a simple fix, but then they got their stories mixed up and it wasn't so simple. So instead of advanced hospital in Hendersonville, nuclear in Charlotte, and advanced community in Asheville, my new schedule is:

February - Advanced Community, Kerr Drug, Asheville NC
March - Advanced Hospital, Angel Medical Center, Franklin NC
April - Nuclear Pharmacy, PETNET Solutions, Winston-Salem, NC

The biggest differences with this new schedule are that I won't be going back to Charlotte for a month, the kind of nuclear pharmacy is different than what I did this summer at my internship or last September which will teach me something new and allow me to network with a new company, and my advanced hospital rotation went from a 30 minute commute to and hour and half ONE WAY!

Is it April yet?

Today, I'll even settle for February.

I'm not loving 2010 too much so far. This rotation in the ICU is really not my favorite. I know last time I blogged I was all excited about my preceptor, well he's not as awesome as I had hoped. Really he's just too busy. He's responsible not only for order entry/verification but also all the consult notes, and not just for the ICU, for the step down units as well. So he really has a lot to do with getting ready for rounds and getting things entered for the nurses and making sure things are dosed right all the time. Doesn't leave much time for teaching (which he, by the way, not so subtly pointed out last week).

This week he's working evenings, so I have won myself some stand in pharmacists. Today my pharmacist hadn't worked in critical care for so long they had moved the unit to a new building (which is still underconstruction) and she didn't even know where she was supposed to go. Her direction for me for the day: do whatever you think will teach you something, because I don't even know what you kids learn in school these days. Gee, helpful. I'll have a different pharmacist tomorrow through the rest of the week, hopefully she'll be willing to share her knowledge a little more.

In addition to checking ICU off the list of Pharmacy Areas Suzanne Might Want To Work In Someday, I'm also feeling neglected about pharmacy residency interviews. Several of my classmates have already lined up multiple interviews and I haven't been invited to one yet. I did get a mighty fine (sucky) form email from Mission (my top choice) letting me know that of the 71 applicants for their TWO residency positions, they would only be inviting 15 people to interview and I was not one of the lucky ones. I am genuinely happy and excited for all of my friends that have interviews and wish them all the best of luck. I am also quite pleased with myself that I am not a trainwreck because I haven't been invited yet. I'm growing up. And I'll get a job too somewhere someday.

So yeah, today was definately not my favorite, but its mostly over. I'll read some of my fun book, eat a coffee gelato truffle, and just keep wondering... is it April yet?

Snow flurries

I know Western North Carolina is the mountains. I know the mountains get cold. And I know that I chose to come here, but its COLD!! For the past three days I have bundled up: gloves, scarf, coat, ear muffs (they never quite fit right, but I had them with me) and walked to and from work in the snow flurries. I start off with a jolt as I walk out the back door of the AHEC house and mildly adjust to the cold about a third of the way there. Then as I approach the traffic light to cross the street my ears start to feel like ice blocks that want to fall off. And finally, as I round the bend to walk up to the front door of the Heart Tower, a wind that was previously non-existant suddenly feels like a tornado of penetrating cold air that literally knocks me backwards. I shiver just thinking about it. At least today, I got my ear muffs to fit right and the flurries stopped on the walk home.

On a warmer note, my preceptor bought me a cup of coffee today! He's been on vacation and the pharmacist I've been working with hasn't been the most outgoing and generally made me feel like I was in her way and that she didn't have time for me. I'm still not super excited about this rotation in the ICU, but at least my real preceptor has a general interest in me being there.

A new year, a new month...

I moved back to Asheville tonight, along with 5 of my classmates. Our January rotations (#5 of 8) start tomorrow morning. I will be in the medical/surgical ICU (med/surg distinguishes it from neuro or trauma or burn, etc). I'm not really looking forward to it.

December was a nice month off from rotations. I had a very lovely Thanksgiving with grandparents, aunt, uncles, cousins, and friends, and a very nice Christmas as well. Lots of family parties, lots of football, and lots of time working at the hospital. It has been great to go back every Christmas and make money, I just wish I didn't need the money so much so I had more time with friends (I know, welcome to the real world - yeah yeah yeah). Santa brought several of my presents early for my trip to Vegas so not everything was a surprise Christmas morning, but it was all greatly appreciated.

For New Year's Eve, Thomas and I went to see Jeff Dunham in Uptown Charlotte. It was a really entertaining show. It was all new material and Jeff kept cracking himself up during the show which was a little funny to see. He does a great job creating his characters. After the show we went to a party at one of my friends from Queens' house. All in all, a good night.

So for the new year, I'm back in Asheville as I've said. As I drove back today, there were still snow remnants along the highway and in our backyard. The heat is apparently broken downstairs so there's a 20 (maybe 40) degree difference between floors. They did some repairs to the house over break and we have a new shower downstairs! It isn't any bigger, but it is nice and shiney and clean. Between the no heat downstairs, fighting with a book shelf for an hour, and realizing I left ALL my pants minus my suit and some jeans in Charlotte -- it has already been "one of those days." I'm looking forward to May and yet praying I learn a LOT between then and now.

Oh, I took WAY too many pictures in the last few months and haven't posted them all. Here is a photo album I made on fb to see them.

"You gotta know when to hold 'em, know when to fold 'em"

WELCOME TO THE FABULOUS LAS VEGAS!!! Last week, Thomas and I, along with a bunch of our classmates, went to the American Society of Health-System Pharmacists' Mid-year Clinical Meeting in Las Vegas. We were there from Sunday through Wednesday, although many of our friends went early to get a head start.

The conference was held at the Venetian, which was magnificent! (Here we are in St. Mark's Square) The convention/expo center had HUGE ballrooms and many floors of them, yet there were still too many people to go to every event. Even the student programming had "such an overwhelming turnout" that we were turned away (by the fire marshall, folks). Anywho, we spent Sunday going to different talks and lectures, learned once again that you shouldn't by a brand new BMW on graduation day, and that this continuing education thing is not going to be interesting in some cases.

Monday morning we heard from Dennis Quaid about the medical error that almost killed his twins. He's planning a documentary for next year, could be interesting, although I didn't find hime to be the best public speaker (and his analogies to plane crashes really made the flights home enjoyable). Monday afternoon and Tuesday morning we went to the Residency Showcase (think GIANORMOUS college/job fair) where we went to talk to the residency programs we're thinking of applying to. Pharmacy residencies are similar to medical residencies -- another year or two of training -- but they aren't required (yet) and aren't as long.

Tuesday afternoon we had some free time. We grabbed lunch at Paris, walked around Caesar's Palace, and played a little black jack at Bill's Gamblin' Saloon. We were up $65 when we walked away, but we went back later that night and lost $15 of that back. My father and stepmother bought us tickets to Cirque du Soleil's KA for Christmas so we made our way down The Strip to the MGM. We went up the Eiffel Tower and watched the Bellagio's water show and then went browsing around NYNY before the show.

I'm not a huge Vegas fan, but I can say I've been, and I walked away a winner. Now if only I had the money to eat at the big name restaurants while I was there! All in all, a good trip.

Rabbit Rabbit

My college roommate told me if you say "rabbit rabbit" as your first words on the first day of a new month, it would bring you good luck for the month. I never remember to do it first thing, but I usually remember later. It doesn't seem to do much for me then.

So its December and I'm back home in Charlotte. I have the month off from clerkships which is a nice break, but by no means "empty" or "free time." I've already gone back to work at Presbyterian Hospital as a technician where I've worked throughout pharmacy school. My big project for the month of December is residency applications. Pharmacists can do residencies just like doctors, only its shorter and not required by everyone (yet). Next week I'm going to Las Vegas for a few days for a HUGE national residency showcase (think monstrous college fair) and pharmacy convention. After which, I get to assemble packets of transcripts, letters of intent, and letters of reference to send in to apply for a one year ambulatory care residency. Interviews will be in late January - February and then the Match is in March (its all very much like sorority recruitment -- just on a national level).

Anywho, the last weekend in Asheville was nice and calm. Only one of the roommates and I were there. I went downtown on Saturday to watch the Holiday Parade. It was a fun, small town parade with marching bands, horses, candy for the kiddies, and floats! Oh, and Santa came at the end of course.

I got back to Charlotte just in time for Thanksgiving: complete with our own turkey and pilgrim!