Hello, my name is Caleb, and I am a third year student pharmacist at the Presbyterian College School of Pharmacy in Clinton, South Carolina. Among other activities at school, I am a student ambassador and serve as the President of the Student Society of Health-System Pharmacists (SSHP), which is an organization dedicated to advocating for and advancing the practice of pharmacy in the hospital and health-system setting.
Each year, three pharmacy students in South Carolina are selected for an honors program known to as the Veterans Affairs Learning Opportunities Residency (VALOR) program. The VALOR program is designed to attract academically successful students of Doctor of Pharmacy programs to serve our country’s veterans by working within the Department of Veterans Affairs. This program gives outstanding students the opportunity to develop competencies in clinical pharmacy while at an approved VA health care facility, and the program aims to provide students with experiences that cannot be achieved through positions in other areas of pharmacy practice. Annually, two students complete the program at the WJB Dorn VA Medical Center in Columbia, and one student is selected to complete the program at the Ralph H. Johnson VA Medical Center in Charleston. I was given interviews for both programs and was ultimately selected for one of the seats at Dorn VA. The other spot at Dorn was given to another PCSP student, John Ngo, who is currently a fourth year student pharmacist completing his advance practice rotations.
I am gaining clinical experience in the inpatient pharmacy setting, but I also have longitudinal staffing duties in the outpatient pharmacy. Although I have only been in my role for a few weeks, I have already learned so much from my experience. One area in which I work in the inpatient setting is known as medication reconciliation. Once a patient is admitted to the Dorn VAMC, a nurse gathers all of their medical history, including the medications which they are currently taking and includes this in the patient’s admission progress note. One of the good things about the VA system is that most of the patients get all of their prescription medications delivered by mail from the centralized VA pharmacy in Charleston, so we already have record of those prescriptions. However, we must be thorough and ensure that they do not get any other prescriptions filled at another pharmacy, take any over the counter medications, or take any type of dietary or herbal supplements. After this information is gathered, the patient is seen by a medical provider. After the provider reviews the patient’s information and performs an exam, he or she inputs his orders, some of which are labs and others are medications. This is where I come in.
I perform a thorough medication reconciliation review for all patients coming through whichever service I am working that day (e.g., pulmonary care unit). To start, I compare the medications that the patient took as an outpatient to the medications that the provider has the patient taking as an admitted inpatient, and I document any new medication additions, any medication discontinuations, as well as any dosage or delivery (e.g., oral to IV) changes to a patient’s medication regimen. After this, I calculate the patient’s creatinine clearance. For those of you who may not know, calculating creatinine clearance is our best way to clinically estimate a patient’s kidney function. Since the kidneys are the organ in our body that eliminates wastes, and since the majority of drugs are partially if not wholly eliminated via the renal route, kidney function is very important when it comes to designing dosage regimens. Persons with poor renal function must have adjustments made to their medication regimens since they will not be able eliminate most drugs from their bodies as effectively as someone with normal renal function. So, after calculating a patient’s kidney function, I review their current inpatient medications and document any recommended dosage adjustments.
My next step in medication reconciliation is documenting drug-drug and drug-food interactions. I place the patient’s medications into the drug interaction tool in Micromedex, which is one of our drug information resources, and make notes for the medical provider about all severe drug interactions. In the event of a contraindication existing on the patient’s current medication regimen, I document my findings in my med rec note and immediately call the inpatient clinical pharmacy specialist. From there, she gets in touch with the medical provider to get the situation corrected ASAP.
My very last step in the medication reconciliation process is to monitor for adherence, at least regarding the prescriptions that the patient takes as an outpatient that are delivered from the VA central pharmacy. For example, I have dates of their last fill, as well as the directions and the quantity of tablets that they were given. If it has been six months since the patient got their last 30 day supply, then they are not taking their medication like they should. I make note of all of the medications with which it is suspected the patient has not been adherent and include it in my med rec note.
Also, there are many residency trained clinical pharmacy specialists that work at the VA, and I will be spending time on their services throughout the next year. Examples of some of the specialized pharmacy services include psychiatry, infectious disease, geriatrics, oncology, informatics, primary (ambulatory) care, and the list goes on!
I know this post was a bit long, but I hope that it helps you to realize all of the awesome opportunities that exist for pharmacists today, especially in the health-system setting!
Written by Caleb, P3 Student
No comments:
Post a Comment