Students have their first immersion (pharmacy rotation) the summer after their PY1 year. They are placed in either a hospital (health system) or community pharmacy. For more information about our curriculum, click here.
Name: Bliss Green
Year: PY2 (Class of 2019)
Rotation: Health System
Where was your immersion located?
UNC Hospital, Cardiac ICU and Central Inpatient Pharmacy/Sterile Products Area
How did you prepare for your immersion experience?
Throughout the second semester of the PY1 year, there will be a few informational meetings that discuss the requirements for various immersion sites and important dates to make sure everyone is on the same page. I reached out to my preceptor about one month before my immersion to introduce myself, ask if he wanted me to have anything prepared for my first day, and set a location/time to meet him. Before my first day of my immersion, I made a trip over to UNC hospital to make sure I knew where to go and to make sure I could connect to the hospital WIFI. I highly recommend this, especially if you are prone to getting lost like me! You don’t want to be late or unprepared on your first day. Besides that, there was not extensive preparation needed before the start of the first immersion.
What was a typical day like?
For the first month of my rotation, I was in the cardiac ICU working with advanced heart failure patients alongside my preceptor, a PGY2 pharmacy resident, and a PY4 pharmacy student. I was assigned patients by my preceptor and followed them throughout their admission (I started with one patient at a time and then worked my way up 3 patients towards the end of the month). A typical day started around 7am. I would look up newly admitted patients on my unit, particularly patients labeled as “high risk for readmission” and perform a medication history assessment. Basically, I would print their list of medications, go find their room, and interview them on which medications they are actually taking and how they are taking them (as well as the last dose). I would then call their pharmacy to confirm fill-dates and make note of any discrepancies. After medication histories, I would open my assigned patient’s medical records on EPIC (UNC’s electronic health record database) and analyze any changes in labs, vitals, medications, notes from physicians, etc. from the night before. Based on this data, I would begin writing my SOAP note that included my assessment of the patient’s status and my proposed plan for each problem. I would then attend rounds with the entire medical team. This is where I could hear the discussion about my patients and make any medicine recommendations to the team. After lunch, I would present my note/findings to my preceptor and we would have a discussion/mini-lecture on the medications involved. The end of my day usually consisted of independent research assigned to me by my preceptor to support our discussion and my recommendations, updating my patient’s notes in EPIC, and discharge counseling in the cases where my assigned patient was ready to go home. I was usually finished around 4:30pm. Some days I also attended journal club, medication safety meetings, transplant discussion meeting, and lectures/discussions with other students/preceptors. I also spent one day with a nurse to witness their role and how they administer the medications. Lastly, I was lucky enough to shadow two serious operations.
What did you like about your rotation?
I liked everything about my rotation! Especially my clinical month in the cardiac ICU. Everything became so real when I stepped foot into the unit. I was challenged on a daily basis and never stopped learning. My preceptor was a phenomenal teacher and a true role model as a pharmacist/professional. I loved seeing how valued and respected he was as the medication expert on the healthcare team. The experience truly motivated me and made me excited about my career path.
What part of your immersion was most surprising and/or interesting to you?
I was able to shadow two open-heart surgeries during my clinical month in the cardiac ICU, which is something I will never forget. I witnessed the insertion of a Left-Ventricular Assist Device (LVAD) into a patient’s heart, as well as a complete sternotomy and aortic dissection. This was the first time I have ever seen a beating heart, working lungs, etc. It was amazing to see what the human body can endure and the advantages that science permits.
What was the most challenging part of your rotation?
The most challenging part of my rotation was the emotional aspect of working with advanced heart failure and the poor health status of patients in my unit . It was difficult to see how sick these patients were and accept the fact that most patients with this stage of the disease do not have good outcomes. I witnessed death and heartbroken families multiple times. It is easy to let your emotions bring you down in this type of setting but you have to remain optimistic and provide the best patient care possible.
Is there anything else you want to share about your immersion experience?
I also spent one month in the central inpatient pharmacy and the sterile products area at UNC hospital. This allowed me to see more of the “operations” side of heath system pharmacy. Within this month, I also spent five days exploring five other types of pharmacy (investigational drugs, pediatrics, specialty pharmacy, special formulations/compounding, and operating room pharmacy). It was a great experience and very beneficial to explore various different aspects of pharmacy. I was offered a job in the IV room/sterile products area after my rotation and am currently working there now!