My Immersion Experience – Bliss Green

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!

My Immersion Experience – Ryan Ragan

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.


ragan-immersion

Name: Ryan Ragan
Year: PY2 (Class of 2019)
Rotation: Community

Where was your immersion located?

Kroger Pharmacy, Durham (home store) and Raleigh.

How did you prepare for your immersion experience?

I prepared for my immersion experience by clearing my mind of expectations and preparing myself to say yes to anything they asked me to explore in the first few weeks. After that, my preceptor allowed me to tailor my experience to participate in unique activities or research interesting topics with more input.

What was a typical day like?

A typical day started at 8am, with the opening of the pharmacy. I would research unique drug information questions the pharmacists would encounter throughout the prescription verification process for about an hour before jumping into the workflow to help clear the queues and free up the technicians to complete other tasks or clean the pharmacy. When the daily order came around 9:30am, I would check in all the controlled substances for the pharmacist to sign off on. After lunch time, I would research more drug information questions that popped up while I was gone and keep working in the queues as both a technician filling prescriptions and as a pharmacist performing first checks on the validity and accuracy of prescriptions. Throughout the day, I would answer customer questions about prescriptions that I felt capable of answering or help patients make decisions abuot over-the-counter medications. I was also responsible for giving vaccinations to all patients that were interested in receiving one while I was there, so that added some excitement to the day.

What did you like about your rotation?

I liked the variety of the experiences I had. The team of preceptors at Kroger did a great job of breaking the static flow of community pharmacy work by realizing that staffing as a technician for 40 hours a day for 2 months would get boring quite quickly. As a result, a concerted effort was made to remove me from the pharmacy to participate in unique projects. I conducted employee health screenings many days, presented weekly news stories to various teams of pharmacy staff, and even made a trip to a retirement community to pre-screen patients for flu-shot eligibility. In an average week, I was at my home store about half the time only.

What was the most challenging part of your rotation?

The most challenging part of my rotation was recalling prescription drug information when talking with patients on an impromptu basis.

My Immersion Experience – Kristina Murphy

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.


murphy-immersion

Name: Kristina Murphy
Year: PY2 (Class of 2019)
Rotation: Health System

Where was your immersion located?

UNC Chapel Hill Hospital

How did you prepare for your immersion experience?

Before immersion, I did some basic research on the services my preceptors covered to become familiar with some of the disease states and drugs I would be seeing throughout the months. Additionally, I communicated with my preceptor prior to my start date to introduce myself and find out a little more about what to expect. Especially during your first immersion, it can be difficult to prepare as it is something you have never experienced before, but if I could give one piece of advice, it would be to trust yourself and the knowledge you have gained throughout your first year. It can be overwhelming at times, but you’ll start picking up on things you saw in class and relate it to real life practice.

What was a typical day like?

For the first month of my rotation, I was located in the Cancer Hospital Infusion Pharmacy also known as CHIP for my distribution/dispensing portion of immersion. I received the opportunity to learn about the verifying and dispensing process from technicians, residents, and pharmacists. Each day I was with a different employee and received the opportunity to see the entire process from various points of view. For my second month, I was part of surgical oncology, ENT, and orthopedic teams located in the Neuroscience wing at UNC. The beginning of my day consisted on reading up on the newly admitted patients from the night before that needed to be seen. After getting background information, I visited each patient and spoke them about their medications used at home prior to admission. I would then update their medical chart, assess the case and develop a plan. Towards the end of the day, I would meet with my preceptor to update them on any important details I found out from the interview and discuss how I thought we should proceed moving forward. It did require waking up early and staying long hours, but in the end my first immersion was very rewarding.

What did you like about your rotation?

I loved my rotation both in the CHIP and on an actual inpatient service! The dynamic nature of the teams I got to work with were incredible. One of my favorite parts of my clinical month was getting to attend rounds with physicians, nurses, social workers, pharmacists, and nutritional specialists. All patients on our service were presented every morning and the team worked together to update everyone on the status of the patient and address any new issues from the previous day while proposing solutions to improve their care. I learned a lot from my preceptors throughout my immersion and am still realizing how much exposure I received when topics I covered are brought up in class. I also enjoyed getting to know the pharmacists I interacted with and learn more about their career journeys. In the CHIP, I had the opportunity to learn from the night shift pharmacists who really took the time to teach and explain clinical details in oncology and even got to verify some orders (under their watchful eye of course). I really felt I could envision my future as a pharmacist and everything I had learn came to life for me.

What part of your immersion was most surprising and/or interesting to you?
I was really excited and surprised by the diverse population of patients I interacted with during my immersion. My experiences ranged from speaking to teenagers to a much older population with various backgrounds, cultures and medical issues.

What was the most challenging part of your rotation?

I think the most challenging part was learning what I could contribute and what role I could play as a first year student; specifically, when I could jump in and help staff and when I was not able during my first month. In the CHIP, hazardous drugs including chemotherapies were produced, however, as students we were not allowed to physically make these drugs making it difficult at times to sit back and watch.

My Immersion Experience: Ashlyn Norris

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: Ashlyn Norris
Year: PY2 (Class of 2019)
Rotation: Community

Where was your immersion located?

Morrisville, NC: Morrisville Pharmacy and Compounding

How did you prepare for your immersion experience?

There was not too much to do to prepare for the community rotation prior to my first day. Once I started I had to go through all of the trainings for the computer systems and medication review systems that the pharmacy used. I also had to familiarize myself with all of the OTC medications that were available and where to find them in the store as patients came in with questions or requesting certain medications.

What was a typical day like?

A typical day at the pharmacy as a Student Intern started off by checking the fax machine for prescriptions, refill request, D/C orders, hospital discharge summaries, etc. I would then enter and process the prescriptions and refill requests and give them to the technicians to fill. I would then update patients profiles with any medication changes and upload any labs or discharge papers. After all of the paper work was taken care of I would work on conducting Complete Medication Reviews for the pharmacy’s patients. This involved comparing the fill history for a patient to a new discharge summary or medication list from their provider. I would then call the patients and providers and go over any medication concerns or discrepancies that I found and update their profile with our conclusions. Throughout the day I would also answer the phone and speak to any patient that had questions.

What did you like about your rotation?

I had a lot of freedom to initiate projects as I saw fit in the pharmacy, which I really enjoyed. I was able to completely renovate the Pharmacy’s OTC selection and reorganize them based on their specific patients needs. The pharmacy served many diabetic patients so I was able to reorganize their diabetic supply area to make it easier to see what was there and what needed to be ordered, while also making it easier for technicians who may not be as familiar with the supplies able to find what they needed. I was also able to create a How to Store Insulin sheet to give to patients and caregivers on the proper storage technique for all of their different types of insulin.