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.

Getting ready for pharmacy school when you’re in high school

One of my favorite questions to ask current students is: when did you get interested in pharmacy as a career? The answers always vary; some students decided on pharmacy in college, whereas others knew as early as middle or high school that pharmacy was the right field for them. If you’re in high school and thinking about pharmacy as a career, that’s great! You’re ahead of the game and have plenty of time to prepare for pharmacy school. Here are some things to focus on now:

  • Take advanced coursework in math and science. If your school offers Honors, AP, IB, or dual enrollment classes, challenge yourself to take hard classes (and do well in them). Taking advanced courses in high school will prepare you for our prerequisite courses and ultimately our curriculum.
  • Talk to your pharmacist; shadow if possible. Anytime you or your family has to go to the doctor or pharmacy, make an effort to talk with the pharmacist. If you let them know that you’re interested in pharmacy as a career, I’m sure they would be happy to talk with you. Depending on the pharmacy, you might be able to set up a time to ask the pharmacist questions about their career or shadow them.
  • Find a passion. What do you like to do with your free time? Are you involved in extracurricular organizations, community service, a sports team, or a music ensemble? Finding a meaningful way to spend your time outside of school will make you more well-rounded. Your passion doesn’t have to be science or pharmacy as a high school student (but that’s great if it is!).
  • Develop strong communication skills. Pharmacists have to be strong in math and science, but they also have to be strong writers, speakers, and overall communicators. Every day, pharmacists talk with patients and health care team members including other pharmacists, doctors, and nurses. Focus on your writing and speaking skills now, and it will help you in the future.

 

 

Student Perspective: My real-life application…

A blog post from Zafeira Sarrimanolis, Class of 2016.

Last weekend, I went to visit my grandmother and her huge greyhound, Victor.  After I told her a little about school, my life and gossiping about the rest of the family, she began telling me some stories – her favorite thing to do. She told me about how Victor had knocked over her favorite flower pot and broken it into a million pieces, how her grumpy neighbor had left an angry note in her mail box because a jug from her recycling bin had blown into his front yard, all about her favorite soap opera and about how dry and red her hands had been lately.  While all of her stories were interesting to me, she really caught my attention when she mentioned the skin condition of her hands. I immediately put on my lab coat, figuratively of course, and started asking her some questions.

My grandmother told me that she had not been using any new lotions or hand soaps lately, hadn’t worn any new gloves or mittens and hadn’t been doing any intense cleaning of her shower or kitchen with bleach. I’ll admit, I was a little stumped and kept looking at how dry, red and irritated her hands appeared.  My grandmother, of course, brushed it off saying everything was fine and brought me a piece of chocolate cake. While eating way too much, I remembered how much my grandmother loves to cook and bake.  Then, mid-bite, a light bulb went off and I started asking her about dish soaps she used when cooking and baking, because my grandmother HATES to use the dishwasher. She told me all about a new purple dish soap she had gotten about a week earlier in her favorite scent, and that she had been using it multiple times a day everyday. I nicely told her that this wonderful dish soap might, unfortunately, be to blame for the skin irritation she had recently been experiencing.  I advised her to stop using the new soap for a week and see if her hands got better or to use rubber gloves when cleaning dishes to avoid direct skin contact with the soap. I took her to the CVS up the street and helped her pick out a Eucerin Cream product that she would use a few times a day to help soothe her hands.

My grandmother was so thankful for the help and advice I was able to offer and promised to follow my recommendations, she even sent me home with another piece of chocolate cake!  While I have applied what I have studied in school at health fairs and blood pressure screenings through CAPS and other school organizations, this was the first time I had done so all by myself in an unorganized setting.  In this case, my grandmother was the patient who had a condition that she didn’t know the cause of and didn’t know how to treat.  I, as a pharmacy student and her granddaughter, was able to offer advice to help treat her condition and come up with a solution that would make her hands feel better and still allow her to do things she loved, like cooking and baking. This made me further appreciate what learn in school and also made me realize how important it is that I can actually apply something I have learned to a real life situation that helped a patient, in this case my very own grandmother!