Another great rotation complete! My first acute hospital rotation was a fast paced, dynamic environment and it challenged me to prioritize as the day and weeks progressed. I quickly learned to shorten the comprehensive SOAP notes from my ambulatory rotation to highlight the essential points. My preceptor introduced an activity that was particularly useful in this. She handed me 4 sticky notes, one for each ‘S’ ‘O’ ‘A’ ‘P’….needless to say that it was a lesson in conciseness (and micrography, but that may have been cheating on my part). The interview process was similarly condensed and I was challenged to adapt my style to meet patient care needs. Not only were there time constraints but also numerous distractions for both the patient and myself. These included other healthcare team members and the unfamiliar environment (talking from a hospital bed is not quite the same as from across the kitchen table).
It was during this rotation that I was truly able to complete the initial patient intake work-up and follow-through to discharge in an acute care setting. It was an evolving process and gave me an appreciation for the need of timely patient discharge planning and counselling. As a pharmacy resident, I was able to play a key role in providing patient information and education. Just as importantly, clear communication of medication changes made during hospital admission was essential to ensuring seamless continuity of care. My experiences working with patients post hospital admission in ambulatory care remained fresh in my mind and reinforced the importance of conscientious discharge planning. This included everything from medication coverage to the logistics of medication administration.
In this rotation I was provided with many opportunities to conduct literature searches, discuss pertinent studies and use these to answer patient specific drug related problems. As for my therapeutic knowledge, I gained greater insight into many disease states including dementia, delirium, pneumonia, rheumatoid arthritis and ulcerative colitis to name a few. My favourite part about residency is not only applying theoretical knowledge, but also gaining the clinical experience that cannot be taught in a classroom. This may sound cliché but I assure you that the clinical picture of acute delirium cannot be accurately described in a textbook.
During my first acute hospital rotation, I was able to more clearly identify the role of a pharmacist in the healthcare team. Through rounds and day-to-day interactions with the physicians, I realized the unique contributions pharmacists make. These include valuable suggestions for improved patient care and safety. Over the weeks, the dynamics shifted as the physicians and team felt more comfortable and confident seeking and discussing the recommendations. This included everything from creating a safe tapering schedule of primidone for essential tremors to managing sleep in an elderly delirious patient with severe bradycardia. From this collaborative effort I was able to both contribute and to gain some clinical pearls from my colleges. I gained a further appreciation of the value of a team approach to patient-centered care and remain convinced that the whole (the team) is much greater than the sum of its parts.