The end of a journey marks the beginning of a new adventure!

 

The clinical teaching unit (CTU) really is an ideal learning environment for medical residents, students and in this case a pharmacy resident! CTU was fast paced learning environment. With the help of my preceptors I was able to adapt and transition into a more independent practice as expected during my final rotation in the practice residency. During this rotation it felt like each of my experiences in the residency had led up to this and each day I felt more prepared to contribute and to help optimize patient care. Although the learning will continue throughout my career this experience in CTU helped to build my confidence in independent practice. I learned when to reach out to colleagues (and in this case my preceptor) and when I felt I had enough information and knowledge to make a recommendation to the team. The volume and turn over challenged me to refine my process and each day was an opportunity to improve. I feel that this rotation enhanced my ability to contribute meaningfully to direct patient care as part of an interdisciplinary team.

This is the final chapter of this journey, thank you for accompanying me along the way. I do not yet know what the future has in store. I do know one thing for sure: I am ready.

Last but definitely not least: the Clinical Teaching Unit

My final rotation will be in the clinical teaching unit (CTU). I am excited for the experience of working as the CTU blue team pharmacist. The patients admitted to CTU are generally acutely ill and often have a clinically interesting condition to facilitate the learning of the medical residents and students. My learning goals for this rotation are to explore the pharmacotherapy and therapeutic alternatives for managing conditions such as pericarditis, diabetic ketoacidosis, cirrhosis, acute heart failure, metabolic acidosis and alkalosis. If you have been reading my ePortfolio at all, you’ll know that I generally speak my mind. So here it is: I am so excited for this challenge and learning opportunity that I have butterflies. So wish me well and I will update you soon!

Moving Forward to ID! Learning Plan, the Next Generation.

The Internal Medicine rotation allowed me several opportunities to formally and thoroughly present patients to my preceptor in a head-to-toe format. Improving my DTP identification and presentation skills were identified as goals for this rotation and these exercises were a fundamental portion in striving towards this. These were important practice opportunities and my goal moving forward in my upcoming ID and Antimicrobial Stewardship rotation will be to concisely and consistently present patients to my preceptor including DTPs and alternatives (within 20mins).

With the process of patient assessment and work-up coming into place, I would like to focus on maintaining a greater number of patients in my care. My goal will be 4 new patients in the first week (keeping in mind the short week with my BC Case-Wide Presentation on the Friday) and 7-10 new patients in week 2. During my second acute care rotation, I would like to maintain at least 15 patients at any given time. My goal for this rotation is to speed up my time to patient work up while continuing to follow my current patient assessment form. I would like to shorten this form where possible and my goal is to decrease my current patient work-up form by one half by the end of my up coming ID and Antimicrobial Stewardship rotation. I would love your suggestions regarding these goals or tips on how you set and achieved your own residency goals…seriously, the floor is open.

I have made some progress in my patient work-up skills and I would like to focus on maintaining the quality of the process while decreasing the time it takes. One thing I learned about myself in the past month is my own need to maintain focus and mental discipline when so many potential questions exist. Someone once said, “If I had an hour to solve a problem and my life depended on it, I would spend the first 55 minutes determining the proper questions to ask.” I think that may be a simple but key statement when faced with seemingly endless information. Focus on the right questions to solve the challenge at hand. This is true in information gathering, patient interviewing and DTP identification and alternatives…Lucky for me a duo called Hepler and Strand may have been thinking the same thing!

The whole (team) is much greater than the sum of its parts.

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.