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.
Beginning my adult ICU rotation, I have outlined the following goals and objectives that I have identified for the next 4 weeks:
1) Goal: Demonstrate necessary skill to provide direct patient care
a) Consistently, identify, justify and prioritize patient-
specific drug therapy problems.
b) Complete patient work up in 2 hrs including interview and
resolution of top DTP.
c) Increase efficiency of care through increasing patient care
These are quite fundamental and areas where I will continue to strive to improve to increase my proficiency in providing effective, timely and safe patient care and recommendations.
Specific to ICU, my learning objectives are to:
1) Understand the different types of shock and various shock treatments depending on etiology.
2) Improve ability in interpreting ABGs.
3) Electrolyte replacement, including magnesium and phosphate, to achieve normal
Reflecting on the two-week precepting skills rotation, I can see now how my previous DPC rotations had been preparing me for this. The process of providing direct instruction, modeling, coaching and facilitating as well as the art of recognizing the appropriate time for each have been demonstrated by my previous preceptors. Being on the other side, I could recall times were each of these methods was employed. I did my best to model this and gauge where my preceptee was at and to interpret her needs. Observing her progression was a rewarding process as she became more independent and curious when completing patient drug therapy assessments. As she became more independent, I was able to focus my attention on optimizing drug therapy for patients on the surgical ward and to practice balancing the two responsibilities. This is a valuable skill and the rotation increased my confidence as a clinical pharmacist as the two roles became easier to manage and in some ways complemented each other.
We were fortunate to be involved in the care of a patient with extreme shoulder pain, not yet diagnosed. While observing the ID physician’s assessment, infection appeared high on the differential however no organism had been isolated and there had been little response to broad-spectrum antibiotics. The purulent discharge was also new therefore infection was not necessarily the primary cause. When examining the CBC, one potentially significant finding was that the patient’s platelets where high at 600 x 10*9/L. The preceptee noticed this and was able to take concepts we had been discussing and recognize some possible causes for this including surgery and hyperproliferative disease. She hypothesized and began to investigate if this could increase her risk of VTE (a subclavian DVT was on the differential however a prior ultrasound, rated low quality, had been negative for this). Soon after this a repeat ultrasound was been ordered. The diagnosis of this patient remains unclear at present however it was extremely rewarding when my preceptee began to synthesize some concepts we had been discussing regarding laboratory values and apply these to a patient assessment.
With another successful rotation complete, on to my final project week. The main objective of this week: complete the data analysis and produce a poster to communicate my findings for the residency poster presentation.