Advice for a New Critical Access Hospital Pharmacist

[TheBlaah]

I'm a new grad with no prior work experience in a hospital other than rotations, and soon I will be starting a new job at a critical access hospital (rural 25 beds).

The hospital itself has been expanding alot recently, and as a result the pharmacy has begun implementing a number of new initiatives (antibiotic stewardship, 340b, ect). Being as small as it is, I will likely be involved in these programs as well. I would appreciate if anyone shed light on what to expect or advice on what to prepare for.

Any other advice for a new pharmacist going in would also be great. While I will be trained for a few months, I do want to hit the ground running.

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[tongiecc]

Though there will be similarities with other hospital jobs, yours will be unique in the sense that you will likely be one of, if not the only rph available at times, so definitely make sure that you get familiar with common IV drip concentrations (your institution will likely have standard ways of making bags, like 4mg levophed in 250ml, etc) and more importantly, what common rates/boluses are.

Really, they should guide you on this, but if you were to focus on a few things it could be: ABX (what covers what, basic kinetics (vanc/AMGs), anti coag (heparin gtts, LMWH/SubQ heparin for PPX and LMWH bridge/tx doses, warfarin, etc), and Critical Care. Get those down and you should have a great start (again, don't need to know it all, but at least make some cheat sheets of common ABX doses (and renally adj), common ICU drips, etc). Also might help to get Lexi comp, etc. on your phone to have access to general drug info in case you are out on the floors and aren't near a reference source/computer.

The final thing would be to get used to how the workflow goes (ie what computer system do they use, do they distribute more through a centralized model or via auto dispensing cabinents (pyxis, etc), also be sure to know how to 'triage' your orders (ie get ED or stats first, then others, standard order sets or PRNs can wait until you get more caught up in a given hour, etc).

Overall, you should be fine, this may be challenging at first, but it should be a great experience, especially with the fact that you will be exposed to some clinical programs that most hospitals this small wouldn't typically have. Just by asking this question you should be well ahead of their expectations and if you can get even a few things under your belt before you start training you should be in a good spot!

 

[Dred Pirate]

I started my career at a critical access hospital - I was the only RPh and I had been out of school 6 months - ya they were desperate.

A couple of questions
1. Are you the only RPh?
2. Is this part of a management company? Mine was, and it made the transition so much easier. I worked for a larger company and had access to all of their policy and procedures and their clinical staff for input.
3. what kind of oncall do you have?

You will have a huge learning curve. Tonglecc gave some good advice. If you are oncall - you will likely gets lots of calls depending on the acuity of your patients. Do yourself a favor and do lots of RN inservices and educate them when new changes are made and new drugs come out - it will save you headaches of cleaning up messes and getting phone calls at 3 in the morning.

Most importantly, be humble and know what you don't know - this is the hardest part for a new grad. You will quickly learn that so much of what you do on a daily basis was likely never covered in school - trust me, I was there.

Learn ACLS and post code care - you will likely have very little staff and you WILL be involved when these situations arise. I probably found myself in a code every month or so, even thou it is a small hospital. First one was a baby, ya, that sucked big time, and probably looked like a deer in the headlights. You are going to find yourselves in situations where you don't know the answer. Don't hesitate to take the time it takes to get it right, again, it will save you headaches in the end.

What state are you in? My state had a group that meet locally quite often, make contacts with local hospitals and use them for advice/help.

 

[TheBlaah]

Really, they should guide you on this, but if you were to focus on a few things it could be: ABX (what covers what, basic kinetics (vanc/AMGs), anti coag (heparin gtts, LMWH/SubQ heparin for PPX and LMWH bridge/tx doses, warfarin, etc), and Critical Care. Get those down and you should have a great start (again, don't need to know it all, but at least make some cheat sheets of common ABX doses (and renally adj), common ICU drips, etc). Also might help to get Lexi comp, etc. on your phone to have access to general drug info in case you are out on the floors and aren't near a reference source/computer.

The final thing would be to get used to how the workflow goes (ie what computer system do they use, do they distribute more through a centralized model or via auto dispensing cabinents (pyxis, etc), also be sure to know how to 'triage' your orders (ie get ED or stats first, then others, standard order sets or PRNs can wait until you get more caught up in a given hour, etc).

Thanks for the info. I plan on using micromedex+drug interaction+IV compatibility since I can still get it free through my school. Hopefully that'll be enough. I'm generally quick to adapt to EMR's so that's not a problem for me, but I'll make sure to learn how to triage.

I started my career at a critical access hospital - I was the only RPh and I had been out of school 6 months - ya they were desperate.

A couple of questions
1. Are you the only RPh?
2. Is this part of a management company? Mine was, and it made the transition so much easier. I worked for a larger company and had access to all of their policy and procedures and their clinical staff for input.
3. what kind of oncall do you have?

1. For the first 3 months, I won't be alone. There will be at least 1 other pharmacist.
2. Not part of a management company.
3. Won't be on-call for 3 months, but once I do start, was told I would be on call 1-2 times a month.

Yeah, my hospital has a maternity/neonate section too. A baby coding sounds terrifying. I'm in Georgia, but that meet would sounds interesting if we had one.

Edit: Corrected 6 months to 3 months