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What do you carry in your pockets on rotations?

Discussion in 'Pharmacy' started by MackandBlues, 02.14.12.

  1. MackandBlues

    MackandBlues

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    What sort of references do you have/make that you carry in your pockets on rotation? Like a loop diuretic conversion chart? or renal dosing antibiotics? Thanks!
  2. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Usually I start off the rotation with just my phone as a reference. And by the end of the rotation I probably have a bunch of tables typed up for reference as well.
  3. MackandBlues

    MackandBlues

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    what sort of tables have you made that were helpful? that's what I'm trying to get at....
  4. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Usually dosing charts and conversion tables.
  5. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member Administrator SDN Senior Moderator

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    I just bought Tarascon Pocket Pharmacopoeia and Sanford Guide. Probably overkill, but what can I say, I don't feel prepared for rotations, so I compensated by buying stuff I will probably never use. :oops:
  6. bacillus1

    bacillus1

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    Nothing. Just the lexi-comp that's on my phone.
  7. joetrisman

    joetrisman

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    This will be me in about 4 months
  8. kvl1027

    kvl1027 Member

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    Sanford Guide, maybe any Abx dosing protocol that the hospital may have. Also an antibiogram from the hospital would be helpful if they have one. Also a pack of breath mints.
  9. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member Administrator SDN Senior Moderator

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    Congrats! :thumbup:
  10. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    Left lower pocket
    1) Sanford Guide
    2) Calculator (i know, i'm old school, using a phone looks like you're texting)
    3) Precedex dosing card ripped from the booklet

    Right lower pocket
    1) Folded half sheets with patient work-up/rounding notes
    2) Granola bars
    3) Institutional dosing guideline cards/laminated sheets
    4) 3ml NSS flush syringe

    Breast pocket
    1) Fine point 0.3 black pen
    2) 0.7 point blue pen
    3) Alcohol spray pen
    4) iPhone
  11. Ackj

    Ackj

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    Whatcha use that for?
  12. pharm B

    pharm B Phar Noir Moderator Emeritus Gold Donor

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    I have these same two books in my coat. Never used them during my hospital IPPE, but maybe they'll get some wear and tear during IPPE?

    I also have a white coat clipboard, but I didn't really need to use it at the time. It's a clipboard that folds in half to just the right size to fit in your coat pocket.
  13. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    But why?
  14. 007rx

    007rx

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    :thumbup: The iPhone calculator app requires too much tapping precision which makes me work at about half the speed, yet I still make mistakes. I, too, carry a real calculator.

    As others have said, the sanford guide is helpful, although looking back I would've dished out the extra money for the app because it has a nice search feature. It can take some time getting used to the hardcopy sanford guide to find what you're looking for, but having those little sticker tabs in strategic places helps out a lot.

    I found a clipboard during internal medicine to be essential. It's not something you carry in your pockets, but its great for note-taking during rounds. I recommend a fancy one at Staples that can store stuff inside of it (paper, pens/pencils) this way you don't need to keep all of your stuff in an extra folder/binder.
  15. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Every hospital rotation I've been on, during rounds, everyone was texting except for the pharmacy students and med students, lol.
  16. Mila T

    Mila T jOURney

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    LOL. Talking about overkill !!!
  17. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member Administrator SDN Senior Moderator

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    Inquiring minds want to know (including me).

    The labcoat clipboard sounds neat. I think I will look into that.

    Did you mean APPE? Cause IPPE is the same as IPPE...:smuggrin:
  18. Chris co2012

    Chris co2012

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    Orbit Winter Mint gum in my right pocket and the Droid in my left.
  19. PharMed2016

    PharMed2016 Eternal Scholar

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    That's pretty much me. :laugh:
  20. Prepharm1214

    Prepharm1214

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    I've never needed anything beyond my PDA containing lexi-comp, paper for taking down notes, and two pens. In my experience anything beyond this is overkill, but it would depend on site/preceptor expectations and activities performed.
  21. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Can somebody please answer the reason for a pharmacy student carrying a 3 mL NS syringe?
  22. xtsukiyox

    xtsukiyox Moderator Emeritus

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    How many granola bars? Like, a box? This could be a really heavy coat....
  23. type b pharmD

    type b pharmD

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    Option to gain an instant ally on the nursing staff.

    That was my reason at least.
  24. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    Haha, I didn't know there'd be so much interest in the 3mL NSS syringe. Here's why I carried them (in order of priority):

    1) Boredom, something to play with that's not a phone.
    2) Ability to squirt fellow rotating students when running into them in hallways and such.
    3) Assist nursing

    As for granola bars, they're the half-sized ones from costco, i'd keep maybe 2-3 in there.

    other items that have come and gone from my pockets:

    1) banana
    2) individually wrapped spoon & fork
    3) code cart type drugs (metoprolol, epi bristojet, amio vials) -- this displaced my granola bars for a few days and I was not happy, so i gave the little bag back to my preceptor.
    4) energy drink -- inside pocket lower right or left, but i'd drink this before rounds so i don't think this counts.
  25. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    of course, haha, and your best dressed members of the rounding team = pharmacy students. even the med students were in scrubs.

    actually, take that back, the fellow was usually the best dressed (full suit). attending was usually in scrubs or jeans, med students in scrubs.
  26. Ackj

    Ackj

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    Yup, the docs and pharmacists are texting all the time, usually to each other, sometimes to ID. Fellow and attending are usually both well dressed, everybody else in scrubs besides the pharmacist and their intern.
  27. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    For my Internal Med rotation, the best dressed person was either me, the ID specialist physician, or the cardiologist. ID specialist gave me some tips on where to find some great shoes and suits.
  28. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    I'd round alone so I'd text my preceptor if something stumped me, but I'd try to do it discreetly or if the attending was younger and knew what I was up to.
  29. Ackj

    Ackj

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    We're told to wear white coats while on rotation, so that kills the suit idea. I suppose I wouldn't want to be mistaken for a physician anyway.
  30. PharMed2016

    PharMed2016 Eternal Scholar

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    A student wearing a suit? :laugh:
  31. Ackj

    Ackj

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    Ask Sparda, I'm not the one doing it.
  32. psychoandy

    psychoandy Junior Member

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    lol @ the flush questions...obviously you've never had to do anything at a code situation. in the context of also holding preceptors bag of amio vials and bristojets it makes sense.

    depends on rotation. for general med, i would expect a P4 to know PO/IV lasix/bumex/demadex conversion. more helpful charts might be ACE-I/BB/statin equivalence, as well as helpful flowcharts for things you don't know...like post MI meds most people should be on, etc. whereas on ICU, opioid/benzo equivalence, renal/hepatic dosing, and a pressor cheat sheet would be much more helpful in that setting. even more important is formulary...you don't wanna recommend something that's unavailable or restricted.

    sanford guide is always good
    tarascon's is garbage, anyone who has truly worked retail/hospital will find it unnecessary; the only time I used mine was to figure out an alternative to nonformulary eyedrops i've never heard of ever.
    pocket medicine is a great tertiary resource for disease management, but not really pharmacy related...and it'll look like you're trying too hard.

    honestly the best thing IMO was a smartphone with medscape & skyscape apps (epocrates is garbage), access to Dr Google/Wikipedia, and being able to get on UpToDate.
  33. UES Girl

    UES Girl

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    Jesus christ, what rotation was this on, surgery ? I have two different surgery rotations and already am buckling down for 14 hour days ( heh, fondly keep remembering Sparda's thread and comments about wishfull adherence to 40 hr work week on rotations :laugh: - def not at this academic institution
    and def not on surgery ) but even that sounds like quite intense. How do you even fit all that stuff in there ? Sounds like a work out to just carry all that stuff, those pockets are not that big. :laugh:
  34. UES Girl

    UES Girl

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    You make it sound like it's a bad thing ? :laugh::laugh::laugh:

    Looking good and attractive will get you further in life ( can't argue with research ), will help you establish better rapport with patients and people generally view you differently if you are wearing a sloppy unkept tee vs. If you are dressed in gucci. It sucks but it is one of the actualities of life.

    My bf been tipping me on how to dress and interact with attendings ( he went to med school ) and generally the idea is how you present yourself to them is how they are gonna take you. At this
    hospital at least, you round with different teams, half the time they have not a clue who you are they have so many people on board, a resident, a med student, a pharm student, so you can make yourself be taken very seriously rather than stumped into dirt, yelled at or treated like a lowly student. One way of course is knowing your sh@t, second, looking nice like a professional you will be in a
    matter of months after graduating.


    I plan on doing both, prolly spent couple k in the last two months on new rotations wardrobe. Girls just need an excuse to shop of course, most of the time. :laugh::smuggrin: :smuggrin:
  35. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    yup gotta love it, i didn't do 14 hour days but more like 10hrs. pockets were definitely full but not bulging, but when i took off my coat getting into my car at the end of the day i felt 5lbs lighter, hahah
  36. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    naloxone was a popular item out of my goodie bag ::shrug::

    and uptodate is the bees knees, hands down best reference tool for quick and dirty knowledge of a topic.
  37. njac

    njac Senior Member

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    just remember that it's written by docs for docs and you need to really research the topic yourself when you get a chance.

    I wasn't allowed to use it as a P4 or at my PGY1.
  38. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Yeah, that 40 hour a week ain't happening on Internal Med or surgery rotations. IMO, Internal Med/Surgery/ID/Critical Care rotations should be increased in hourly requirements to like 60 hours a week. But at the same time, they should decrease the community pharmacy rotation hourly requirements to like 20 hours a week, same for the managed care rotations, and whatnot.

    On most of my non clinical rotations, I'd only have stuff to do for a couple hours at the beginning of the day, and then spend the rest of the day on my laptop browsing VWVortex and SDN or taking Naplex review exams, which is exactly what I'm doing right now on my Public Health rotation.
  39. UES Girl

    UES Girl

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    It sounds like you have a lot of bs non acute rotations then ? How many acute ones do you have ? How many community and can you select which ones ? I have one community and I ranked an HIV pharmacy that also compounds highest since Both areas can use some improvemeny fot me.
  40. psychoandy

    psychoandy Junior Member

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    if you spend more than 40 hours a week at a site, you're probably doing it wrong (not counting homework like working on slide decks, searching for studies, etc). just as a baseline, i did my IM, MICU, SICU, and pain & palliative care at top tier academic medical centers, and my day usually went like this:
    7:45-8: prerounding
    8 to 12: AM rounds
    12-12:30: shoving food in my face
    12:30 - 4: discuss pts/topics or presentation time or look up stuff

    idk, maybe you guys are doing med rec/discharge counseling or going on call with the team like a med student? what else are you doing that i didn't? i guess if you're working on projects maybe but i can do that stuff at home.

    finally, can someone explain these so called "surgery rounds"...dont they round at 6AM and then go to the OR? do they actually value pharmacy input? details plz!
  41. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    yeah, i did use it a lot to refresh myself on disease states and general treatment approaches especially with unfamiliar topics since one of my crit care rotations was in a specialized area.

    as for actually answering pharmacy questions that were thrown my way, it sucked. but it enabled me to get a broad overview before going into more detailed sources.
  42. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    I had my institutional, ambulatory care, and internal medicine, which I felt needed more than 40 hours a week

    Community pharmacy - All I was doing was doctor calls, so once they doctor offices closed, really not much for me to do.

    MTM Elective - 40 hours a week is about right. Pretty much spent all day on the phone calling patients around the country and giving them MTM counseling.

    Long Term Care Elective - Was at an Omnicare type of place. Only useful stuff they had us do was compounding, which was almost always in the morning. Spent afternoons on my laptop.

    Oncology Elective - At a not for profit oncology clinic. Again, just helping compound chemo and pre-chemo meds. Most of the appointments were in the morning, so nothing to do in the afternoon.

    Public Health Elective - For the NYC Department of Health. Driving around to different schools and interviewing principals about what they're school was doing in terms of physical education and nutrition. Program was about combating childhood obesity.

    And I got one more left in April. A compounding elective at a specialty pharmacy. I did my MTM rotation here and I noticed most of the stuff the students do on the compounding side is in the morning and they don't have much to do in the afternoons.

    Ahh, my internal med rotation. I was following about 30 patients at a time.

    Pre-Rounding: 7AM-9AM
    Breakfast: 9AM-930AM
    Rounds: 930AM-12PM
    Lunch: 12PM-1PM
    Lecture: 1PM-2PM (directed at the medical residents, preceptor wanted us to attend)
    2PM-7PM: Continue following patients, projects, med rec/discharge counseling.

    I almost always was on the floor with the medical residents and medical students. I only ever stepped foot in the pharmacy occasionally during the day just to check in with preceptor.
  43. bacillus1

    bacillus1

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    Sounds like infernal med (bad pun?).

    How do you get thru 30 patients in 2 hours though? Especially on a Monday when there's probably lots of new ones? And to a poster above, how do you get thru all your patients in 15 mins? Right now I'm doing ID and it takes me about an hour to do my 5 patients, esp. since I have to go on the floors and find the charts (at least this place has CPOE), and for internal med i had to spend like 45 mins on 4 patients, since I had to look up disease states and dosing at the same time since I usually met with my preceptor right afterward to discuss the patients, and she wanted me to know them forwards and backwards (she completed a PGY2 in internal med).
  44. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Monday goes longer than expected usually. The residents usually have notes on the patients so I take a look through their notes first, and then complete it with the chart info later. The morning labs don't come back until around 12PM, so that's one less thing to have to check on.

    I didn't have to go back to my preceptor for interventions. I just went straight to the attending who was my proxy-preceptor, and then informed e-mailed my preceptor my interventions. This backfired once. It was a patient who came in with severe hyperglycemia, noncompliant, etc. They wanted me to initiate the insulin dosing.

    Our rounds are usually stationary at the nursing station and we don't see the patients unless we have to. So this patient was apparently 170 kg according to the chart. I dosed the insulin for 170 kg. Everything worked out fine, his glucose went down pretty fast, no hypoglycemia. However, when I went to make discharge counseling, this guy was pretty skinny. What happened was the nurse weighed the guy in pounds, but transcribed it in kg without converting it over.
    Last edited: 02.25.12
  45. clutzyshell

    clutzyshell

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    - Sanford guide antibiotics and Sanford HIV/HCV guide (depending on the patients you have) I think its important to know how to read/use it before going on rounds. And you should be an expert on coverage before you embark on clinical rotations. Pharmacy is a major asset in a medical team because, granted, I've met some AMAZING doctors that even knew pharmacy very well--but they're pretty weak in I.D. if its not their specialty. As a student, I blew them away with what PK/PD and coverage I knew for every antibiotics.

    - Lexicomp for phone... very awesome.

    - This might seem a lot of work, but I make my own cards. I'm weak in cardio so I made a protocol card for different cardiac disease states based on disease states. I even have clinical importance, e.g.: as add- on therapy, the RALES trial demonstrate that spironolactone decreased mortality by 32% (?) in patients with severe CHF. With evidence based medicine, this will make the team take you VERY seriously and your interventions will be accepted left and right. I also made a critical care protocol with the FAST-HUG methodology for every single patient in the ICU--it usually leaves no stone unturned.

    ... Now its a lot of work to make your own info card, obviously, but it pays off.
  46. clutzyshell

    clutzyshell

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    Don't you go to Touro (NY) College?

    From what I heard, students rarely get rounding experiences... What hospital is this?

    "Following" 30 patients? Are you telling me you're working up/following up on progress of 30 patients as a student? Or are there 30 patients on your census. Those are two different stories.

    I'm really interested in how Touro College's rotations are. Don't get me wrong, I do not look down on Touro being a new school on the block, but I've heard even some students complain that their not learning enough. And from what I saw on my I.D. rotation with a handful of Touro students....they never had experience with rounds...
  47. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    Depends which hospital I guess. I was at North Shore/LIJ Forest Hills for Internal Med. Most students didn't pick this site because they live in the city and it's hard to get there without a car. For me, I had a car and I hated taking the subway so I didn't pick too many sites in the city.

    Yes, following 30 patients, which is exactly how many there are on the wing of the floor I was assigned to. So always, every patient on 5 South, as well as any patients who ended up getting transferred into the ICU.

    Where did you have your ID rotation? I remember there was a guy from LIU having his ID or ICU elective there.

    Some of the students who went to Nyack and Mt. Sinai said they had a terrible time on that rotation. From what I've heard, our best sites are Montefiore, North Central Bronx, St. Luke's, and North Shore. I usually hear negatives about Beth Israel, Nyack, and the other upstate hospitals. Also, if they are on their hospital IPPE, then they are probably not gonna get rounding experience.
  48. drugdoc

    drugdoc Member

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    Getting back to the topic at hand....

    -references:
    Sanford Guide
    Renal dosing chart
    Do not crush list (for oddities reference d/t lots of intubated pts)
    ACLS & PALS cards, rhythms quick reference cheat sheet
    (couple others I can't remember)
    -2x 3mL syringes
    -2x needles for syringes
    -salt
    -coffee stamp card
    -calculator
    -code pager, resident pager
    -iTouch with LexiComp, electrolytes app, ACLS app, etc

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