Appropriate Complaint or not?

[Sparda29]

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Alright, so the hospital I'm currently at has a weird policy regard the reconstitution of IVs. Only pharmacists are allowed to do it. Thus, after the initial hour of labeling some IV bags and filling PO orders, I am bored as hell because I'm not allowed to make any IVs, and we aren't allowed to go out on the floors to do chart reviews since apparently at this hospital we need to be supervised.

Only thing I'm basically doing after the IV labeling is done, is basically standing around the pharmacy, hovering around a pharmacist breathing down their necks. Or watching pharmacists do interventions during order entry and adding that on to our PxDx intervention log.

The last hospital I was at, I was able to make IVs myself unsupervised. I was allowed to go out on the floors and do chart reviews unsupervised. Basically, I was able to keep myself busy and work on projects.

At this hospital, my shift is 8AM-4PM. From 8AM-12PM, I am bored as hell waiting for it to reach 12PM so I can go to lunch, and then we have from 1PM-4PM to work on our projects, and that time seems to fly by especially since our projects consume a lot of time.

So here's the thing: we have reflections at school on Friday, and we have another reflection at the end of the month. Followed by us giving an evaluation of the site. Would it be appropriate for me to complain to our school's director of practice experience that I'm not getting enough IV practice or not much work at this site? Hence, possibly our school's director putting pressure on the Director of Pharmacy at the hospital to allow the interns to do more?

The problem is, this might cause a problem for the faculty that works at this hospital. (Basically, all the hospitals we have contracts with, usually have a school faculty member who also works at that hospital. So if I complain to my school's director, and then they pressure the director of pharmacy at the hospital, that might result in backlash on the faculty member who is working there).

Should I complain about this? Or should I just grind out the boring hours?

 

[njac]

are you on rotation there or working there? that has been unclear in recent posts.

 

[Sparda29]

are you on rotation there or working there? that has been unclear in recent posts.

Site A - I was on rotation in June 2010, and now I have a paid job there. This place I can compound IVs unsupervised, I can make chart reviews and interventions unsupervised, but before I submit them, I send them to the clinical pharmacist for review who then approves or makes changes to them before I submit them.



Site B - I'm on rotation in August 2010 and September 2010. This is the place where I'm not allowed to compound IVs or do chart reviews unsupervised.

 

[Its Z]

my question also...i thought it was an intern job at first but now im thinking this is a rotation.

 

[njac]

Site B - I'm on rotation in August 2010 and September 2010. This is the place where I'm not allowed to compound IVs or do chart reviews unsupervised.

you're on rotation. they're legally liable for any clinical decisions that make it to a patient - there is no way you should do anything unsupervised. Nevermind only as a 3rd year.

You can definitely bring up that there needs to be more structure and that the faculty member there should accompany you to the floors; IF that is what they do there. If it's an institutional rotation, learn to work the inpatient pharmacy.

 

[Sparda29]

you're on rotation. they're legally liable for any clinical decisions that make it to a patient - there is no way you should do anything unsupervised. Nevermind only as a 3rd year.

You can definitely bring up that there needs to be more structure and that the faculty member there should accompany you to the floors; IF that is what they do there. If it's an institutional rotation, learn to work the inpatient pharmacy.

It is an institutional rotation. But I'm not gonna learn much by watching people do order entry all day long. I'm not asking to make chart reviews and clinical decisions, what I'm asking for is the ability to go up to the floors, review the charts and learn more about the pharmacotherapy that is being used and get into the mind of how the physician is thinking when they treat the patients (by reading their notes).

 

[All4MyDaughter]

If it's an institutional rotation, I agree that you should learn how to work the inpatient pharmacy. Some of that may be learning what the techs do, but I think that's important for (future) pharmacists to understand.

Do you have a syllabus for the rotation?

 

[Sparda29]

If it's an institutional rotation, I agree that you should learn how to work the inpatient pharmacy. Some of that may be learning what the techs do, but I think that's important for (future) pharmacists to understand.

Do you have a syllabus for the rotation?

Yep. However, my first rotation in June was an Institutional Long Term Care Facility. And there I was allowed to do a lot of the work that I'm not allowed to do at this hospital.

 

[All4MyDaughter]

Yep. However, my first rotation in June was an Institutional Long Term Care Facility. And there I was allowed to do a lot of the work that I'm not allowed to do at this hospital.

You can't compare rotations at different institutions. Each institution is allowed to decide what they want you to do. Policies are going to vary from institution to institution and from preceptor to preceptor. You just have to deal with that. Maybe they'll give you more responsibility after they feel you've earned it. You won't earn it by constantly asking to go run off to the floors to read charts, IMO.

If this is an introductory hospital pharmacy rotation, I think you should be learning how to work in the IV room, learning how the Pyxis (or whatever) works, compounding (if they do any), practice calculating TPNs, learn how to do ward stock, learn to use the pre-pack/unit dose machine, etc. Do they stock crash carts or anesthesia trays? Make a list of all of the medications in each type of tray and find out what they are used for.

Go through the shelves and find out what drugs in specific classes are stocked. What PPIs does the hospital carry? What's first line on the formulary? Second line therapy? What 5HT3 antagonists are they using? Why was one chosen over another? Get a little notebook and write down what you find.

Look at the chemo drugs and write down brand/generic in your notebook. When you have time, you can look up the indications for each agent. You might also make notes of any specific instructions like must be reconstituted 'ONLY in NS" or "ONLY in D5W." What can be given IV push and what must be infused?

Check out the different IV fluids. Why would NS be used over D5W? What about D51/2NS? What is Lactated Ringer's used for/what the hell is Lactated Ringer's? What other fluids are there and what are they for? What's a K-run?

IPPE hospital is supposed to be dispensing oriented. I think you can find PLENTY of stuff to do related to dispensing. You're just going to have to figure out how to help facilitate your learning. You'll be a better pharmacist if you understand how the pharmacy runs and what the techs do.

 

[rxlea]

Pyxis =

Having to tell the nurse how to use pyxis or fix a failed drawer =

Although you should learn pyxis, don't get sucked in to doing anybody's dirty work

Just like A4MD said, go learn about all that chemo. Fun stuff right there, man.

 

[WVUPharm2007]

Pyxis =

Pyxis is great.

You just haven't seen the alternatives.

 

[spacecowgirl]

I heart Pyxis.

Also I agree - is there a syllabus? You need to ask for opportunities. It's not fair to sit there and be upset and complain to the school about it. Talk to your preceptor 😕

 

[spacecowgirl]

Ask if you can do some kinetics and compare your findings to the pharmacists. Same with warfarin - have the pharmacists give you a list of patients on anticoagulants - check their labs. If you don't have computer access, ask for it, read-only or whatever.

It would be great if every site and preceptor had a nice detailed syllabus, but they don't. You need to be proactive sometimes. Do you have syllabus from the school with objectives you need to meet? Ask your preceptor how you can meet those and arrange opportunities.

 

[ucrx]

If this is a basic institutional rotation, your focus should be on dispensing/operations. This is order entry, making IVs, etc like others have said. If the hospital policy is that only pharmacists can do these things, your only option is to watch and talk to them about what they're doing. And you'll probably be bored. Institutional rotations are for the most part NOT clinical. This means you won't be out reviewing charts, learning pharmacotherapy, and understanding doctors. Not all of pharmacy is clinical; not all of your rotations will be clinical.

Pyxis is great.

You just haven't seen the alternatives.

I just wish some of the nurses where I work would learn to touch the screen when it won't give them the drug. It really isn't hard- empty, faulty drawer, or (I think- I'm new to Pyxis) you aren't supposed to be giving the drug now. Then call our special phone number for Pyxis and we'll have our Pyxis pharmacist or tech handle it. Calling the IV room isn't going to help get the med out quickly.