Help! Clinical pharmacists please!

[Lisochka]

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I am starting a new hospital job. Ive been a pharmacist at retail for one year and never been a hospital pharmacist...Ive been an intern in a hospital while in pharmacy school, but its was a low volume hospital...
So, I have a few questions:
When you check orders, what do you pay attention to? What things should not be done?
May be you could give examples?
For example, I think I need to memorize insulin doses...
I am not too concerned with large volumes, If its above 250 ml/hr it is probably too much...
I dont know much about TPNs and Chemos...Chemos scare the crap out of me...
Please help me, I am just scared, but I know that if other pharmacist can do it, then probably I can too..I made it through pharmacy school, I made it as a retail pharmacist...
Please let me know of any rules that you follow when you check IV orders and TPN orders...
Chemo as well...
Thank you 🙂

 

[Success Seeker]

Firstly, I'd advise dropping the fearful attitude. Secondly, I'd advise that you acknowledge the fact that you have a doctorate degree and that you gain some confidence. Lastly, I wouldn't come to SDN for advice from clinical pharmacists necessarily because you didn't even specify which pharmacy-setting you're in AND the majority of what you will learn shall be a result of on-the-job training. Best of luck to you. But seriously, step your game up. You're a pharmacist. 🙂

 

[medicinegal]

For Gods sake you are a DOCTOR!!! 🙄 Just stop it!

 

[nafcillin]

I check chemos in a certain order each time. If I get interrupted I start over. I do the process twice and make sure to do the math on the dose to ensure it is ok.

Read some journal articles and like others said don't act scared. People can smell fear

 

[Lisochka]

I check chemos in a certain order each time. If I get interrupted I start over. I do the process twice and make sure to do the math on the dose to ensure it is ok.

Read some journal articles and like others said don't act scared. People can smell fear

Thank you guys for your support 🙂
I do appreciate it 🙂
So, especially chemo routs could be confusing...Is there a general rule such as all chemos are IV's except this or that?
And something like, no chemo should be administered intrathecally, except this is the only one you can administer intrathecally...?

Do you always calculate the chemo dose based on BSA?

 

[medicinegal]

Thank you guys for your support 🙂
I do appreciate it 🙂
So, especially chemo routs could be confusing...Is there a general rule such as all chemos are IV's except this or that?
And something like, no chemo should be administered intrathecally, except this is the only one you can administer intrathecally...?

Do you always calculate the chemo dose based on BSA?

I have attached a document that you may find helpful. 🙂

 

[xiphoid2010]

Thank you guys for your support 🙂
I do appreciate it 🙂
So, especially chemo routs could be confusing...Is there a general rule such as all chemos are IV's except this or that?
And something like, no chemo should be administered intrathecally, except this is the only one you can administer intrathecally...?

Do you always calculate the chemo dose based on BSA?

No, take nothing for granted, especially comes to chemos. Carboplatin for example is calculated based on Calvert formula.

Look dude, when comes to things you are not familiar with, get in the habit of double checking. Look it up, ask, verify. You will be slow ass at first, but better that than a dead patient. You will learn it overtime, but not you heavenly discharge a patient before then.

 

[BeLikeBueller]

Thank you guys for your support 🙂
I do appreciate it 🙂
So, especially chemo routs could be confusing...Is there a general rule such as all chemos are IV's except this or that?
And something like, no chemo should be administered intrathecally, except this is the only one you can administer intrathecally...?

Do you always calculate the chemo dose based on BSA?

When I was on rotation this past summer, the hospital I was at used the following website in the verification of chemo regimens: http://chemoregimen.com/

It has a lot of your dosing info, route, etc (and everything is cited), but it's divided based on cancer type, so if you don't have access to an EMR, it may not be that helpful.

Hopefully some other hospital pharmacists can verify if they've used this before? Probably your institution will have some system or protocol for chemo verification? Plus, I'm sure you'll get the hands-on training you need in the first month or two while you're there. Best of luck!

 

[xiphoid2010]

When I was on rotation this past summer, the hospital I was at used the following website in the verification of chemo regimens: http://chemoregimen.com/

It has a lot of your dosing info, route, etc (and everything is cited), but it's divided based on cancer type, so if you don't have access to an EMR, it may not be that helpful.

Hopefully some other hospital pharmacists can verify if they've used this before? Probably your institution will have some system or protocol for chemo verification? Plus, I'm sure you'll get the hands-on training you need in the first month or two while you're there. Best of luck!

The larger teritiary hospitals often have a 2 pharmacists check off on systemic chemos. But you can't take those for granted for mid-small facilities. If I want to preach one thing into the brains of my staff, it is "err on the side of caution/legality". I will back you up if it's clearly to save a life, but not if its cutting corners during routine business.

Eg,levophed during rapid response vs. Irinotecan without route.

edit: damned ipad, something wrong with the coding. When I edit in firefox, everything is messed up.

 

[rxlea]

Thank you guys for your support 🙂
I do appreciate it 🙂
So, especially chemo routs could be confusing...Is there a general rule such as all chemos are IV's except this or that?
And something like, no chemo should be administered intrathecally, except this is the only one you can administer intrathecally...?

Do you always calculate the chemo dose based on BSA?

Read about vincristine.

Check your institutions protocol for subq volumes for things like azacitidine.

Know chemos that need light protection esp if they are running it as a cont infusion over 24 hours.

Know stabilities- and what's fridge or not fridge.

Make sure solution is correct and if the chemo requires non PVC bag and tubing (carmustine, straight up etoposide, etc).

Make sure if a chemo is intrathecal (methotrexate, cytarabine, etc), the tech prepared it with the correct filter!

Check one chemo at a time and redo the dosing calculation yourself. There should be standard order sets at most places.

Watch the tech inject the chemo.

Learn how long it takes to prepare them and make sure your patients get their pre meds.

Know when to use secondary, primary, or taxol tubing sets.

Know what needs to be filtered and make sure tech uses proper filter needle.

Read, read, read.

Make friends with the experienced chemo techs.

 

[MackandBlues]

Read about vincristine.

Check your institutions protocol for subq volumes for things like azacitidine.

Know chemos that need light protection esp if they are running it as a cont infusion over 24 hours.

Know stabilities- and what's fridge or not fridge.

Make sure solution is correct and if the chemo requires non PVC bag and tubing (carmustine, straight up etoposide, etc).

Make sure if a chemo is intrathecal (methotrexate, cytarabine, etc), the tech prepared it with the correct filter!

Check one chemo at a time and redo the dosing calculation yourself. There should be standard order sets at most places.

Watch the tech inject the chemo.

Learn how long it takes to prepare them and make sure your patients get their pre meds.

Know when to use secondary, primary, or taxol tubing sets.

Know what needs to be filtered and make sure tech uses proper filter needle.

Read, read, read.

Make friends with the experienced chemo techs.

you will learn all the above on the job. chemoregimen.com is your friend. stop freaking out. I was training a new grad the other day and they didn't know what fluid boluses were used for and wanted to look at the labs... Rule of thumb for anything as a pharmacist: if you don't know it you gotta look it up. Just because the doctor ordered it doesnt mean its right. Just because one of the other pharmacists verified it before doesn't mean that it's right.

 

[Lisochka]

Thank you guys so much!
Chemoregimen is awesome! 🙂
So, what about regular IV orders? Is there any generalizations? For example, usually antibiotics are infused over 30 minutes, or something like that?

 

[Lisochka]

Oh, what about insulin? Do you check blood glucose with a new insulin order? What beginning doses for insulins would you feel ok with? For example, fast acting are usually 1-20 units...Would you say if a dr writes a new insulin order on an insulin naive pt with 27 units of Novolog TID ac, would you be ok with that?
Where can I learn more about insulin doses, especially in insulin naive pts?

 

[MackandBlues]

Oh, what about insulin? Do you check blood glucose with a new insulin order? What beginning doses for insulins would you feel ok with? For example, fast acting are usually 1-20 units...Would you say if a dr writes a new insulin order on an insulin naive pt with 27 units of Novolog TID ac, would you be ok with that?
Where can I learn more about insulin doses, especially in insulin naive pts?

That you can easily find in any drug reference such as micromedex.

 

[Lisochka]

That you can easily find in any drug reference such as micromedex.

Right, I was just thinking may be there were any general rules? Like dont start quick acting insulins above 20 units or something like that...
Anyways, thank you guys so much for everything 🙂
BEsides drug info sites , do you use any other websites? Such as globalRPH and so on? What do u use?
BTW, chemoregimen is awesome 🙂

 

[rxstudent204]

Seriously? I mean, I'm not trying to be mean but seriously???

 

[atlrph]

How did you get hired? Don't they provide training anymore ?


Sent from my iPhone using Tapatalk

 

[rxstudent204]

Okay, I'm actually looking at this again and sort of freaked out by the questions you are asking. Like yeah some this is stuff you forget but you should know how to find all these answers. Every antibiotic infused over 30 minutes?! How did you get hired to work in a hospital?

 

[Lisochka]

Every antibiotic infused over 30 minutes?! How did you get hired to work in a hospital?

By passing a 2 step interview conducted by a panel that consisted of 4 Rphs. And by beating other 20 applicants 😉

 

[Lisochka]

Don't they provide training anymore ?


Sent from my iPhone using Tapatalk

They will as soon as I start..

 

[Lisochka]

Seriously? I mean, I'm not trying to be mean but seriously???

In 2 hospitals where I worked for many years as a tech and an intern, Rphs who were not afraid to ask stupid questions, or non stupid questions, usually did better than those who were like you..
One Rph, who was a star, "Knew it all" in rounds, almost killed a baby. He had 20 years of clinical experience.
I would rather ask stupid questions and not be like him.
I am not afraid of your criticism. When it comes to patient's safety there are no stupid questions.
If you don't like my questions then refrain from coming to my topic.


.

 

[MackandBlues]

Oh, what about insulin? Do you check blood glucose with a new insulin order? What beginning doses for insulins would you feel ok with? For example, fast acting are usually 1-20 units...Would you say if a dr writes a new insulin order on an insulin naive pt with 27 units of Novolog TID ac, would you be ok with that?
Where can I learn more about insulin doses, especially in insulin naive pts?

like I said before, it's your license so the answer is whatever you are ok with, not what someone else thinks.

 

[Lisochka]

Thanks to all who have tried to help me out and share experience and knowledge 🙂