I've been working as a retail pharmacist for the past 2 years and I'm starting a PRN Inpatient/Outpatient hospital job pretty soon. I walked around the pharmacy and the director was showing me order entry, IV bags, pyxis, etc...and I started noticed how much I don't know about this job.
Does anybody have articles or PDF files on commonly used IV bags/combos, or maybe even a summary of what exactly happens and what I need to know in the inpatient world? I have ZERO experience in this outside of the few rotation sites that I've been on.
Here are some tips based on my experience working at a small (10-20 occupied beds at a given time) critical care hospital. Some may or may not apply to you depending on the size of the hospital or the scope of your job duties, but hopefully you can glean some information about workflow and responsibilities.
Get in to work, answer drug info messages and stat orders on the answering machine if applicable, start checking/entering orders, check to see that the techs have compiled the appropriate pyxis meds from a pyxis refill list (ie check to see everything is there). Check techs iv bag work. Enter more orders. field drug info questions. Take angry nurses' calls. Take impatient doctors' stat call in orders. Re-check pyxis in the afternoon along with another set of iv bags. Of course there re also the dosing tasks , which you may or may not need to be familiar with depending on the position (TPN formulation if your hospital doesnt use an outside service, filling out forms regarding vanco dosing following the clinical algorithms, following up with lab companies to get applicable results). Probably spend time some time phoning local outpatient pharmacies or the hospital's outpatient pharmacy to work on discharge related issues (insurance related drug switching for instance). Other tasks mixed into your free time / downtime would include med rec, and or following up on pyxis alerts, such as yelling at the nurses for doing too many pyxis overrides and following up on discrepancies with the medication administration records (discrepancies between the MAR and the pxyis dispensing logs, narcotics counts, etc).
Look up the IV compounding of high risk drugs / safety alert type drugs. You will probably be using trissels extensively your first month or two until you get the hang of all of the compounding basics. Remember to look for particulates in TPN solutions before sending them to the floors.
Pharmacists at my hospital needed to be able to make determinations routinely about stability.. techs and pharmacists labeled each bag as to its expiration after we made them, often times involving use of trissels or online DI resources, but sometimes we searched primary literature to back up our claims for extended stability. Keeping in mind that nurses often leave bags sitting out unrefrigerated even when they are supposed to be refrigerated , of course.
I'd look up which drugs can only be mixed in plastic (the name is eluding me right now) iv bags compared to the typical rubberized iv bags. Also theres a few common tech errors you may encounter that could pose safety risks, such as mixing bicarb ampules into NS (too hypertonic, needs d5), bags that need to be stored away from light that arent, look alike/sound alike errors, etc, bags that are sent up without the appropriate micron filters (common where i worked, for example TPN and ambisome).
Just my 2c from hospital tech experience. Of course you probably already knew most of this but hopefully at least something is helpful.
Tips:
Get techs to answer the phones as much as possible. Most times callers wont need a licensed pharmacist to answer their question and will just waste your time. Make sure you or your techs write down important stat call ins so that they are not forgotten. You'll need to learn to differentiate between annoyed nurses who claim that their request is an emergency (when it really isnt) and people who are in actual need of a stat delivery. Don't let the nurses overwhelm you with impatient requests. Being able to courteously dismiss and reassure someone that you'll help them on the phone is a good skill to have in this situation.
Be able to prioritize what your techs are working on at a given time. Compounding such as ambisome may take a half hour to make, so if you get the call or the printout and have your tech start making the dose 5 minutes before it is due, it will not be able to be delivered on time. Also, you'll find out that some abx take 10-15 minutes to dissolve in their vials before they can be compounded, which can screw up a stat order situation as well.
Find out what drug information database your hospital subscribes to and be familiar with how to quickly navigate it. Know when *not* to use it. For example, a very large percentage of compounding instructions can be located in the package insert for the IV vials.
Also. When a nurse calls about running out of insulin vials (or a few other things), 80+% of the time it is bogus. . At our hospital, it didnt matter how many vials we took up, practically ALL of them would be pocketed by the nurses (or moved to the nursing carts) by the end of the day. >:O This is why it's good to have techs answer the phones, a lot of your calls will be about a missing medication. Your standard response will/should be "go check the drawers and the carts". Repeat this enough times (sometimes it takes 100 times) , and eventually they will start doing their own work instead of asking you to enable their laziness. Not to slam nurses in general, as they are great people and important healthcare system assets, but they WILL try to take advantage of you, especially if they learn that you're new.
If a nurse is upset because we were late on taking a med down to the unit or whatever and the patient had to be waiting for them to administer the med, that would be a different story. The nurses that tend to give pharmacy a hard time are very condescending. That being said, I tend to get along well with my department and most of the nurses.
