Newbie pharmacist staffing night shift solo

[positivesign]

Hi all, what are your thoughts and tips on how to survive the night shift in a hospital setting? Got a new job, will have ~1 month training in days then will be by myself during nights 🙂 wish me luck...

But otherwise, I'm excited for the opportunity to be knowledgeable and eventually become comfortable running the pharmacy independently.

What are your must-know stuffs and go-to resources? Any materials I need to start re-studying? I have limited clinical pharmacy experience but can work under pressure in a fast paced environment.

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[BidingMyTime]

If your hospital has a 3rd shift, then you probably have sister hospitals (hopefully with a 3rd shift).....make sure you have their direct numbers, so you can call with questions. I assume you will also have a technician who can help? If not, make sure you know where everything is kept, what supplies come from central, the procedure for handling crash carts--the kind of stuff that you might not think about on days because a technician takes care of it. Make sure you know emergency call numbers, and the direct number for the house supervisor.

Have an IV compatibility reference handy, that will be the biggest 3rd shift question, from new nurses.

Expect some nights to be pretty slow, and some nights when everything will drop at the same moment. See if you can have at least a few nights training with another pharmacist to talk to them, about what kind of stuff to expect (ie what kind of emergency surgeries are done, is everything done in-house and/or what conditions will be transferred out, etc.)

Try to find out where day shift nurses hide IV's or other specialty drugs...expect to get many calls from nurses looking for stuff that was delivered on day shift, and it's not in the med box, not in the pyxis/omnicell, not anywhere where it should be or even expected places where it shouldn't be (like the patient's room.) Trust me, all nurses have secret hiding spots, you need to find where they are, so you aren't having to remake IV's, or worse, TPN's, because they mysteriously disappeared.

 

[positivesign]

Thank you for all the helpful tips! I don't think we have a sister hospital but I'll be able to call the on-call Rph if worse comes to worst. I plan to save that as the last resort and try learning where things are during the training period.

 

[Dalteparin]

GlobalRPh is your friend for any calculations you need to do.

Find out where your department's protocols for things like antibiotic dosing, therapeutic interchange, heparin dosing, etc, are and have them available at all times. My hospital keeps ours on an internal website and I keep one browser tab with that open throughout my shift. This is probably what you'll do the most of. Read all of your protocols thoroughly, especially the ones for emergencies like KCentra, tPA, overdoses. Also, it helps to have an ACLS pocket card - if you're by yourself you probably won't attend any codes but that won't stop them from calling you for doses.

If your EMR allows it, come up with shortcuts for things that you type frequently (in EPIC these are called "dot phrases") - stuff like "do not exceed X doses in 24 hours" or "medication is not on formulary, please ask the patient to bring their own."

Get a list of phone and pager numbers for your nightshift hospitalists, medical residents, and any other providers you might need to call at 0200. Oh yeah, and be mindful of when it's OK to call a doc at 0200 and when you can leave it for day shift. 🙂

 

[farmadiazepine]

Know where everything is kept. Know where all the antidotes are, for example, CyanoKit.

 

[PharmDBro2017]

GlobalRPh is your friend for any calculations you need to do.

Find out where your department's protocols for things like antibiotic dosing, therapeutic interchange, heparin dosing, etc, are and have them available at all times. My hospital keeps ours on an internal website and I keep one browser tab with that open throughout my shift. This is probably what you'll do the most of. Read all of your protocols thoroughly, especially the ones for emergencies like KCentra, tPA, overdoses. Also, it helps to have an ACLS pocket card - if you're by yourself you probably won't attend any codes but that won't stop them from calling you for doses.

If your EMR allows it, come up with shortcuts for things that you type frequently (in EPIC these are called "dot phrases") - stuff like "do not exceed X doses in 24 hours" or "medication is not on formulary, please ask the patient to bring their own."

Get a list of phone and pager numbers for your nightshift hospitalists, medical residents, and any other providers you might need to call at 0200. Oh yeah, and be mindful of when it's OK to call a doc at 0200 and when you can leave it for day shift. 🙂

x2... those epic dot phrases are life changers. You can even create your own, right? I've been using some customized ones (preceptor created I think) this month for vanc monitoring, CSF monitoring, etc.

I do find "the peripheral brain for the pharmacist 2017" to be a decent resource to have on hand (and it's cheap).

OP I'm in the same boat as you. I'm a little worried about attending codes tbh.

 

[gwarm01]

x2... those epic dot phrases are life changers. You can even create your own, right? I've been using some customized ones (preceptor created I think) this month for vanc monitoring, CSF monitoring, etc.

I do find "the peripheral brain for the pharmacist 2017" to be a decent resource to have on hand (and it's cheap).

OP I'm in the same boat as you. I'm a little worried about attending codes tbh.

For codes, see if your department has created any cheat sheets. We had them built out with the appropriate dose for every code drug, both in mg and mL, with a sheet for several weight ranges (peds hospital). I always brought it with me on codes, even after I had most of it memorized. If your pharmacy doesn't have one then this could be a good opportunity for you to create one and share it with your colleagues.