Recommendations during rounds

[baron]

What are some good resources to make recommendations during rounding, for ltc, small hospitals, and physical rehabilitation facilities ? Thank you.

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[Xarelto-10]

Are you wanting drug references? lexicomp is pretty popular

 

[JustFillIt]

Don’t forget about your brain also.. it’s about creating your own brand.

 

[mustang sally]

Don’t forget about your brain also.. it’s about creating your own brand.

Agreed. I'm guessing OP is a student or brand new pharmacist (or just new to rounding)?

It will get easier with time and practice to the point that it's pretty much second nature.

 

[SELDANE]

Don’t forget about your brain also.. it’s about creating your own brand.

This is really great advice. As a pharmacist on rounds you should be able to incorporate you basic pharmacy knowledge with the hospital formulary to come up with viable alternatives to suggested protocols. Remember the prescriber can look up Lexicomp on their iPhone just as quick as you.

 

[RxEvileye]

In hospitals, try to be somewhat selective with your recommendations so that you do not appear to be nitpicking. Focus on high-impact medication changes during rounding time (e.g. antibiotic regimens, anticoagulation). Save changes to things like bowel regimens unrelated to the primary issue for an aside with an intern.

In LTC/Rehab type settings consider thinking about unmet patient needs. If they talk about fall risk, make recommendations like deprescribing anticholinergics. Consider untreated disease states, like whether they need to be on a statin.

 

[zelman]

Remember the prescriber can look up Lexicomp on their iPhone just as quick as you.

I’d take that challenge.

 

[mentos]

I’d take that challenge.

Some of them can't even find common drugs in CPOE.

 

[baronzb]

Are you wanting drug references? lexicomp is pretty popular

Sorry for the confusion. I meant resources and tips for rounding inpatient, both acute and critical. A drug reference would not have this information

 

[GradVantageRx]

Sorry for the confusion. I meant resources and tips for rounding inpatient, both acute and critical. A drug reference would not have this information

Hmmm, drug interactions arent super easy to pull for providers, because they would have to manually enter the full med list. Perhaps concentrate on pulling interaction reports on new meds? Also know the guidelines for common things - VTE, CAP, COPD/CHF exacerbations etc

 

[baronzb]

Im not talking dur, but attending rounds as part of an interdisciplinary team inpatient

 

[GradVantageRx]

Im not being snippy here, but you have tried to clarify what you are looking for twice in this thread and I still have no idea what you are asking.

My advice is now: be clear and succinct with your recommendations (and your forum questions)

 

[owlegrad]

Yeah what kind of "reference for rounds" are you looking for? Exactly what kind of information are you trying to look up during rounds?

Maybe UpToDate is what you are looking for?

 

[confettiflyer]

I don’t want to paint people with a broad brush, but I’ve found that ID is not in the wheelhouse of many physicians. So knowing IDSA guidelines + local antibiogram often yields fruitful interventions.

Otherwise you end up seeing a regimen like vanco, zosyn, doxycycline, levaquin, flagyl on some poor pt with a presumed pna.


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[JustFillIt]

I don’t want to paint people with a broad brush, but I’ve found that ID is not in the wheelhouse of many physicians. So knowing IDSA guidelines + local antibiogram often yields fruitful interventions.

Otherwise you end up seeing a regimen like vanco, zosyn, doxycycline, levaquin, flagyl on some poor pt with a presumed pna.


Sent from my iPhone using SDN

All at once? Vanq/zosyn sure... but holy smokes I’ve never seen that before. What is the docs rationale for that regimen? I can’t even think what it may be.

 

[Rockinacoustic]

All at once? Vanq/zosyn sure... but holy smokes I’ve never seen that before. What is the docs rationale for that regimen? I can’t even think what it may be.

Clearly double pseudomonal and anaerobic coverage with a splash of Doxy for the salt water they inhaled

Just kidding please no one do this...

 

[JustFillIt]

Clearly double pseudomonal and anaerobic coverage with a splash of Doxy for the salt water they inhaled

Just kidding please no one do this...

Oh yea... how could I have missed it...

I just remembered an order for 100g of Ceftriaxone qd x 7d, hat I rejected one time. Don’t ask me how that happened.. typo?

 

[radio frequency]

Oh yea... how could I have missed it...

I just remembered an order for 100g of Ceftriaxone qd x 7d, hat I rejected one time. Don’t ask me how that happened.. typo?

Maybe a brain fart trying to order 100 mg/kg? Anything is possible with sleep deprived residents.

 

[lane one]

Clearly double pseudomonal and anaerobic coverage with a splash of Doxy for the salt water they inhaled

Just kidding please no one do this...

The doxy is for double MRSA...duh. You guys don't use the "Triple-double"???

 

[baronzb]

Yeah what kind of "reference for rounds" are you looking for? Exactly what kind of information are you trying to look up during rounds?

Maybe UpToDate is what you are looking for?

Not inpatient rounds, I supposed ambulatory, as in MTM, med rec, adjusting meds for chronic diseases with MD permission, etc.

 

[owlegrad]

Not inpatient rounds, I supposed ambulatory, as in MTM, med rec, adjusting meds for chronic diseases with MD permission, etc.

It still sounds to me like what you are looking for are the boring references everyone uses. Either Clinical Pharmacology or Lexicomp for basic drug facts. Maybe UpToDate for treatment and practice standards. Pubmed if you are ambitious or your preceptor is a jerk or the information you seek just can't be found elsewhere.

Personally I like Pharmacist's Letter but that isn't comprehensive by any means. Any topic they do cover they cover well though, imo, and sometimes they have neat easy to use charts.

When I worked for an MTM company we had lists of standard recommendations/interventions we would try to make. Besides that we were just expected to be knowledgable about stuff and use that knowledge. Of course the interaction checker for whatever service is your favorite can be used in this setting as well although in my experience very few of our interventions came from that route.

I can't speak to med recs or the rest though so maybe someone else can point you in the right direction for those.

 

[JustFillIt]

Saw your thread on the main forum.. I could not help but to comment on something you said. “I am looking for a textbook or a help guide, not a tertiary resource like uptodate.”

I really try to not criticize people because we all have strengths and weaknesses but this comment lacks insight bigtime. Each of those examples are “tertiary resources”, and if you will be someone who is making recommendations to a physician, uptodate is probably more relevant than a textbook or a help guide.

Besides, MTMs are a piece of cake.. just fill out all the fields accurately and if you notice any glaring irregularities, you just fax the doc your recommendation and move on. If you don’t hear back, call the nurse and have a brief discussion - then they will treat you like an idiot (I know I have plenty of experience in this) then shrug it off, Mark the outcome as physician maintained therapy, and cash that check.

You do not need to be a bastion of clinical knowledge to do MTMs