The IPPE diaries

Discussion in 'Pharmacy' started by bacillus1, Dec 15, 2008.

  1. bacillus1

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    I decided to chronicle my 4-day hospital IPPE experience. My school divides our IPPEs so we have 1 IPPE every semester. This semester's is 32 hours. Now I realize that all IPPE experiences aren't the same, but I guess this will just be a picture of what an IPPE can be like.

    Today was day 1.

    I chose to do my IPPE at a children's hospital. The staff were pretty nice but it was a bit upsetting that the staff pharmacists just sit in the inpatient pharmacy and verify orders from their computer (there are quite a few pharmacists, and each one only handles a few drugs a day). Mostly they just read the order and verify that the doctor's order makes sense for the patient.

    My preceptor didn't have much for me to do. We talked a bit about patient care in the hospital (only the clinical pharmacists and somewhat outpatient pharmacists are involved in patient care). I actually got to take a look at an investigational drug protocol, which was kinda interesting. But a lot of the time I just sat around since no one (quite knew why I was there. We discussed a few questions provided to me by the school, and they were insanely confusing, but I guess I learned a few things.

    We visited the oncology wing where little kids were getting chemo. A bit sad, but they actually looked more lively than I thought they would.

    Lunch was good because as a part of the hospital personnel, I got a discount at the cafeteria, which is pretty nice.

    After lunch again my preceptor went back to verifying orders from the computer, and I got stuck with nothing to do. I have worksheets where I have to log medication orders, but I didn't see any charts around, and the preceptor seemed busy, so I just started pulling out medication bottles and reading the suggested dosage. Then I figured out that this wasn't the best way to handle things, so my preceptor logged me in to the computer where I could look at the charts. I did that for like 3 hours. It was a bit strange how the pharmacist didn't know the brand names for a lot of the drugs (though I admit that some of the drugs were quite exotic). I just looked up the warnings and classes of the drugs from the drug information handbook.

    An interesting thing I saw was a kid being prescribed a viagra suspension. This was for pulmonary hypertension.

    Tomorrow we should be going to the IV room. I hope he also arranges that I shadow some clinical pharmacists, but that's only if they have free time.

    So far the pro of hospital inpatient pharmacy is that you actually have time to breath, and the con is that you mostly sit in front of a computer all day. I think these pharmacists take turns in the IV room, so that's why there aren't that many actual physical drugs for a pharmacist to verify most days.

    More coming tomorrow
     
  2. medicalCPA

    medicalCPA Actually, it's medicalCPA, PhD now
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    This is unrelated to your post...but yay! I guessed right. Viagra CAN be used for hypertension!

    Good luck on your remaining IPPE's.
     
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  3. confettiflyer

    confettiflyer Did you just say something?
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    Yeah they have some "low dose viagra" out there for HTN (I think).

    But I remember it treats patent expiration pretty well also.
     
  4. JeremyE30

    JeremyE30 Accepted Pharmacy Student
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    Sounds about right, most of the pharmacists I work with at the hospital sit at the computer about 90% of the day.
     
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  5. RxWildcat

    RxWildcat Julius Randle BEASTMODE!
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    whoa whoa whoa, pulmonary hypertension is a different story then general hypertension.
     
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  6. confettiflyer

    confettiflyer Did you just say something?
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    yeah true...forgot to make that distinction in my post too!

    brand is "Revatio" for the 20mg prep.
     
  7. janeno

    janeno Senior Member
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    Thank you for posting your diary. I will have to do 3 weeks of IPPE at the hospital this summer, so your diary will help me prepare for what to expect.

    Does anyone want to share rotations diary? Or do you know of any good ones?
     
  8. girllein

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    That's what it was initially studied for. Dogs had crazy erections during the original drug trial, but not the rats, according to my old Biochem professor. Somebody on the drug design team had a dirty mindset if you ask me, because they actually thought about marketing a drug that causes erections.
    Supposedly questionnaires were sent out to doctors too to decide if an erection medicine would appeal to men and be marketable. Initially they didn't realize that it would fly off the shelves at 15 bucks a pill. :rolleyes: Stupid Pfizer! I hope they don't hold back female sex drugs based on poor questionnaire data. That would be a drag...
     
  9. medicalCPA

    medicalCPA Actually, it's medicalCPA, PhD now
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    OK then, enlighten me. I know I should probably Google it, but with the proliferation of new members too lazy to even check what's on SDN, I thought I might as well follow their example.
     
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  10. girllein

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  11. Prepharm1214

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    My IPPE was fairly worthless this semester as well. I was assigned to retail, which was boring as heck when you have already worked in retail. The store was extremely high volume and the preceptor was always busy and had very little planned for us to do, so we ended up just stocking bottles away for nearly the whole time every week.
     
  12. RxWildcat

    RxWildcat Julius Randle BEASTMODE!
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    basically pulmonary hypertension is where the pulmonary artery is constricted, blood is more difficult to pump through it, and cardiac dysfunction usually develops. Theres actually a lot more to it, I just don't feel like typing it all up :D
     
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  13. gabapentin

    gabapentin Drug dealing 4 life!
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    at the hospital i work at...revatio is considered a "narcotic"...i thought it was funny...the pharmacy is afraid the doctors and nurses would try to get a boner :laugh:
     
  14. confettiflyer

    confettiflyer Did you just say something?
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    hahah

    I hate the word "narcotic" the way I hate phrases like "I could care less."

    99% of the time, they're just misused.
     
  15. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    My employer also keeps Viagra and Levitra in the "narc vault."
     
  16. bacillus1

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    Day 2:

    Today was a little more fast-paced. I started the day off with shadowing some techs for half an hour (they were doing oral doses). Then I went to the chemo room and saw how those drugs are handled.

    I have this worksheet where I have to log some IV drugs, so I did that. I spent about 2 hours in the IV room observing. Again, the drug info handbook was my best friend in trying to find out indications for a lot of the drugs. I found out that there are different kinds of staff pharmacist at the hospital. There are the unit pharmacist who verify the meds received by each unit, and there are pharmacists which sit at the computer all day verifying labels and making sure the dosage makes sense.
    My pharmacist did get some drug interaction today with TPNs. The hospital has a TPN machine, so I watched him calibrate it and enter ingredients into the TPNs that weren't in the machine. I also interviewed him and the ordering tech on the medication order process (one of the things I have to do for the portfolio).

    Again, we talked about some questions provided by the school. I really don't think they should limit our dialog in this way (we have to write narratives about these questions). I did, however learn that the pharmacy is starting to implement medication therapy reconciliation (monitoring what medicine the pt. was on after vs. before treatment) and that he hopes this may carry ver to retail.

    Though there are still some times when I just sit there and do nothing, I am learning something about hospital pharmacy. I feel that the IPPE is a beneficial experience, but I think having 100 IPPE hours instead of 300 would be sufficient (50 hosp, 50 retail maybe?).

    Tomorrow I am supposed to start my day off at the outpatient pharmacy. Thursday I may actually observe some rounds! Yay!

    I'm basically done with my worksheets, so the pace of the next 2 days will probably be pretty slow. I guess that'll be a chance to get my notes together and write something coherent.
     
  17. bacillus1

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    Day 3

    I came in today at 9 and did some worksheets I needed to fill out. At 10 I went to the outpatient pharmacy and stayed there for a little less than 2 hours. I talked to the outpt. pharmacist about how it's similar and different from retail, and I did some price labeling for the drugs (they don't have a UPC scanner because the volume is really low). Then I talked to a person on rotations for a little. She basically described to me what she does on rotations. It's a clinical (pediatric) rotations, so she does a lot of rounds. She also does a lot of different projects for the hosp.

    After lunch I just did the paperwork I need to complete for the school. I had to write up some discussion questions I discussed with my preceptor and a flowchart of the medication process. I also wrote my narrative about professional pharamcy organizations (also required by school).

    Around 3:30 I was done, and I am still here at the hospital. I leave at 5 but I really have absolutely nothing to do today.

    Rounds are tomorrow, but I won't be able to see that much of them. The pharmacist that does rounds wanted me to come at 7, but I can't come until 9 (don't have a car, so don't have a ride at 7, and if I did, I wouldn't have a ride back at 3). She'll still be doing rounds, but I guess I won't see her doing them for long. I also still need to discuss some questions with my preceptor that are on the grading rubric. Otherwise, I don't have anything else to do, so I'll probably spend much of tomorrow doing nothing.
     
  18. bacillus1

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    Day 4--final day

    Came in at 8:45 today and went straight to the ICU for rounds. It was pretty interesting how the medical team discussed the cases, and the pharmacist definitely has a say in the treatment. Of course, the final treatment decisions are up to the attending MD, but otherwise the pharmacists are equal to all the other personnel on rounds (anesthesiologist, EM doctor, etc...).

    Then I watched how TPNs were entered into the system. At lunch, my preceptor and I discussed the final questions we needed to discuss for the grading rubric (medication order process and difference between techs, pharmacists and managers). After lunch I went down to the pyxis machine and saw meds put into it. After that, I'm just chillin online. I end at 4:45. I can't use the hosp's gym and pool because I don't have a permanent badge, so I'll just stay on the computer for lack of better things to do. I've already observed everything there is to observe.

    Out of all the pharmacy roles I've observed (outpatient, IV room, clinical and computer verification) I liked clinical the best, since it really feels like clinical pharmacists affect patient outcomes. Second best was outpatient. It is like retail, but with less customers and with no annoying customers bringing cartfulls of frozen food and diapers.

    I could see myself at this hospital in the future as a clinical pharmacist, since it has a great staff and the hospital seems to treat them relatively well (although they were complaining of budget cuts because of the economic crisis). Of course, that is if I decided to stay in Delaware after graduation (which is unlikely). I think it would be better to do next year's IPPE at a different hospital though, just to get experiences from different facilities. As I've stated before, however, ACPE could definitely reduce the hours needed for the IPPEs.

    Well, next semester is my retail IPPE. I hope it's just as informative and will not just be free labor.

    Off to my Rite Aid job tomorrow :(
     
  19. rxlynn

    rxlynn Senior Member
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    Just a tip about your retail IPPE. I felt the same way about it, since I had already spent 6 years as a tech before I had it. Go in the first day and tell your preceptor (in a nice way) what you already feel comfortable with in the retail setting, and what you think you need to work on. My IPPE ended up being a really good learning experience for me, because the preceptor made sure to give me things that I hadn't done before, pick out complicated patient profiles for me to look at, etc.
     
  20. bacillus1

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    Alright, will do. Thanks for the tip.
     
  21. Glycerin

    Glycerin Commercially Unavailable
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    Yep, primary pulmonary hypertension. Compounding is just one of the neat things about children's hospitals. We made just about every tablet/capsule under the sun that wasn't commercially available as a suspension into one.

    As far as chemo goes, I was a pediatric chemo tech for 2 years, and I have to say that as long as they were feeling "well," they were among some of the seemingly happiest and liveliest kids in the place.
     
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  22. tussionex

    tussionex Pharmacist
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    the hospital has a gym and a pool?


    for real?

    sign me up....
     
  23. bacillus1

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    Haha...yes it does...I don't know how many others do. It has a bowling alley as well, but I'm not sure if that's for the employees, or only the patients can use it. I did end up using the gym for a half an hour when I found out it's not locked. It's alright, just a few machines and dumbells that go up to a decent weight and cardio equipment, but hey, what more could you ask from a hospital gym?
     
  24. slick cat

    slick cat UT-Memphis Bound!!!
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    I will take your IPPE over our IPPE anyday. :)
     
  25. pharmwannebe2

    pharmwannebe2 Senior Member
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    ugh. I hate my retail IPPE so far

    my preceptor is busy so she keeps me filling. Really...filling...that isn't a new experience!

    She won't even let me Imput prescriptions....
    Also no one talks at the pharmacy i am doing IPPEs at!! i am confuses as so how silent and boring it can be.
     
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