tips for newbie hospital pharmacist

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jkhwun

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hello!
so i've been starting to work as a hospital pharmacist about two months or so though I feel like there are so many things that I need to know and learn!
What I was expecting from hospital pharmacy was slow, loose, boring and etc. (b/c that's what i've seeing from this forum and hearing from other ppl that i know) but it's NOT like that at alllll at my hospital...!
i'm literally running my a** off every day. calling doctors, nurses and nurses calling me for missing meds, other stupid stuffs, checking meds to go up to the floors, etc.
I'm like dead tired after the work..

I mean some of the things will get better as experience comes but i just want to hear from those of you who moved from being a newbie to pro
like those drug interaction...! on lexi, micromedex it says X but i think i still verify like 90% of them...? (totally different from the rotations..) do you guys do this too?

how long did u guys take to get used to? and any tips?! thanks!
 
Current pharmacy resident here. I had a one month staffing rotation and by the end of the fourth week, I felt very comfortable staffing. Be sure to lean on more experienced pharmacists if you have trouble and just think critically about risk v. benefit when it comes to interactions.
 
What I was expecting from hospital pharmacy was slow, loose, boring and etc. (b/c that's what i've seeing from this forum and hearing from other ppl that i know) but it's NOT like that at alllll at my hospital...!
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Seriously? Whoever told you that was joking. Slow hospitals long ago closed up, just like slow retail pharmacies have closed up. Just as retail pharmacies are staffed to a bare minimum, similarly hospital pharmacies are staffed to a bare minimum.The biggest difference is that you will get a sit-up down, undisturbed (only exception is if you have to respond to codes) lunch break.

how long did u guys take to get used to? and any tips?! thanks!
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With any new job, it takes 6 months to a year to really be proficient at it, but by 3 - 4 months you should have a good routine down.

Biggest advice, be nice to the nurses. No matter how many times they lose meds, or call and ask you the same question, or harrass you for a non-stat medication, or complain about how much harder their job is than yours....no matter what they do, always be nice to them. Trust me on this.
 
@BidingMyTime knows what's up. It took me six months to feel truly comfortable. Even when I knew how to handle 95% of everything that could happen, inevitably I get a panicked call from the ICU needing me to do something I had never heard of in my entire life.. and this is 5 minutes after my partner left for lunch. Handle a few situations like that and you gain the confidence to realize that while you may not know what to do in every situation, you know how to work through the problem until you find a solution.

Having working in a few hospitals, I have been in frantic institutions where you are putting out fires the entire time (my first job), and in relaxed institutions where things seem to just work on their own (my current weekend job). A lot of it has to do with the culture of the hospital, and the policies in effect. A pharmacy that fully embraces technology can save itself a lot of stress and give the staff more time to handle clinical issues. A pharmacy that doesn't trust a nurse to split a tablet in half or connect a vial to an advantage bag.. you are setting yourself up for a stressful situation.
 
Do not be afraid to get the nurse or physicians number and call them back in 5 minutes after you've researched their question further. Sure, you'll disgruntle them for taking more than 10 seconds, but it's better than losing their trust if you cause patient harm.

Also do not be afraid to call your other colleagues. This isn't APPEs or residency where they'll just respond "What do the guidelines say?"
 
msweph said:
Lol @ the resident who said he could staff after 4 weeks. NONE of the residents I've worked with have been close to proficient in 4 weeks, despite how clinically savvy they think they are
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Eh. They didn't say they could do it alone.
 
thanks for all of your posts! i really am glad it takes time!
 
msweph said:
Lol @ the resident who said he could staff after 4 weeks. NONE of the residents I've worked with have been close to proficient in 4 weeks, despite how clinically savvy they think they are
Click to expand...

And I'm sure that person thinks he or she is God's gift to pharmacy and will change the world, too. Add some discharge counseling in there and special projects and "posters" they are what every DOP wants. NOT.

Took me a year and a half to feel comfortable, and I'm still not used to everything. I can say, however, I'm a very good worker and people will take me over any one of the lazy 10 year veterans at my hospital any day.

It's important to learn how the pharmacy operates. Some people I work with focus solely on verifying orders and interventions. While it is necessary, that's not how a pharmacy runs. You need to understand everything from the moment an order is entered to how it is finally delivered to a patient. Workflow is important. Pyxis is important. Preparation of medications is important. Unit dosing is important. Batching, IV's, par levels, loading drugs, removing drugs, monthly inspections, how to properly and cleaning profile is important. There are a lot of sloppy pharmacists who know what to check but don't know how to properly use their computer system. Knowing work flow of first shift, second shift, and third shift, and not just your own shift, is important. You get what I'm saying? Know the entire process. The rest, like verifying orders, is easy.
 
farmadiazepine said:
And I'm sure that person thinks he or she is God's gift to pharmacy and will change the world, too. Add some discharge counseling in there and special projects and "posters" they are what every DOP wants. NOT.

Took me a year and a half to feel comfortable, and I'm still not used to everything. I can say, however, I'm a very good worker and people will take me over any one of the lazy 10 year veterans at my hospital any day.

It's important to learn how the pharmacy operates. Some people I work with focus solely on verifying orders and interventions. While it is necessary, that's not how a pharmacy runs. You need to understand everything from the moment an order is entered to how it is finally delivered to a patient. Workflow is important. Pyxis is important. Preparation of medications is important. Unit dosing is important. Batching, IV's, par levels, loading drugs, removing drugs, monthly inspections, how to properly and cleaning profile is important. There are a lot of sloppy pharmacists who know what to check but don't know how to properly use their computer system. Knowing work flow of first shift, second shift, and third shift, and not just your own shift, is important. You get what I'm saying? Know the entire process. The rest, like verifying orders, is easy.
Click to expand...

Yeah Im definitely getting used to the workflow at my hospital. Since I work the evening most of the time there isn't that much of work to do.
At our hospital we have a robot that fills the medications so it's nice that I do not need to check some fast movers going up to the floors.
I feel like verifying orders is the main thing. Sometimes it gets too busy i just don't know what I am doing.. but I guess I need some time.
Thank you for your tips!
 
I must have been a late-bloomer. It took me 1.5-2 years to really feel comfortable with central operations although I would say that I could run every position in the hospital competently at the end, something few of my colleagues could do. I echo @gwarm01 and @BidingMyTime and my first hospital and reactor experience when I studied for the BCNP was at a disaster of a place where you just never caught up. I learned everything I needed to know about how not to run a hospital pharmacy from the incompetent operations director and RSA there.

I do think that all new pharmacists in a hospital irrespective of experience should be started on days to learn the local patterns before dispatch to other tours. It has been my experience that the hardest shift to man properly is either swing (where you get a mess from the day, and you have new admit orders come through) or graveyard where you're left alone and things happen in a trauma center (as well as possibly dealing with stupid outpatient dispensary work). However, good pharmacists in those positions set a tone where the day shift, it's hard to actually establish a proper command tone unless you rotate pharmacists through all the central positions including the clinical pharmacists.
 
I work evening and yeah sometimes things can get crazy, you only need 1-2 patients to go bad and **** to hit the fan. Staffing wiss we have less techs and less overlap for lunch/dinner, all the holes in the schedule are evenings shifts. Probably more challenging to a beginner is that there could be no one here to ask except for your other random prn pharmacist, who could know nothing. Still, I like getting up at 10 and seeing the bosses leave at 4.
 
Thanks guys for all ur inputs about starting a new Hospital career.I started also like 8weeks ago and it's a lot to learn and navigate the system especially when u come to learn that the staff is not very cooperative and I feel sometimes that iam at the wrong place for a minute..anyways..trying to set my comfort level to learn as much as I can and I think with time it might get better.
 
Be efficient, prioritize your orders (which ones need to be done immediately, which can wait in line, what's ward stock vs. something you need to make and send)

Feel free to ask questions. Totally agree, you're no longer a student (no one's there to test you), so if you have a question, use your resources - ask the more experienced pharmacists instead of guessing and worrying.

I'm impressed with the resident who felt confident by 4 weeks, haha. When I was a pharmacy resident, it took me months before I felt confident with our formulary, dispensing policies, answering phone calls, etc.

Be respectful of your technicians, you're in it together. They work really hard, and in some hospitals, they're the ones fielding all of the calls from stressed out nurses, etc. 🙂

Good luck! It'll come with time!
 
Ketchupbottle said:
Be efficient, prioritize your orders (which ones need to be done immediately, which can wait in line, what's ward stock vs. something you need to make and send)

Feel free to ask questions. Totally agree, you're no longer a student (no one's there to test you), so if you have a question, use your resources - ask the more experienced pharmacists instead of guessing and worrying.

I'm impressed with the resident who felt confident by 4 weeks, haha. When I was a pharmacy resident, it took me months before I felt confident with our formulary, dispensing policies, answering phone calls, etc.

Be respectful of your technicians, you're in it together. They work really hard, and in some hospitals, they're the ones fielding all of the calls from stressed out nurses, etc. 🙂

Good luck! It'll come with time!
Click to expand...

I guess I should elaborate. I worked as a technician at this hospital prior to pharmacy school and stayed on for the residency. So I knew things like formulary and how things worked in this hospital since I had been here for 6 years already.

When I said comfortable I just meant I wasn't asking questions as much, could figure things out on my own.

Tough crowd here.
 
gwarm01 said:
@BidingMyTime knows what's up. It took me six months to feel truly comfortable. Even when I knew how to handle 95% of everything that could happen, inevitably I get a panicked call from the ICU needing me to do something I had never heard of in my entire life.. and this is 5 minutes after my partner left for lunch. Handle a few situations like that and you gain the confidence to realize that while you may not know what to do in every situation, you know how to work through the problem until you find a solution.

Having working in a few hospitals, I have been in frantic institutions where you are putting out fires the entire time (my first job), and in relaxed institutions where things seem to just work on their own (my current weekend job). A lot of it has to do with the culture of the hospital, and the policies in effect. A pharmacy that fully embraces technology can save itself a lot of stress and give the staff more time to handle clinical issues. A pharmacy that doesn't trust a nurse to split a tablet in half or connect a vial to an advantage bag.. you are setting yourself up for a stressful situation.
Click to expand...

Yup, there was an incident with some med at one of my hospitals a few years ago. I think Metoprolol, and the doctor insisted on dosing it 12.5 BID and told the nurse to just split the 25. It took 2 days for this order to get released because no pharmacist wanted to sign off it because they didn't believe that splitting a pill without a pill splitter is accurate enough. They actually made the clinical pharmacist call up the manufacturer and talk to the medical science liason to get an answer.

Also to the OP: figure out how much stuff you can get away with regarding making changes to orders without contacting prescribers, you'll save yourself a lot of time. (Most places will just tell you that you cannot switch something without speaking to a doctor. Figure out which doctor's don't care if they are called and for those make whatever changes you feel necessary without authorization.)
 
Niosh said:
Did more than one pharmacists seriously believe this? I can't even.
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Perhaps one pharmacist didn't want to verify it, so the rest just ignored it, waiting for that one to sign off on it? I have seen things like that.

Sent from my SAMSUNG-SM-G920A using SDN mobile
 
Niosh said:
Did more than one pharmacists seriously believe this? I can't even.
Click to expand...

The daytime pharmacists at my hospital would hold orders for the stupidest and smallest of mistakes. Doctor ordered Vancomycin 1 mg instead of 1 gram. (the system uses mg instead of grams as the base choice for drug strength). Someone actually held the order and called the doctor about it...

If you know what the doctor actually meant to order and you still hold it up instead of correcting/modifying the order yourself, you're just being an dingus.
 
So guys can u share what software u r using for order verification in my hospital they use a Epic..which is very helpful but has some defaulting issues
 
Sparda29 said:
The daytime pharmacists at my hospital would hold orders for the stupidest and smallest of mistakes. Doctor ordered Vancomycin 1 mg instead of 1 gram. (the system uses mg instead of grams as the base choice for drug strength). Someone actually held the order and called the doctor about it...

If you know what the doctor actually meant to order and you still hold it up instead of correcting/modifying the order yourself, you're just being an dingus.
Click to expand...

Damn.. you'd think New York would have top quality pharmacists.

The whole half tab thing made me laugh. It just goes to show how much the culture of your hospital can affect your decisions. I guess I benefited from getting my start with a pharmacy crew that had the philosophy of we are all on the same team, we are here for the patients, so don't drag your ass or make excuses.. just make it happen. If my docs made a mistake and I could tell what they wanted, or it was a minor dosing error (even greater than our policy of 10%), just fix the damn thing. Probably why our docs liked us so much. We didn't bother them over stupid crap, we would use our professional judgement and give them something that works. If I called my docs it was because they made a serious mistake that would harm the patient or some sort of clinical decision that made a difference.

Nano1971 said:
So guys can u share what software u r using for order verification in my hospital they use a Epic..which is very helpful but has some defaulting issues
Click to expand...

I've used Epic and Meditech. Epic has a better baseline.. but these things are all configured by your local team. Doing an Epic install right now and I can easily see how it might be done wrong.
 
gwarm01 said:
Damn.. you'd think New York would have top quality pharmacists.

The whole half tab thing made me laugh. It just goes to show how much the culture of your hospital can affect your decisions. I guess I benefited from getting my start with a pharmacy crew that had the philosophy of we are all on the same team, we are here for the patients, so don't drag your ass or make excuses.. just make it happen. If my docs made a mistake and I could tell what they wanted, or it was a minor dosing error (even greater than our policy of 10%), just fix the damn thing. Probably why our docs liked us so much. We didn't bother them over stupid crap, we would use our professional judgement and give them something that works. If I called my docs it was because they made a serious mistake that would harm the patient or some sort of clinical decision that made a difference.



I've used Epic and Meditech. Epic has a better baseline.. but these things are all configured by your local team. Doing an Epic install right now and I can easily see how it might be done wrong.
Click to expand...

Perhaps they are top quality. But they are afraid of doing anything without approval. Me, if I speak to a doctor once and get approval on something, I'm going to write "spoke to MD" every time I see the same or similar issues pop up. Fact is, most doctors don't care if you change their orders without permission.
 
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