Ways to be more clinical

Discussion in 'Pharmacy' started by sherlockRX, 10.30.14.

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  1. sherlockRX

    sherlockRX 7+ Year Member

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    I'm currently working at a small hospital (120-bed) and I'm the only evening pharmacist to staff here. I didn't do residency and just went straight in for this job. I guess I got hired because nobody wanted to do the shift (12:30pm to 9pm) especially if they have kids or family.

    The hospital has clinical pharmacists in the morning who go on rounds with doctors, make recommendations and clinical interventions, and handle the discharge counseling. When I come in the afternoon, my main responsibility is staffing/dispensing aka. order entry and verification of technician's work. I also get new admissions' orders and I have to verify all of those then supervise the tech when they prepare meds for these new admits. Among other duties, there are IV checks, Pyxis refills check, and patient cart fills. The only clinical stuff that I may get to work on is when morning clinical pharmacists cannot follow a late vancomycin's trough or a culture sensitivity that comes back at night. Maybe once or twice a month, I got a late evening's pharmacy-to-dose vancomycin or aminoglycosides. I occasionally get doctors called in for random drug info questions, but that's usually the non-experienced residents who have no idea what we have in stock/formulary. I just personally don't feel it's a lot of clinical stuff that I can do around here.

    Anyway, since all the morning pharmacists and director leave around 4pm, I'm the only pharmacist left to take care of stuff. There's a lot of autonomy and rooms to get more clinically involved if I want, and I already started a few things:
    1) I made a database of all in-house patients on Coumadin and following them with PT/INR to see how the dosing changes were done. I actually caught some misses from the clinical pharmacists, such as forgetting about d/c Lovenox when INR is therapeutic
    2) I also had a database of all patients on IV antibiotics that I would follow up for cultures, labs, and renally adjust dose if appropriate.
    3) I also created another database for IV-to-PO switch.

    ...but I now ran out of ideas...I know I'm at disadvantage for not going to residency, but I want to sharpen my clinical skills and at least remain as much as competitive against newly residency-trained pharmacists in my area. I am actually planning to take BCPS exam next year as well.

    What other ways that I can do to help to build up more clinical skills? What other duties/responsibilities other clinical staff pharmacists have in their hybrid model practice that may work with my situation? I just want to get some more ideas of what I should do on my job to make it more clinically oriented...

    Thanks!
     
    oldstock likes this.
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  3. rxglasshalffull

    rxglasshalffull 2+ Year Member

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    its awesome that you want to be ore clinically involved. i dont give two ****s about the clinical aspects of pharmacy, thank god i didnt apply for residencies. i also couldnt deal with chain retail either, but now im very comfortable at where i am. no bull**** and stress from chain retail, not much clinical stuff either.
     
    farmadiazepine likes this.
  4. stark3

    stark3 2+ Year Member

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    ... I don't see how your comment helps him at all. Why would he care that you don't want to do clinical work?
     
  5. KARM12

    KARM12 Super Member 10+ Year Member

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    Can you get involved in a committee or project? Do you have Drug Guidelines? Maybe offer to create or update those. Talk to your boss, he/she would probably be happy to hear that you want to be more involved.

    Can you do med/rec or patient counseling?
     
  6. rxglasshalffull

    rxglasshalffull 2+ Year Member

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    at least my comment is relevant to the topic, your comment above isnt even relevant!
     
  7. bacillus1

    bacillus1 7+ Year Member

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    1)Admission and discharge med rec (as well as discharge counseling) for all patients coming in or leaving during your shift
    2)ER discharges
    3)Go to all codes that happen during your shift (upon ACLS certification, of course)
    4)kinetics for vanco/aminoglycosides

    Have fun, that'll keep you busy.
     
  8. Sparda29

    Sparda29 En Taro Adun Gold Donor 7+ Year Member

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    He's the only dude on his shift. Probably can't leave the pharmacy.

    - You could set up a database for patients on simvastatin and monitor for interactions with amlodipine, etc based on the new guidelines.
    - Monitor renal fx of patients on Metformin.
    - Monitor vanco troughs
    - Monitor lovenox doses for appropriateness

    PS: How is it that no one wanted that shift? I'd love that shift.
     
  9. bacillus1

    bacillus1 7+ Year Member

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    Our night pharmacist does all that by himself with no tech (except non-ER discharges), and our hospital is 3 times the size of this person's. If there's a code, tough luck, the orders will have to wait. Not saying that that is safe at all, but just saying that that's how it's done here. I had to do 3 nights of this and it was pretty ridiculous, but I did it.
     
  10. bacillus1

    bacillus1 7+ Year Member

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  11. msweph

    msweph 2+ Year Member

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    That's seems pretty hard to do. Props to him. I would die if I had to do that when I work nnigts.
     
  12. mustang sally

    mustang sally 7+ Year Member

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    Yeah, that would suck. I wonder how that hospital handles overrides. Hopefully no one direly needs anything while the only pharmacist in the building is off at a code.
     
  13. Dred Pirate

    Dred Pirate 2+ Year Member

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    this - one of our overnight pharmacists (we have three) is actually our P&T lead, just because the timing of your shift doesn't mean you can't do other things. It just means you have to be able to balance multi tasking, if you are able to do this, once a day shift position opens up, you will run circles around those than can't
     
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  14. sherlockRX

    sherlockRX 7+ Year Member

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    First one: we don't use Simvastatin. Non-formulary. Automatic substitution to Pravastatin or Atorvastatin.
    Next 3: already done! :) Had a database to look at vanc/AG dosing. Working on another renal adjustment database including metformin's sCr monitoring and of course, Lovenox.

    A bit more about my hospital. Not to disclose where I'm working, but it's not really an acute care hospital. We don't have ICU or ER. It's more in line as a LTACH or Specialty Hospital. Codes do happen, but we transfer patients out ASAP too. Anyway, I'm planning to get ACLS certified to prepare better for codes.

    I like my shift...It's not too crazy when I get all the new admits and orders taken care of. The evening can be quite relaxing and laid back. At the same time, I appreciate the peacefulness of my shift, I'm starting to worry that I will eventually loose all my critical and acute care knowledge and skills too. And, doing all just staffing duties only, I don't think I can ever become a good clinical pharmacist.
     
  15. bacillus1

    bacillus1 7+ Year Member

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    Not sure what an override is, maybe we have a different term for it. Yes, it absolutely sucks...and dayshift pharmacists have to rotate through nights on weekends. Just did 3 days a few weeks ago and it was absolutely horrible and was one more thing to push me to accelerate my job search for another position.
     
  16. KARM12

    KARM12 Super Member 10+ Year Member

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    If the OP comes in at noon, I am sure there are a few hours of overlap that he may have to get involved in other projects. Honestly, show your interest to your boss and I am sure you will get suggestions
     
  17. mustang sally

    mustang sally 7+ Year Member

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    Override = when the nurse pulls something from an ADC without pharmacist verification. All nurses here have access to override life saving medications (pretty much anything you would need can be found in the crash carts anyway), but for departments that require pharmacist review first, it's policy that RNs are not allowed to override the medication (and actually, most of them can't, since override access is turned off for most medications/most RNs).

    So if the pharmacist is not available and/or getting the orders verified right away, the RNs have a bit of a tendency to freak out.

    And good luck in finding a new job! I don't think overnight shifts or trying to deal with a large hospital as the only pharmacist would be my cup of tea either.
     

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