Hello everyone, I am blogging again to describe my internship experience at the University of Michigan Hospital. In my last post, I portrayed my compounding experience in the Clean Room of the central pharmacy department. In this post, I will illustrate my new position of working in the satellite pharmacies, which are located on the individual floors (units) of the hospital.The satellite pharmacies are an exciting atmosphere to work in. They are the "first line" of contact and solution for most patients who are admitted into the hospital and require pharmaceutical care. Pharmacists who work in the satellites are termed ‘generalists’ and answer inquiries from nurses on a variety of topics ranging from the selection of blood pressure medication to the administration of inhaled oral medication to dosing frequency of heartburn medication to recommendations for patient self-treatment. An environment such as the satellite requires pharmacists to have a broad sense of pharmaceutical knowledge and great communication skills. There isn’t a day of work where the pharmacist doesn't learn something new.
While operating in the satellite, I have held multiple responsibilities that require swift and accurate working skills in order to fulfill patient medication requirements. The first position that I will describe is the so-called “runner”. As the runner, I am responsible for filling oral medication requests that are sent to the satellite pharmacy. This sounds like an easy task but like in retail pharmacy, there are over 2,000 in-house alphabetized medications with 1,000 more uncommonly used medications available through contact with the central pharmacy department. The key here is having an organizational system that works and being able to find the medication in a timely fashion! In addition to filling the correct dose of oral tablets, capsules, liquids, and powders, the runner also compounds liquids into oral syringes for administration. This part of the job can be quite unique because while preparing the pharmaceutical-active medication with an additive to mask the taste, additives, such as syrup, are quite strong smelling and can leave the immediate surrounding smelling like strawberries. After collecting the required oral medications and syringes, they are given to the pharmacist to check for dose and drug accuracy in comparison to the medication request form printed on a stickered label within the satellite pharmacy. Once approved, the pharmacist signs the label and the label is officially placed on the bulk medication to be delivered. The oral medications are combined with IV bags compounded from the satellite’s chemical hood personnel and are then stored into holding bins designated by patient's room numbers.
The runner’s second responsibility is delivering the medications from the holding areas to the correct patient's room or medication holding area on a unit. This involves delivering general patient medications to multiple numerical-coded medication holding rooms on each floor, delivery of narcotics and other controlled medications to Omnicells (computerized medication storage areas requiring user identification), or to patient's rooms (medications that are immediately required such as electrolyte dialysis bags). The runner position is exactly what the title describes: a position in which I get ample exercise by way of medication distribution throughout the hospital.
Another cool opportunity in which I have been able to take part in has been IV piggyback compounding in the satellite. While the same procedure applies as described in my last post (compounding IVPBs in the clean room), the satellite IV-compounding position is considered to be much more spontaneous. It is spontaneous in the fact that the medications that I compound into IV form may change drastically day-to-day based on the hospital’s inpatient population. While one day I might be compounding numerous electrolyte dialysis bags for renal therapy, I might compound many narcotics or insulin the next. Since no one day is the same, working in the satellite IV compounding hood keeps me on my feet and excited for what the rest of the day has to bring. The feeling of accomplishment is also felt when I work in this position. When a patient codes in the hospital, a medication request is sent to the pharmacy requiring sometimes 4, 5, or 6 medications that are required STAT. It is then up to my compounding ability to provide the medications in a quick yet accurate fashion. At the end of the day, I know I have tried my hardest in helping that patient survive.
A unique aspect to IV compounding in satellite pharmacies is the opportunity to compound narcotics. Based on the power of medications such as hydromorphone, fentanyl, and amphetamine, accuracy is of high importance. It is necessary to show the pharmacist all of the narcotic and IV-base syringe volumes I use to compound the narcotic as well as the narcotic waste I do not use. Presenting the pharmacist with the waste is imperative in controlling the use and distribution of the narcotic among the hospital.
In summary, working in UofM hospital’s satellite pharmacy is a great experience in having the opportunity to act as the patient's emergency pharmaceutical responder. While I have explored with you the central pharmacy department's clean room and roles within the satellite pharmacies, I will next be writing about my experience in managing the hospital’s drug inventory. Stay tuned and have a great summer!