One of the benefits of my current rotation, cardiology, is that it's not at my university hospital.
There's only one cardio rotation at University Hospital, so because cardiology was lower on my list of Most Wanted Rotations, I got sent out to Smaller Hospital 40 minutes away, which has a big cardiology department. (It's not a small hospital, exactly - their CCU alone has 17 beds. It's just smaller than most I've been to.)
So I'm a bit out of my comfort zone, because I don't know the hospital or their computer systems or the way they practice pharmacy. When I got there, I found that there are a number of other students from another nearby pharmacy school who do all of their rotations at Smaller Hospital. They, of course, know the system very well, and they were happy to show me around.
But it's interesting to see how pharmacy is practiced differently. For example, at this hospital, the pharmacy (the staff pharmacists, not the clinical pharmacists) is responsible for doing about half the Coumadin and antibiotic dosing. As such, they routinely write orders for certain antibiotics, INRs, and antibiotic levels. Their stewardship program consists of monitoring all the restricted antibiotics (and then not being able to do anything about it unless they're consulted. It's a pretty ineffective stewardship program). Another thing I've noticed is that they're big on loading doses. They load Coumadin (which I'm pretty sure is flat-out wrong, even though they have their adaptations and apparently haven't had any major problems). I've also seen loading doses of Vancomycin and aminoglycosides. That's something I almost never saw at University Hospital, though it's not necessarily wrong.
And of course, sometimes it feels just like home. Their pharmacy, like all others, is in the basement. Clinical pharmacy there works pretty much the same as it does at University Hospital - you make recommendations to the intern and/or the residents, and you're responsible on rounds for knowing all about drugs. And the interactions among pharmacists, doctors, and nurses are about the same as what I've seen other places.
It's a little reassuring to know that some things never change. Next year I'll (hopefully) be doing a residency year, and my top two choices are 600 miles away from here. So hopefully, this experience will help me learn to adapt to a different hospital in a different place. The students from Other Nearby Pharmacy School have occasionally said that they wish they could do rotations in other places, just to see what it's like. I'm glad my school gives us that option.
Alb: If some of the terminology is above your head, refer to the comments for a bit of clarification from Shari. :-)
Just a few questions to help out non-med readers:
1. What does it mean to load a drug?
2. What's a stewardship program?
3. What's the difference between staff pharmacy and clinical pharmacy?
4. Can you explain the purpose(s) of the drugs you mentioned?
1. Loading a drug means giving a higher dose right away, to get bloodstream levels up to where they need to be as fast as possible. Sometimes it makes a difference in outcomes, sometimes it doesn't. Occasionally it's harmful, because if you give too much, it's essentially an overdose.
2. A stewardship program monitors antibiotic use. If antibiotics are used appropriately and for appropriate durations, you can reduce resistance and of course also control costs.
3. Staff pharmacists dispense drugs from the pharmacy. Clinical pharmacists round with doctors and are more involved with direct patient care and some administration.
4. It's not really important, but Coumadin is a blood thinner. The others are antibiotics.