23 June 2010
The Hospital is about 30 minutes walk from our accommodation, so we starting walking a little bit earlier than usual today and reached there just on time.
There were 4 pharmacists on duty today and each of them taught us different things during the day.
We had a quick tour around the whole hospital and at the same time, picked up discharges.
Then, we went back to the pharmacy to do 2 referral cases. One was a referral to the pharmacy due to falls risk and another one due to dysphagia, therefore medications have to be given through routes other than orally.
We were given a little bit of time to do the 2 cases and then we discussed it with the pharmacist. We then went up and talked to the patients, as well as the doctor to come up with the best solutions for the patients.
The major concern with the lady who had a high risk of falls was that she was taking Warfarin, as well as Aspirin. If she falls again and knocks her head, she would have a massive bleed in her head and this would be the last thing we want to see happen. She was on Perindopril and high dose Frusemide as well, which could cause hypotension. MS-Contin and PRN Endone can cause her to become drowsy and fall. The pharmacist needed to talk to the doctor about the patient's meds but before that she counselled the patient about the importance of not having a fall while in the hospital.
The other patient had cancer and was on numerous antiemetic drugs as well as opiod analgesics. We had to go through all the drugs and pick out those that are not given IV, and then think about whether to dissolve the tablets, crush them or use capsules, patches, suppositories, etc. However, when we got up to the ward, we found that he's got no IV lines therefore all the other drugs that we thought we could give IV had to be given using other routes as well. And while we were there, we found that there were a few more meds charted on the drug chart. Thankfully the doctor was there, so we had a good discussion with the doctor. I am surprised at how the doctor valued our opinions, not only the pharmacist's but he valued highly our opinions as well.
Our discussion revolved around whether Nurofen was better than Indomethacin in terms of causing fluid retention; whether the patient should be taking regular paracetamol despite having metastatic cancer in the liver and elevated liver enzymes; whether we should use a patch to replace sustained-release morphine; and whether Cyclizine was needed.
Our conclusion was that Nurofen was no better; that it is alright to take short term paracetamol because it undergoes phase II metabolism, which is less affected by disease; that a Fentanyl patch would be a good alternative as long as he is not opioid naive; and that Cyclizine can be withheld unless and until necessary.
Maria and i were wondering how the PPI tablets can be dispersed in water when they are enteric-coated. Today, the pharmacist showed us what happens when an Omeprazole tablet is dispersed in water. What becomes of the mixture is a cloudy solution with little yellow beads at the bottom and these small little beads themselves are enteric coated, not the whole tablet. Therefore, even if you disperse it in water, it still has an enteric coating. The other thing that i found interesting, was that the pharmacist highly recommended the patient to opt for the Ondansetron wafers if he can because it gives a quicker relief of his nausea.
We also had the chance to see how a cytotoxic IV infusion was made up. The drug was, if i've not mistaken, Temsirolimus. Later on in the day, we observed how Lignocaine and Adrenaline with Hyalorunidase are made up and put in 6mL syringes for eye surgeries. We also had a closer look and understanding of how leur-lock syringes and elastomeric infusers are used in real life.
The best part of today's visit was talking to the pharmacists and hearing their different stories of how they ended up working in the hospital. Most of them tell us that there are pros and cons to working in a regional hospital and one of the pros is that you get to learn to do everything. I can really see with my own eyes that they are skilled in every area of pharmacy, from reviewing medications to making up aseptic preparations, from administrative work to counselling patients. I find this rather impressive.
One special thing about this hospital is that most of its doctors are GPs who come in during the day to see the patients and then come in again the next morning. The other special thing about this hospital is that the blood products are handled by the pharmacy department, where they have to label each and every one of the products before they are given to the patients, where as this is not usually done by hospital pharmacies elsewhere.
Well, that's about all that has happened today and i thoroughly enjoyed my learning time at the hospital pharmacy today.
p/s: my friend and i are a little stressed now, having to do all the homework assigned to us as well as preparing for job applications. But we always come home feeling very tired.. :( she is already snoring away next to me, half way doing her stuff. I shall go join her now, cos my eyes can barely open! Good nite!
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