Archive for the ‘Uncategorized’ Category
Poster Presentation Night
Posted on: May 22, 2010
On Wednesday, we travelled to Vancouver for the annual BC Residency Poster Presentation Night. During the afternoon, the evaluators came around to each our posters to ask questions. In the evening, we did a quick 5 minute Powerpoint presentation for pharmacists.
It was a long day but my poster turned out really well. I had some great discussions with renal pharmacists who showed up to the event.
Although, we did have some glitches and issues with the printing services department along the way. Everything worked out in the end. My poster is currently on display in the Renal Unit at RJH.
Here is a copy of my poster: HChui poster
I just finished off my last day of my “outpatient clinic” rotation. Overall, I learned a lot during the last few weeks.
Pain Clinic
- I did 4 full patient work ups. Some of the patients were very complicated but it was nice to have time to sit down and do a full work up without being pressed for time. The staff at the Pain Clinic were also very welcoming and appreciated having us around so it was a nice environment to work in. patient1 patient2 patient3
- Instead of doing a case presentation, I did an in-service for the staff. The topic I presented on was a new patch that is soon to be released by Purdue Pharmaceuticals. I did review some of the evidence but geared it more toward a non-pharmacy audience (which was a challenge because all the presentations I have done up to this point have been for pharmacists). I did not get a very good turn out unfortunately but I left some handouts for the staff and my email if they had any questions. Here is a copy of the presentation slides: bupherenorphinepatchslides
Anticoagulation Clinic
- I had a variety of different preceptors because my primary preceptor was away on vacation for part of the rotation. The first week I felt pretty uncomfortable because I felt like I had no idea what was going on. But once I got the process down and figured out how to organized the patients I slowly got the hang out it. I think I could handle covering it next year if they needed me to. I am also more comfortable with increasing and decreasing doses of warfarin, which I admit prior to this rotation I was not that skilled at.
- I also taught the Warfarin Classes twice a week on Tuesday and Thursdays. I really enjoyed the experience and most of the patients came out of the class saying they learned many things and they also had numerous questions.
- Lastly, I did photocopy some of my work ups and dosage adjustments which I’ve attached here: documentation
CIVA Rotation
Posted on: January 10, 2010
Objectives
CHPRB Standard 2010
The resident shall demonstrate a working knowledge of medication use system(s) as well as pharmacy and other care provider roles within the system, in order to manage and improve medication use for individual patients and groups of patients.
Levels of expectations
1. Clearly, concisely, and completely describe the functioning of the drug distribution system and medication prescribing processes within the health care organization to another health professional.
2. Assess prescriptions for accuracy, appropriateness, and adherence to health care organizational policies and practices.
3. Consistently identify and complete medication incident reports.
4. Explain & educate others about health care organizational practices and policies related to preparation of sterile products (such as cytotoxic agents, parenteral nutrition, injectable medications), and narcotic & controlled drugs. Independent preparation of sterile products is beyond the expected level of the standards, but active participation in preparing sterile products can help the understanding of aseptic technique.
5. Document prescriptions and prescription changes clearly and completely.
Overall Goal
To introduce the resident to the area of intravenous admixture by increasing their knowledge, skills and abilities in the following areas:
1. Aseptic Technique
2. Aseptic compounding policies & clinical concepts.
3. Technology in sterile product preparation
4. Chemotherapy
5. Total Parenteral Nutrition
Pediatrics – Week 1
Posted on: October 31, 2009
Objectives: Pediatric Rotation
I just finished my first week on the pediatric ward at VGH. I admit it is a totally different world and I no longer can work up patients as quickly as I did in internal medicine and geriatrics. My first patient had multiple complicated disease states such as seizures, hypertension, GERD and short bowel syndrome. I’ve had to do a lot of reading because we did not get a lot of exposure to pediatrics during school.
The H1N1 flu is also a bit of a concern on the ward. There has been a few patients who have been admitted with flu-like symptoms and any patient who is influenza A positive gets put on Tamiflu. To get H1N1 confirmation, we have been sending the samples to Vancouver (BCCDC) and this usually takes ~ 1 week. However, starting Monday the labs in Victoria should be able to run the tests.
I’m faciliating a journal club on Tuesday so I will post a copy of my handout after it is done!
Internal Medicine – Week 3
Posted on: October 10, 2009
I presented my case presentation on the use of glucocorticoids in the treatment of alcoholic hepatitis this week. It did not go as well as I had hoped. But I received some constructive feedback that will help me make changes to it before I present it in Vancouver. Here is a copy of my presentation: slides.
I am also feeling more comfortable speaking up during rounds and I am finding that the residents are calling me more often to ask questions. There were a few instances where the attending and the senior resident did not agree with me but I don’t regret giving them my opinion! For instance, there is no evidence that one PPI is clinically more effective than the other and the attending believes esomeprazole is more potent and therefore “more effective” than the other PPIs.
On Wednesday, we had our session of ARF. We went through a real patient case and discussed how ARF could have been prevented in this patient. A few interesting things I learned were:
– A increase in > 100 micromol/L of SCr is indicative of ARF
– Having “Normal” aminoglycoside (or other nephorotoxic drugs) levels does not necessarily mean ARF will be prevented.
– Rifampin has been known to cause acute interstitial nephritis.
– Hydration is key in ARF, followed by diuretics if fluid overload is occuring. This gets the kidneys per fusing.
– Earthquakes victims who are caught under rumble are at increased risk of hyperkalemia when they are “rescued”. People in Turkey (where earthquakes are common) keep kayxelate in their earthquake disaster kits. (This last point was not part of the case but one of Dan’s random facts at the end of the session).
Five weeks goes by fast! Friday was my last day. I do admit I was getting a bit overwhelmed with the number of patients I had to cover but I made it through. A few things I have taken away from the past five weeks:
1) Developing a relationship with other health care professionals is really important. I had the opportunity to work with one geriatrician who was very appreciative of my suggestions and often came to ask my input. The same relationship is also very important with nurses too. I got to know a few of them and they would often ask me questions about what was on the formulary and this is where my experience in the dispensary came in handy! Nurses are also a great source of information because they interact with the patients so much more than we do and have great insight into things such as pain control, bowels, mood, etc.
2) Learning to juggle your patients. I had up to fourteen patients I think at one point and toward the end I admit that I got a bit overwhelmed as it was my first rotation. I developed a word document to help me keep track of progress and basically updated it with relevant information.
3) Backing up your recommendation is very important. This is something I struggle with when I write my SOAP notes. I know what I’m going to recommend most of the time but giving concrete reasons is something I am having difficultly with for some reason. This is something I really need to work on over the next couple of months.
Lastly, I’ve attached a copy of my slides for my case presentation. Geriatrics case presentation
Depression….
Posted on: September 3, 2009
Yesterday, we had our therapeutic session on depression with Dr. Bree Zehm. The session was a nice review and I also learned a few new things.
1) Seroquel XR is indicated as monotherapy for depression.
2) Sertraline has relatively few drug interactions with the exception doses which exceed 150 mg/per day. It exhibits CYP 2D6 inhibition at higher doses.
3)Venlafaxine doses greater than 300 mg per day are more likely to cause an increase in blood pressure.
4) Acutely suicidal/psychotic patients and pregnant patients are people most likely to receive ECT.
I am looking forward to doing my psych rotation in April. Psychiatry is an area I really feel I need more exposure to as I am not usually comfortable making recommendations with psych meds!
Side note: Bree is going to try to arrange for me to watch a patient getting ECT when I am on rotation with her. I am looking forward to that!
Geriatrics – 3 days down!
Posted on: August 19, 2009
My first clinical rotation started off with an unexpected twist. The first patient I interviewed spoke very little english and I had to interview her in Cantonese. It was really hard trying to translate medical terms and medications but I think I got a pretty good history considering the circumstances. It was a little un-nerving since I’m still trying to develop my interview technique in english but in the end it worked out! The patient was also very appreciative of the fact that I made the effort to talk to her in her native tongue.
All the staff on 7N are really nice and the doctors are easily accessible so you don’t have to page them or track them down. There are weekly rounds and the atmosphere is extremely “multi-disciplinary”. All the patients I have interviewed so far have been really great and answer most of my questions. I have learned to really tailor the interview to the patient as some have hearing problems, vision problems and/or have cognitive impairment. So far, I have done 4 patient assessments and have 4 more to go. Tomorrow we are getting a new admission so I have to do an initial med rec followed by a more thorough assessment.
7N is a great place to start as a first rotation. Right now the ward isn’t too busy so I can take my time and get my bearings.
This week we started our direct patient care rotation. Basically it is an introduction on the process we use to assess patients. We talked about pharmaceutical care, how to communicate with physicians, the different “types” of DRPs, and how to “systematically” interview and assess a patient. We spent two mornings with Sean (Spina) practicing physical assessment on each other. Although, I am not sure if I am comfortable doing that on real patients without someone supervising me. I think the physical assessment part will help though when I am reading charts and will help me understand different information in the progress notes.
I actually went to see a real live patient yesterday and observed an interview. I also hadn’t look at a patient chart since May so I had to get my bearings around that again. It was a bit overwhelming in the sense that there are so many factors to consider and I am scared when I’m the one doing the interviews that I will miss something. But I guess that’s why there is a systematic approach! We managed to raise a couple of DRPs that weren’t resolved and will continue to follow the patient next week.
One thing I will always have to keep in mind is that not all patients will be able to give you answers to all your questions and to be patient when they are answering questions. Our patient was elderly, just had 8 mg of morphine and had delirium so she was having trouble staying awake when we talked to her.
All in all, it was a good introduction and I am slowly learning the “process”. Hopefully, I will be preped for August 17th when I start my first clinical rotation!
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