I can’t believe I’m half way done this rotation. It seems like I just started.  I have a lot of patients and never thought I would ever be able to keep them straight. But somehow I am keeping them organized! Things I have been doing over the past three weeks:

1)  Putting almost every patient on calcium and vitamin D and I’d say half of them I’m recommending a bisphosphonate as well. The risk of falls and fractures is huge on this ward!

2) Learning so much about chronic pain – both MSK and neuropathic. I’ve maxed out most patients with pain on Tylenol 1 g QID for those with MSK pain! Gabapentin seems to be the “go-to” drug for neuropathic pain but I am seeing that even small intial doses  can cause dizziness and sedation. We actually had to recommend a starting dose of 50 mg qhs (using liquid ) today because the patient got extremely sedated and dizzy when they started him on 200 mg qhs three days ago.

3) Assessing compliance. This is often overlooked when pharmacists assess compliance and even if it is assessed nothing is done about it at discharge to ensure that they can actually handle their medications at home.  Patients also lie a lot more often than you think. I think a lot of times they want to be “good patients” and are actually scared to tell you that they have difficulty managing their medications.

4) Learning about the statin controversy. Most statin trials exclude patients older than 85 so whether the results can be extrapolated to the geriatric population is debatable.  Unless a patient has multiple CV risk factors, some doctors are not keen on starting/ keeping them on a statin.

September 18, 2009

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