A Resident’s Typical Day

Cardiovascular Intensive Care Unit

A typical day in the CVICU starts with pre-rounding on patients to assess pertinent clinical findings and form recommendations. I then go to rounds where I participate in making clinical decisions on patients with an interdisciplinary team. I also especially help with answering any medication related questions or making medication adjustments. After rounds, I will write TPNs with my preceptor because the CVICU has a TPN per pharmacy protocol.

I will also catch up on monitoring notes, such as vancomycin per pharmacy notes, follow-up with my preceptor on patient care, lead a topic discussion with my preceptor, or follow-up on questions my preceptor given to me the day prior. I will also attend code blues and be present for emergency interventions such as a rapid sequence intubation or extracorporeal membrane oxygenation.

Overall, I find the CVICU environment very interesting and exciting. There are many patients with complex heart physiologies and pharmacy is an integral part of the patient care team, so being involved in many clinical decisions is very fulfilling to me.

Solid Organ Transplant

My day begins with chart review of my patient list and reviewing my recommendations with my preceptor before 8:30 a.m. rounds. I assess pertinent clinical information such as immunosuppressant therapeutic drug monitoring, appropriate opportunistic infection prophylaxis, and post-transplant antithrombotic therapy. I had the opportunity to care for pre-transplant evaluation consults, fresh post-transplant patients, and readmitted patients for transplant complications such as rejection or infection.

After rounds, I spent my afternoons teaching patients and caregivers how to safely and effectively adhere to their complex post-transplant medication regimens. Spending this time establishing their understanding of this lifelong responsibility was the most rewarding part of this learning experience.

Acute Care Pediatrics

My typical day starts with a thorough chart review of my patients. I use the information provided to form meaningful interventions that I go on to pose to my preceptor and the interdisciplinary team. While on rounds, I field pertinent medication-related questions and discuss ways in we can best optimize a patient’s therapy so that we can achieve a shared set of common goals.

After rounds, the rest of the afternoon is reserved for resident learning, patient education, and pharmacy documentation. The most rewarding aspect of this learning experience is the ability to learn from such a skilled, diligent group of individuals.

Antimicrobial Stewardship Program

Our goal as antimicrobial stewards is to ensure the safe and effective use of antimicrobial therapies, in other to reduce resistance and prolong longevity of all antimicrobials in our society. A typical day in ASP I begins with prospective audit reviews and feedback of current antimicrobials in our hospital. Depending on my work load for the day, and the day of the week, I typically arrive around 6:30 to 7 a.m. My mornings entail reviewing antimicrobial therapies in order to identify, discuss, and relay recommendations to the primary team through their pharmacist, ideally before 9 a.m. My afternoons are often filled with recommendation follow-ups, journal articles and guideline reviews, ASP meetings, mini-project work, presentations preparation, and topic discussions.

I also gain exposure to the outpatient infectious disease side of care through attendance of weekly clinics where I get to observe physician based ambulatory care and or interact with patients. ASP allows me to stay connected with inter-disciplinary team and to build on my infectious diseases knowledge base. I have thoroughly enjoyed this experiences as I get to expand my knowledge base and make an impact one antimicrobial at a time.

Ambulatory Oncology

Every morning, I would perform a chart review of the patients coming into our Bass Center Outpatient Clinic who have appointments starting at 9 a.m. I review the patients who are on our specific pillbox and medication calendar lists. These patients are those with increased risk of nonadherence due to low health literacy, complex medication regimens, or specific patient factors requiring additional aid. I review their oncology roadmaps to determine which day they are in their chemotherapy regimen.

As soon the patient’s blood work results are available, I evaluate their levels to ensure continuation with their chemotherapy is appropriate. For any concerns, I contact our providers to make recommendations and discuss the medication changes. Once the regimen has been confirmed, I pick up the patient’s pillbox as they wait in the clinic lobby to label and fill it with the appropriate medications. For patients with liquid chemotherapy such as methotrexate and mercaptopurine, we create a medication calendar labeled with color coded stickers to improve ease and understanding and provide marked syringes to increase accuracy for each dose.

When there are no patients, I would work on various projects including drug information questions and reviewing patient charts for those who experienced specific chemo-related adverse events.

Transitions of Care

My day in transitions of care begins with chart reviewing and identifying pharmacological interventions for patients on the general pediatrics, general surgery, neurosurgery, neurology, and otolaryngology services. I then meet with providers to discuss interventions, provide recommendations for total parenteral nutrition, and review medication needs for patients close to discharge. During the afternoon, I attend daily patient progression huddles with the interdisciplinary team to identify discharge times and ongoing barriers to discharge.

Throughout the day, I provide support to acute care pharmacists by performing discharge medication education and medication reconciliation for patients on the general pediatrics services. I additionally collaborate with the on-site outpatient and specialty pharmacies to triage order clarifications, refill needs, and medication teachings.

Overall, the transitions of care learning experience has been a unique opportunity to build relationships with patients and work collaboratively with the interdisciplinary teams. I have enjoyed providing pharmacological support throughout a continuum of care, including admission, inpatient stay, and discharge.

Infectious Diseases

My day in infectious disease begins every morning with chart reviewing and assessing the antimicrobials that patients are on. Our patients can be highly complex, so I focus on gathering pertinent clinical information to identify chances to optimize antibiotic, antifungal, and/or antiviral therapy. Depending on the patient census, I typically arrive around 6:30 to 7 a.m. to prepare for pre-rounding with my preceptor around 9 a.m.

Our infectious disease teams do not have a routine schedule for rounding, as it may vary day to day depending on meetings, case conferences, didactic lectures, and presentations. We typically round all afternoon, where I have the opportunity to participate in clinical decision making with the infectious disease and primary team providers. I also spend my time in the afternoon relaying recommendations to the team, following up any questions that were presented to me throughout the day, and attending meetings.

Overall, infectious disease has been an extremely rewarding experience and enabled me to play a role in ensuring appropriate use of antimicrobial therapy for our complex and immunocompromised patients.

Hematology/Oncology

The hematology/oncology unit is split into three teams: liquid, solid, and CAR-T cell. As a resident, you primarily round with the liquid team and help manage patient’s supportive care regimen. My typical day starts by reviewing patients and assessing necessary changes to their medication orders. I review my recommendations with my preceptor and join rounds with the medical team at 9 a.m.

As the pharmacist on the team, we help manage patient’s medication regimen for tumor lysis syndrome, febrile neutropenia, chemotherapy-induced nausea and vomiting, constipation, pain, and concomitant infections. In addition, we ensure appropriate clearance of high dose methotrexate.

After rounds, I attend weekly leukemia meetings, present topic discussions, provide discharge teaching, and review all the medication changes that occurred throughout the day. The most rewarding aspect of this learning experience is the ability to work alongside amazing individuals with compassionate leadership to help improve the quality of life of our patients.

Administration

My typical day with admin rotation starts with daily clinical and production huddles, then working up to tiered hospital admin meetings until 11 a.m. During the sessions, we examine and communicate any updated workflow changes, improvements, or patient safety concerns to the pharmacy team. We also take inputs from the group daily to improve ourselves for better patient outcomes in our workflow system.

I take on various administrative projects for the specific month after the morning inpatient huddles. For example, I am working with the inpatient pharmacy director, Dr. Melanie Chan, on the Medication Error Reporting Project to examine and follow up on ongoing safety projects within the past year. Other duties include attending Adverse Event Reporting and Drug Shortages meetings to follow updates and communicate to the pharmacy staff on the continuous changes and impacts to pharmacy workflow. After an afternoon with projects, we end the day with an inpatient production huddle to follow up on the day's flow.

Being an admin is different from an ordinary experience compared to a clinical care rotation's day. Many things seen on this rotation are going behind the scenes to see how admin plays a critical role in making the clinical pharmacists', technicians', and staff's day look like. Throughout this rotation, I found it imperative to have a connected and well-communicated admin team to take in our pharmacy teams’ feedback and implement it in our hospital systems for further advancement. Administration is a one-of-a-kind rotation experience to truly understand how the hospital, not just the pharmacy department, works as a whole.