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I’m half way through my internal medicine rotation! It is a completely different environment than my other rotations and I’ve learned so much about a variety of disease states.

This is my first rotation with medical students, first year medical residents, and a team room. I enjoy working along side medical students because they are eager to share their new knowledge and I am able to teach them a lot about pharmacy practice and medications. We have a team room where we do seated rounds (my feet love it) and where everyone works together throughout the day. 

My main role is to follow a few patients. I work them up by looking at their labs, vitals, ER notes, previous discharge summaries, and other documentation. I create a problem list and try to determine if everything is treated correctly. I double-check doses and indications for certain medications. I regularly evaluate the need for VTE prophylaxis, evaluate if certain IV medications can be changed to PO, and check vancomycin troughs. I present my findings to my preceptor every morning, along with my plan for things I want to change or look out for. If my preceptor agrees, I make my recommendations to the medical team during rounds.

Every new patient needs a medication reconciliation. It is regularly done in the ER by the medical staff, but the pharmacy team routinely does it again to get a more thorough history. We ask the patient what he or she is taking, and try to gage their understanding of the medication and their adherence. We are interested to know if any of their medications have changed lately or if they experience any side effects. We always double-check what the patient says with more objective evidence. It is helpful if the patient has the medication bottles or if their family member can read the bottles to us over the phone. We frequently call their pharmacy for their refill history. If a patient wasn’t taking their blood pressure or diabetes medication regularly, we could make them hypotensive or hypoglycemic if we restarted it in the hospital. If a patient was taking additional pain medicine at home, we need to know so we can appropriately adjust their pain regimen in the hospital. Upon discharge, we educate the patient on the changes we made so they understand what regimen they should be on at home. 

Overall, it has been a great experience and look forward to learning a lot more over the next 3 weeks.