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Advance Pharmacy Practice Experiences... A Focus on Third-Year Student Rotations
Advance Pharmacy Practice Experiences... Johns Hopkins Hospital Rotation
Janssen Pharmaceuticals Rotation
By Yunghon (Eric) Lee, PharmD Candidate
I had a virtual rotation at Janssen Pharmaceuticals in Global Pharmacovigilance due to the COVID-19 pandemic. This rotation was geared toward learning about the role a pharmacist plays in Global Pharmacovigilance within the pharmaceutical industry especially for the collection and processing of individual case safety reports for investigational clinical trials. A typical day in this rotation can vary, but usually it will consist of a meeting with your preceptor where they will go over industry-specific topics. I learned about the importance of writing Suspected Unexpected Serious Adverse Reaction (SUSAR) narrative cases and how they are completed, had meetings with current fellows in pharmacovigilance, and worked on assignments and presentations.
This rotation is a great experience to learn about one of the many roles pharmacists can play in the pharmaceutical industry. It is a great opportunity to gain exposure to industry if you are interested in pursuing a post-graduate fellowship. If I had to give one tip for this rotation, it would be to NETWORK, NETWORK, NETWORK. Use your five weeks to learn as much as you can about as many functional pharmaceutical industry areas. Many of the fellows and employees are willing to meet with students for 30 minutes to discuss their role, their functional area, and give advice to students who are interested in this career path. These are great experiences to gain insight as well as create a network of colleagues that may help in the future. I am grateful for having this opportunity to rotate at Janssen Pharmaceuticals and I would highly recommend this rotation to any student that wants to see how a pharmacist can play an integral role in the pharmaceutical industry.
By Edelquine Mandzo, PharmD Candidate
During my Pediatric Cardiac Intensive Care Unit (PCICU) rotation at The Johns Hopkins Hospital, I saw patients between 1 hour old to 18 years of age. These patients were either born with a congenital heart defect or had developed heart failure due to infections or other risk factors. Most patients were in the hospital long-term connected to machines such as the Berlin Heart Machine and Extracorporeal membrane oxygenation (ECMO) that were lifesustaining until they could get a heart transplant. Some patients were often heavily sedated and on several medications that needed the expertise of a well-trained pharmacist to monitor the efficacy, drug interactions, contraindications, and possible side effects.
With minimal studies on infants, many of our recommendations as pharmacists were inferred from adult patients based on the literature and evidence available. In addition, medications were prescribed at reduced doses with regards to the patient’s weight. Therefore, knowing every medication, their mechanism of action, recommended pediatric and adult doses, and the side effects were significant to treating these patients. A solid organ transplant is a medical miracle that restores life, and medications play a significant role in sustaining life. The role of the pharmacist is crucial in the field of transplantation as patients are always on several medications that need to be constantly monitored. This rotation taught me to be very thorough in my assessments because a patient’s life depends on my ability to make appropriate recommendations. Furthermore, my preceptor taught me always to ask ‘WHY” because it keeps me curious and proactive as a lifelong learner.
Advance Pharmacy Practice Experiences...A Focus on Third-Year Student Rotations Johns Hopkins Hospital Rotation
Home Infusion Rotation
By Mercedes Vilasoa, PharmD Candidate
The John G. Bartlett Specialty Practice home infusion clinic provided a wide variety of services that a patient with infectious diseases may need, including specialty care in HIV/ AIDS, endocrinology, gynecology, nutrition, hepatitis, and nephrology. The rotation gave me the opportunity to collaborate interprofessionally with other health care providers including infectious disease physicians, social workers, and pharmacists that specialize in home infusion, HIV/AIDS, and ambulatory care. I found it very beneficial to observe the responsibilities of social workers when they ensure patients receive coverage with medical assistance programs. I learned how home infusions are performed for patients receiving parenteral antimicrobial therapy in the comfort of their own home using eclipse ball infusions. Shadowing an ambulatory care pharmacist in the diabetes and HIV clinic showed me the barriers to adherence that some patients experience. At the HIV clinic, I learned about useful HIV resources available for providers, including the University of Liverpool’s HIV Drug Interactions website, the NIH’s Clinical Info HIV Guidelines, and HIV-ASSIST. I was able to work with physicians that developed the HIV-ASSIST platform to ensure that the penalties assigned to certain antiretroviral therapy (ART) matched the interaction statuses provided by the University of Liverpool on their Drug Interactions website. Another major project I completed was updating the Pharmacy Refill Assist Program Standard Operating Procedure (SOP) with the new changes that had been implemented on the EnterpriseRX and EPIC electronic medical record. Because of this rotation, I am more confident in my ability to access clinical decision support tools to provide optimal individualized care for patients with HIV that I will encounter in the future.
Psychiatry Rotation
By Michelle Yang, PharmD Candidate
My psychiatry rotation was primarily virtual with 1-2 on-site days every week. My day-to-day consisted of morning pharmacotherapy rounds with the attending, medical residents, and the social worker on Zoom. As a team, we would walk through each patient and discuss any new lab/imaging results, updates on the patient’s well-being, and adjust the patient’s therapy plans. Afterwards, I met up with my preceptor to discuss therapy adjustments and bring up any questions I may have had during rounds. Other activities throughout the rotation included topic discussions, drug information questions, designing a Medication Education Group session for the patients, and observing electroconvulsive therapy (ECT) sessions. Although there was one other student with me on rotation, majority of the work was completed independently.
With the emergence of aducanumab, the new agent for management of mild Alzheimer’s disease, I was able to work on a presentation that showcases the new agent, review the clinical trials that support its approval, and address any drug controversies. During my rotation, I presented the information to mid-level practitioners and provided my insight into whether this medication should be added to the Johns Hopkins formulary or not. I am currently drafting a new drug article to be published in the MSHP Pharmascript newsletter on aducanumab. I highly recommend applying for this rotation if you are interested in mental health and being an integral member of a multidisciplinary team to optimize patient care.
Pain Management Rotation
By Alyssa Reese, PharmD Candidate
The Johns Hopkins pain management rotation was devised into acute/postsurgical pain and palliative care. The first two weeks comprised of rounding with attending physicians and anesthesiologists to assist with postsurgical pain medication interventions. During this experience, I was able to assist the pain management team by obtaining thorough patient histories to identify contraindications or treatment failures, participate in physical exams to evaluate acute pain and function, assess current pain medication utilization through the electronic medical record and patient-controlled analgesia (PCA) pumps, and demonstrate competency in my understanding of the pharmacology of pain management medications. We also worked in tandem with physical therapists, social workers, midlevel providers, and nurses to provide an interdisciplinary, multimodal approach to patient care.
The palliative care focus during this rotation consisted of both outpatient telehealth appointments and inpatient visits. The purpose of palliative care is to focus on anticipating, preventing, diagnosing, and treating symptoms that patients with serious or life-threatening illnesses may experience. It also works to provide psychosocial support by building a network of care. For telehealth appointments, we met with patients over a secure server as part of an interprofessional healthcare team including pharmacists, physicians, and nurse practitioners to assess and treat their symptoms. For inpatient visits, our service was consulted by attending providers to assess patients’ needs and determine how we can provide interventions to alleviate the physical aspect of their total pain.
This rotation allowed me to provide care to patients that were arguably in their most vulnerable state. As one can expect, patients displayed a wide range of emotions, and I was able to sharpen my communication skills as I provided empathy and rolled with resistance. Goals of care conversations can be very hard to initiate, but I feel very fortunate to have had the opportunity to assist in the care of the patients served.
Johns Hopkins Hospital Clinical Track
By Blair Yesko, PharmD Candidate
I completed a clinical track at Johns Hopkins Hospital with four consecutive rotations there including pediatrics, internal medicine, bone marrow transplant, and critical care. On my first day in my pediatrics rotation, I was introduced to the pediatric pharmacy and pediatric gastrointestinal team and immediately felt welcome. I got to work interprofessionally with a variety of medical students, attendings, dieticians, nurses, and case workers. One thing I learned on my pediatric rotation was “don’t push the babies!”, meaning babies usually can only handle one change at a time.
My second rotation was with the Janeway internal medicine team. I got the opportunity here to learn about managing warfarin in different coagulable states. On this rotation I learned to anticipate what the team will ask you ahead of time, so you can know the answer before they ask!
On my third rotation, I got to experience bone marrow transplant. This was where oncology side effects, infectious disease, and anticoagulation knowledge all came in handy. I learned to pay attention to the patients when the attending is speaking with them—you may catch a medication side effect that the rest of the team does not see! Finally, on my fourth rotation in critical care surgery, I got to learn about the pharmacy verification process. I even toured the operating rooms to see where medications are stored and rounded with the oncology ICU team. Pharmacists in the critical care pharmacy see a variety of disease states, including patients on phenytoin or vancomycin. I learned to appreciate your pharmacy technicians— without them, the pharmacy would not be able to run!
