Getting out what I put in
Starting APPEs can have a huge learning curve. Beginnings are usually tough and the first few days in a new environment can be difficult. A common message I received through pharmacy school and especially prior to starting my APPE rotations was, “You will get out what you put in.” While I understood the concept, I am thankful I was able to experience this first-hand during one of my earliest rotations.
Out of my comfort zone
My first day at Magee Rehabilitation Hospital in Philadelphia, PA, was a learning experience. My background is primarily community-based practice, and working in a hospital was outside of my comfort zone. But the APPE year is meant to push me—I wanted to learn, so I was willing to put in the work.
The biggest adjustment to starting APPE rotations is the level of independence you have, although this will obviously vary depending on the preceptor. I now appreciate all the situations that made me uncomfortable because they helped me grow. The nerves and anxiety eventually subsided as I gained confidence and insight into my role in the pharmacy and when rounding with the medical team. This role may not have been clearly defined during the first few weeks, but the beauty of being a current student is that you always have a preceptor to help guide you.
Although this was my general hospital rotation, I was pleasantly surprised to be so actively involved in patient care. My responsibilities included rounding with the medical team, answering drug information questions, shadowing staff pharmacists, and providing in-services to pharmacy and nursing staff. My most notable and significant responsibility was with Magee’s medication reconciliation program.
Comprehensive med rec
My preceptor and fellow students at the Thomas Jefferson University Jefferson College of Pharmacy started this program. Given the setting of a rehabilitation hospital, pharmacists and student pharmacists are placed in the unique situation of performing comprehensive medication reconciliations, including interviews with patients, families, and providers, and confirming the findings with outpatient pharmacy records. We asked family members to bring the medications the patient took at home so that the entire team could accurately record the medications the patient needed and to determine new prescriptions. Additionally, we offered to discard any expired or recently discontinued medications, to create a safer medication environment once the patient returned home.
Prior to discharge, the attending would review the final medication list and write the necessary prescriptions. Patients would then have the option to use a “med to bed” program that ensured they would get medications at discharge. Discharged patients received a medication schedule and counseling from either a student pharmacist or pharmacist to confirm they had all of their medications and understood what they were taking and why.
While a medication reconciliation process sounds simple, time restrictions and relatively short length of stays in the acute setting sometimes make it difficult to perform carefully. I was at times shocked at the inconsistencies between discharge documents and what the patient understood. The patients at Magee were typically admitted for at least 2 weeks, giving pharmacists plenty of time to accomplish this process. Medication reconciliation is essential to a safe transition of care, especially for patients who are transitioning from acute care to rehab before returning home. A longer length of stay facilitated the resolution of discrepancies from the acute care hospital into the rehabilitation stay.
This program benefits patients, caregivers, and health care providers. While it was a time intensive process, it gave me the opportunity to familiarize myself with a variety of disease states, patient literacy, and compliance issues as a student pharmacist. I was also able work with the entire health care team to determine optimal drug therapy for our patients.
I gained confidence in my patient interviewing skills and making recommendations to health care providers. Ultimately, the outcome of this process and the rotation was well worth the time and effort, both for the patients and me. I definitely got out of this APPE what I put in, and I am immensely glad to have had this experience.