A Resident’s Typical Day

Oncology

The oncology learning experience offers comprehensive experience in the inpatient care setting, focusing on the complex medication needs of pediatric oncology patients. A typical day involves collaborating closely with the oncology team, including attending physicians, fellows, nurses, and clinical pharmacists. I attend medical rounds with the inpatient oncology team, reviewing patients, adjusting medications used for supportive care, and monitoring for adverse effects or drug interactions. Additionally, I help complete pharmacy monitoring, such as reviewing labs, assessing renal function, and ensuring appropriate dosing of high-risk medications like vancomycin, which is managed per pharmacy protocols.

As a PGY1 resident, I also perform admission medication reconciliations and discharge medication teaching. My favorite part of the rotation is the medication education aspect to it. I enjoy talking to families and helping them better understand the proper use of their medications. Taking care of pediatric oncology patients with complex medical needs is challenging, but it is a highly rewarding experience.

Acute Care Pediatrics

During my acute care learning experience, I was the pharmacist for general pediatrics, gastroenterology/hepatology, and nephrology/rheumatology teams. My day began with chart review of my patient list and reviewing my recommendations before 9 a.m. rounds. I managed appropriate steroid durations in acute asthma exacerbation, antimicrobial stewardship, parenteral nutrition adjustments in intestinal rehabilitation, drug dosing in hemodialysis, and use of immunosuppressive therapies in lupus. I had the opportunity to serve as an acute care student preceptor who led student topic discussions and managed multiple acute care teams daily.

After rounds, I spent my afternoons coordinating delivery of discharge medications to the bedside and teaching patients and caregivers how to safely and effectively adhere to their medication regimens.

Pediatric Intensive Care Unit (PICU)

During my PICU learning experience, I gained valuable insight into the management of critically ill patients. My typical day started with a thorough chart review of my patients. I started the day by discussing medical interventions with my preceptor that I then posed to the interdisciplinary team on rounds. While on rounds, I fielded pertinent medication-related questions and discussed ways in which we could optimize patient care.

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

Transitions of Care

The transitions of care (TOC) learning experience (LE) is focused on understanding the impact and importance of the pharmacist when helping patients transition from one care setting to another. This LE is different than other LEs because you get to experience both ambulatory and inpatient settings. Inpatient, I work with the TOC pharmacist and how to do their role. We work on medication histories upon patient admission, reviewing discharge medication reconciliations and counseling patients and their families on the medication they are being sent home with.

Throughout the day we also follow and work-up patients on the pulmonology and surgery teams and support the other pediatric teams with any medication reconciliations or medication education they may need. Every day on this LE is a little different which makes it even more interesting. 

Cardiovascular Intensive Care Unit (CVICU)

My day in CVICU begins every morning with chart reviewing and assessing patients' medication lists. Our patients are very complex, so I focus on gathering clinical information to optimize medication therapy, complete therapeutic drug monitoring, as well as prepare for any medication related questions from the team. I also form my recommendations during this time, which I then review with my preceptor during pre-rounds.

We place a heavy emphasis on nutrition in the CVICU, and many of our patients receive parenteral nutrition (PN). In the CVICU, we have a PN per pharmacy protocol, so I will write PNs with my preceptor after rounds. Additional tasks for the afternoon typically include completing monitoring notes, topic discussions with my preceptor or any rotating students, or following up with the team if they have any questions for me. I also attend code blues and am present at bedside for any assistance as requested by our team.

Overall, the CVICU environment is very fast-paced, complex, and exciting. Many of our patients have unique heart physiologies and it is extremely rewarding to be part of the patient care team.  

Infectious Diseases

The infectious disease (ID) learning experience focuses on the management of complex and unique infection states, emphasizing the optimization of antimicrobials and patient monitoring to improve care outcomes. Given the rare and often complicated disease states encountered, I spend much time on this rotation reviewing literature and recent guidelines to address therapeutic questions and develop evidence-based treatment plans. I’m also responsible for therapeutic drug monitoring and dose adjustments for our patient’s anti-microbial regimens.

A typical day involves closely collaborating with our ID providers on twice-daily rounds, to engage in clinical assessments. Afternoons are dedicated to topic discussions and presentations, where I present the evidence from my literature searches to fellow pharmacists and ID providers to better enrich our clinical knowledge on the newest evidence out there!

Cystic Fibrosis and Lung Transplant

The cystic fibrosis and lung transplant learning experience focuses on management of patients with cystic fibrosis and pre- and post- lung transplant in the ambulatory setting. As a resident, I worked with a multi-disciplinary team to create comprehensive care plans for patients. A typical day in cystic fibrosis clinic will have about 6-8 patients. As the resident, you will do the annual or follow-up visit, which consists of conducting a comprehensive medication review with the patients, modifying the care plan, and being a primary contact for drug information questions.

As a part of the lung transplant team, you also get to participate in transplant selection committee meetings and transplant planning meetings. This learning experience will provide both outpatient and inpatient opportunities for cystic fibrosis and lung transplant.

Administration

This learning experience encompasses the administrative component of inpatient pharmacy, with project-based work relating to longitudinal goals for the pharmacy as well as interactions with various committees that assist with setting hospital policy and procedure. As a resident participating in this experience every morning would begin with attending the “huddles” or meetings with updates for various types of staff- a main pharmacy huddle to discuss updates to medication filling and delivery news, a clinical verification huddle for updates pertaining to our pharmacist staff and a management huddle where the different arms of the pharmacy department would report out on the status of their team to the upper level administrators.

Outside of the standard morning huddles, every day is different! There might be committee meetings for discussions around topics like Controlled Substances, Opioid Stewardship or Adverse Drug Event report reviews to evaluate policy and procedure related to these topics. Or you could be given project time to work on more longitudinal projects related to process improvement. Participating in helping to set the inpatient pharmacy’s goals for the year or working with the quality improvement team to improve the workflow of the medication filling process using principles from industrial engineering. The learning experience provides a view of the pharmacy from a high level, allowing for an engaging time solving problems and tackling systemwide issues to support the staff on the ground. 

Finance and Budget

The finance and budget learning experience focuses on understanding and applying the concepts of 340B pricing, monitoring financial performance, and operating budget processes at a pediatric institution level. As a resident, I acquired additional training in pharmacy finance and revenue. The training includes but is not limited to 340B Apexus training, pharmacy revenue cycle, etc. I applied the training and skills I learned to my typical daily projects associated with drug-cost analysis, contract negotiations, and partaking in non-labor savings initiatives.

My morning would start with participating in 340B and the buyers' huddles with the pharmacy finance manager. At the huddles, we identify and address concerns that have or may occur with data extractions from EPIC orders and contract pharmacies, inventory/ shipment concerns, and any additional outstanding tasks. This learning experience offers me extensive learning and development, transitioning from a simple understanding of pharmacy budgeting to comprehensively integrating the skills and collaborating with the administrative team.

Antimicrobial Stewardship Program I

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.