Learning Goal #1: I will gain an overall grasp of pharmacy in order to figure out what I personally like and dislike of about overall pharmacy.
Learning Goal #2: I will find out if I like working in pediatric pharmacy in order to help guide my future career path.
Learning Goal #3: I will figure out what areas of pharmacy I like the best so that I can help focus my interest in pharmacy school.
___________________________________________ Learning Goal #4: I will decide if I want to take a 8 year versus 6 year path in college in order to obtain a PharmD.
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Below you will find a link to my FINAL POST!! Thank you to all who have supported me through this entire process. Stay tuned this upcoming fall when I conquer my next big adventure...college :).
I have less than 20 school days until I graduate high school. Man oh man- where has the time gone?! It feels like just yesterday I was a freshman just starting in a big high school. As I now talk with my friends, we all wonder how we've gotten here. Recently, It is especially hard because I have developed such deep relationships with friends I’ve known for years and soon we will all be off to separate colleges. As I look back, I feel that I have accomplished all of my goals in high school. I have kept all A’s, become a drum major and leader in my marching band, am the head of many clubs, and have received numerous awards. However, most importantly, I have developed some of the deepest friendships. I have become so close with some of the best people I've ever met and it’s hard to believe we will soon be leaving the place we all grew up together. I think back to myself as a freshman and cannot believe how much I’ve changed. When I was a freshman, I was somewhat quiet. I didn’t like a lot of attention on me, I did the bare minimum to get A’s in my classes, and I never wanted to really take charge with anything. Throughout high school though, I really started opening up. Marching band has helped immensely, as I was given leadership roles and continued to make great friends. Within the past couple of years, I feel I have truly made a 180 degree turn in who I am. After my trip to the mountains last summer, something changed inside of me. I went into my senior year feeling confident and having a better grasp on who I was and who I wished to be. I’ve not only learned to put all of my effort into school but to also get completely involved in clubs and activities. As a freshman, I never would’ve thought I would be the head of multiple clubs, a drum major, and have an internship at Nationwide Children’s Hospital in just a few short years. I’m really proud of everything I have accomplished in high school! However, the biggest difference is the motivation and excitement for the future I have now. I know what I am capable of and what my goals for the future are. I know with hard times comes lessons to learn and personal growth. I would like to thank my family, friends, and most importantly teachers for helping to point me in the right direction and always pushing me to reach far beyond my potential! I honestly believe I would not be where I am today if I did not have these amazing people and mentors in my life. I cannot wait to see what the future has in store for me and how I am going to change the world! Purdue......I'm coming for you!! I would like to officially announce that I will be attending Purdue University in the pursuit of a PharmD (Doctor of Pharmacy)! I have been admitted into the Honors College where I will also be minoring in Wildlife Science. I would like to thank everyone who has helped me get to where I am. I cannot wait to see what the future has in store for me and where it'll take me. Boiler Up!! ![]() MISSION STATEMENT A personal mission statement. I believe this is a great thing for everyone to have- why not have one myself! In order to write my personal mission statement, I looked at a various amount of successful people's and companies mission statements. This helped me to get a general idea of the set up of a mission statement and different ideas I may want to incorporate into my own. Afterwards, I started just writing- trying to get all of my ideas down on paper and in front of me. Once I had a solid base, I started tweaking and editing my mission statement. Some of the more easier things were getting a solid base. I knew what set up I wanted and had the so called “skeleton” of my mission statement done. Some of the challenges I faced were trying to figure out what I wanted to say and fitting everything into one sentence. I want to do so many things in my life and impact so many people, so finding such few words to capture that was hard. Another challenge I faced was making sure my mission statement wasn’t too long. Like I said before, they were many things I wanted to fit into my mission statement. However I wished to simplify it in order to capture the basic purpose of how I wish to live. It will be very important to remind myself of my mission statement every day. This will help me to remind myself of my main focus and remember who I wish to become. I think simply by printing my mission statement out and hanging it on my mirror will help me to accomplish this. LIFE GOALS When it came to setting my life goals, I really started thinking about what goals I specifically wanted to keep and/or start in college. I believe setting goals for the next 5-10 years will really help me zone in on what I want to accomplish! One of my goals is to stay healthy and moving. Especially being in college, junk food and stress becomes a big issue. In order to try to stay healthy, I plan on eating healthier foods and trying to stay away from foods that aren’t as good for me. I also hope to stay moving, whether it means going to the gym, going for a run, or simply taking the stairs instead of the elevator. Another goal is to maintain deep friendships with high school friends. I have made some great friendships in high school and I hope to be able to stay in contact with these people. I believe that true friendship can withstand the tests of time and distance. I would also like to keep in good contact with my family when I’m off at college. Because I won’t be seeing them everyday, it will be harder for me to have them as involved in my life as they were at home. I believe just by simplifying calling 3 times a week will help me to keep good relationships with them without being overbearing. My last goal is one that I will (hopefully) accomplish in around 8-10 years. I want to be working in a pediatric hospital as a clinical pharmacist, hopefully specializing in either Cardio, Oncology, or the NICU floor. This is a goal that is very far in the future but will be the ultimate one I will be working to accomplish! While there will be challenges in my way (like time and money), I believe commitment will help me to accomplish all of these goals. Both my mission statement and life goals are only put into place in order to help me focus and make the greatest impact I can. I wish to live a life with direction and purpose!! Note: My mission statement will be uploaded to my website VERY soon!! Stay tuned. ![]() While mentoring at the hospital, I have been working on trying to accomplish my learning goals (To see my learning goals, click the button to the right side of the screen!). I have already achieved some of my goals and am currently working on the evidence for them. Hopefully I will have these posted soon! I am still currently working on learning more pharmacy related terms and seeing which areas (Cardio, ED, etc) I like the best. Some challenges I have run into trying to accomplish my goals are feeling comfortable asking questions and simply time. Most of these pharmacists are wicked smart and it can be intimidating at times! A lot of my goals also require thinking over an extended amount of time. I have found the easiest way to go accomplishing my goals is finding the courage to talk to the pharmacists around me! They are all quite a source of information and are always open to talking with me. ![]() I have found within the past couple of months just how much I love being at the hospital! I have this feeling of belonging there and can completely see myself having a future career there. I would much rather be working at the hospital than be at school. However, some of the biggest lessons I have learn are unrelated to my career field. I have learned to smile and say hello to those I pass in the hospital hallways- you never know what a family might be going through. I have learned to always think of those around me. Gestures such as holding the elevator for a family or paying the parking garage fee for the people behind me can make a world’s difference. All together, I have learned that the best thing you can do for another is to be kind. Families who are constantly in and out of hospitals need kindness and understanding than almost anything else! "A warm smile is the universal language of kindness."
-William Arthur Ward ![]() What exactly is the CTICU? The CTICU stands for the Cardiothoracic Intensive Care Unit. If you have read my past blog post on the Cardio floor, it is similar. Both floors deal with heart patients, however the CTICU deals with patients who have a much more severe heart condition and/or are more critical (hence the name). A majority of these patients are those who have just come from heart surgery as well. The CTICU Pharmacist plays a major role on this particular floor. When dealing with some of the most critical and ill patients in the entire hospital, a lot of medications are going into these patients and usually need to be monitored 24/7. There are 2 teams on the CTICU floor at Nationwide Children’s Hospital, however only one CTICU Pharmacist. This makes it much harder on the pharmacist as they obviously cannot be in two places at once. Therefore, the CTICU Pharmacist must pick one team to round with. This decision is made after many factors are taken into consideration. Sunday night, the CTICU Pharmacist first checks on all of the CTICU patients. Once they have a solid overview of all the patients, they decide which team will need them the most based on their set of CTICU patients. Rounds, going over each patient's files and medications outside of their room with a NCH team, are much more extensive on the CTICU floor. This comes from the patients being more severe, therefore the time spent going over each patient is much more extensive and detailed. During rounds, the CTICU Pharmacist is doing many tasks. One of these tasks includes checking which medications are being taken and seeing if any of the medications need to be changed and/or discontinued. Included in these medications are any medications the patient may be taking at home (those prescribed by a primary care doctor, etc.). Once the CTICU Pharmacist feels comfortable about all of the medications, they then make sure all of these home medications are at the hospital. ![]() After rounds, both teams will “huddle”, aka meet in a conference room, and discuss each patient. It is here where the CTICU Pharmacist will catch up with the team they chose not to round with. Once every patient on both teams is discussed, questions will be answered followed by everyone dispersing. After the huddle, the CTICU Pharmacist will catch up on any patient they need to. This includes creating and/or changing levels in TPN (Total Parental Nutrition) bags for their patients. Spare time afterwards can be spent educating the patients and their families and doing workups on any patients that require additional attention. While patients recover from heart surgery in the CTICU, the CTICU is also where it is determined if a patient needs a heart transplant. There are many logistics behind determining if a patient needs a heart transplant such as heart condition severity, age, environmental factors, etc. There is an entire separate NCH team whose only focus is on heart transplants! Another common situation seen in the CTICU is weaning children off of “heavy” drugs and determining if they are withdrawing or not. While with some older children you can talk with them to see if they are withdrawing, the younger children are much more difficult to determine. The WAT (Withdrawal Assessment Tool) is used to decide whether a child is withdrawing from a certain medication. A WAT Score is given to a patient based on many common withdrawal signals and symptoms they exhibit. This can include sweating, tremors, muscle tone, temperature, vomiting, etc. The WAT Score is proven highly affective and if a patient’s total score is above a certain value, they are then determined to be in withdrawal. ![]() On another note, a random fact I learned while on the CTICU floor is that 50% of people with Trisomy 21, also known as Down Syndrome, have a Cardiovascular Disease. 25% of these Down Syndrome patients with a Cardiovascular Disease have an AV Canal Defect. An AV Canal Defect is when there is a hole between the heart chambers. This may be one of many heart defects, all which are present at birth. While I had an amazing experience on the CTICU floor, I personally believe it may be a little too intense for me! ![]() What exactly is anxiety? I like to think that anxiety is a long-term disorder that doesn’t just “fade away”. Often with anxiety, the person does not know the source the anxiety is coming from. It is something that cannot be cured in one day- it is a constant fight. The person does not feel better after actions such as eating or taking a warm bath (things that often work with stress). So what is the difference between anxiety and stress? I like to think that anxiety is triggered by stress. Stress is more short-term and the person can usually find the source of their stress- perhaps having a lot of homework. When I get stressed, it usually stems from me being super busy/having a lot of things to accomplish in not a lot of time. I first like to make a list of everything I have to do and then prioritize. What can I do now and what can wait to be done later? This strategy helps me to accomplish the absolute necessary things first. I also find that playing with my dogs helps quite a lot. I have 3 of them, so there’s never a shortage with who wants to play! I have found the easiest way to avoid stress is to be proactive. This involves getting on top of things early and not procrastinating things until the last minute. ![]() How does this all relate back the workplace? When at the hospital, there are many stressful situations occurring all the time. Children’s lives are always in the balance, so of course it’s always stressful! The more stressful situations are probably the ones where you are directly dealing with a child- such as a child who is coding (heart stopped pumping), those who are traumas coming into the ER, and surgeries. The pharmacists have a role in many of these different situations like giving life-saving medications in an emergency. ![]() More in-line with clinical pharmacy on a floor, most of the stress comes from trying to figure out the best medications and dosage to be giving the child. Every single person is different- a medication and dosage that worked for one patient may not work for the next. While there are protocols in place to help with these types of situations, sometimes it comes down to trial and error. From what I’ve seen and heard about, the best way to deal with stress in this type of hospital setting is to talk to fellow coworkers about it. My mentor mentioned how her fellow coworkers and her always discuss and give recommendations on how to treat tougher patients. Nationwide Children’s Hospital specifically does a fantastic job on trying to relieve stress for their staff. They have an entire campaign dedicated to making their staff’s workplace as positive and stress-free as possible. They even have people walking around giving out candy to the staff! Personally, in order to do well in this type of stressful environment, I will need to continue to get a head-start on my work and ask advice from those around me! I also might need a dog or two... My top "Life Values":
What is your most important core value? What could you not live without? What value drives you to succeed, to be yourself, and to achieve your goals? My most important value is most likely my concern for others. While this was not the highest value listed on my Life Value Inventory, it is one that I hold the close to my heart. I have my concern for others frequently, as I am always that one person who is constantly checking up on people and always wondering if people are doing okay. I value equality and honesty, as well as wanting peace to be apart of my everyday life. I love giving advice to people and feel that people seek me for help when they need it. However, one downside is that I do get quite frustrated with people who are solely focused on a selfish agenda. Another effect this value has is it can also lead to burnout and I often feel responsible for trying to fix other people’s problems. While these are some negatives, I believe positively affecting someone’s life is always worth the struggles. What core value do you envision as being most valuable in supporting you into the future? How do you foresee this core value will help you in becoming more the person you want to be and picture for yourself? I believe one core value that I envision being the most valuable for my future is responsibility. As I start the process of moving from high school to college, there are many responsibilities that I must start to take charge of before I move into college. These tasks are things such as being organized for class, waking up on time, getting involved on campus and in the community, and obtaining a job. I believe responsibility also aligns with my goals as I start to move from childhood to adulthood. I am learning more about myself and what I wish to do in the future, as well as obtaining professional relationships that may be useful in the future. Update: Last night I had another Pharmacy shift in the Emergency Department (ED)- therefore I will be updating my “Pharmacist Series: Emergency Department” blog with the information I have recently learned! During the past 2 months I have been in the hospital, I have seen many similarities between pharmacists and their workplaces. No matter what department I am in, every pharmacist has a computer and calculator with them 24/7. They are constantly verifying and checking medication orders, so both a computer and calculator are a must! I have also noticed that the clinical pharmacists tend to make checklists and take notes during rounds, making sure they don’t miss anything they may have to change or add to a patient’s medication list. In addition, I have noticed that pharmacists in general must be good with numbers and triple checking everything. They must be diligent and detailed, as one decimal place off can result in an entire wrong dosage for a patient.
The hospital workplace is one I absolutely love and feel comfortable in. Being in so many different departments, I have been all over the hospital- from the clinical floors to the basement. I find myself being drawn more to the clinical floors, as I am working more directly with patients. While I know every aspect of pharmacy has a direct impact on the patients, I can see more of a visual impact when I am working hand and hand with the patients. At first I was very anxious to get started, especially since I would be jumping around with a variety of different people. However, I feel like I have been able get myself together and be professional with everyone I have shadowed. Their jobs can be a matter of life and death for patients, and I have an extremely high level of respect for them and what they do. Everyone I have worked with has been so kind and welcoming, and I am forever grateful for this wonderful opportunity! ![]() Warning: The following blog may be graphic for some readers. Disclaimer: No organ pictures are from my experience as pictures were not allowed due to privacy regulations. Today was a day I will never forget. My club, Future Medical Sciences, had the opportunity to go to the Ohio State University’s Human Cadaver Lab. We had today off from school, so there were about 15 members who attended! At first I was super nervous, as I did not know how I would react. I have never seen a deceased person before, let alone the insides of a human body. I definitely did not know what to expect and did not know what I would see. I ended up seeing way more of the human body than I thought I would. The very first thing that hits as soon as you walk into the lab is the smell. It is not the smell of a deceased body, but rather the chemicals they use to preserve the body. The cadavers they have are people who have donated their bodies to science. OSU preserves cadavers for an average of 2 years, however they do have a cadaver that they have had for almost 20 years! Once the cadaver is not longer being used, OSU will cremate the body and either return the ashes to the family or, if there is no family left, will bury the ashes in a local cemetery. Three stations were set up for us when we walked into the lab. One table had containers of different organs, one had a cross section of the upper half of a cadaver, and the last table had a full human cadaver wrapped up. Organ Table: The first table had a variety of organs on it, including hearts, 3 different types of lungs, brains, ovaries, eyes, and a liver. For each of them, one of the residents explained different characteristics about each and allowed us to hold all of them. A real heart! The thing that made the body function and work all together as one, the very thing keeping every one of us alive. Holding it seemed unreal, like something I had made up in my head. The actual heart was much different than I thought it would be like. The different valves were visible and both the superior vena cava and inferior vena cava was noticeable as well. We could also see the 4 different chambers of the heart. If you make a fist with your hand, your heart is a little bigger than it! The 3 different types of lungs included a healthy lung, a smoker’s lung, and a lung that had cancer. The healthy lung was much heavier and larger than I had originally thought. The were multiple layers of tissue on the outside and (while this may sound gross/weird to some people) when squeezed, the liquid that had soaked into the lungs created air bubbles that we could see. The best way to describe the smoker’s lung is that it is literally rock hard on parts of the outside and has a blackish/brown color to it. There is a dramatic difference between the smoker’s lung and healthy lung when compared side to side. Due to the fact that the smoker’s lung is hard, this is why smokers do have a much tougher time breathing. The lung with cancer was also VERY interesting, as we could see and touch the cancer masses on the outside of the lung. Yes you read that correctly- WE GOT TO TOUCH CANCER! It was so cool to finally put an image in my head of what I thought cancer looked like to the actual thing. ![]() There were 2 brains that we had the opportunity to hold- 1 whole brain and 1 cross-sectioned brain. The inside of the whole brain is indeed “squishy” has some may describe it. The cross-sectioned brain allowed us to see actually inside of the brain and its different parts. There are no words to be able to describe what it felt like to hold someone’s brain- every experience, feeling, and emotion all literally in the palms of my hands. Everything that made that person unique, made them human. Mind-blowing brain fact: The brain actually named itself! If you really think about it, someone with a brain named the brain, a brain. Cross-Section Table If I had to pick a table that was uncomfortable, it would most likely be this one. The reason being that it had a cross section of a cadaver- a body that was cut so that the face was in half and only had the top portion of the body (cut across the abdominal area). While a little uncomfortable, it was a very interesting site! I never realized how compacted together everything was in the body. Tissues on tissues, everything having an exact position. The airway and food way was also exposed and showed how it connects to the stomach. I never realized how big the tongue is! It is quite a large muscle. The spinal cord was also right on the surface and ribs were visible. With the spinal cord, it gets larger and thicker as it goes down the body in order to help support our body weight! Full Cadaver Table The last table had a full cadaver on it- here everything about the body was put together. The chest plate was already removed and the arms and legs had been cut for full muscle exposure. We saw how all of the organs connect and how they all fit perfectly inside the body. Tendons and ligaments were also visible in the arms and legs, along with the bones. One of the most cool parts was definitely the head! In order to see the head, the resident had to uncover the face. (While this was uncomfortable, it reminded us all that this was a real person who had so graciously donated their body for learning) The brain had already been taken out, so the skull was visible- and goodness is that thing thick and hard! We could also see where the the eyes connected to the brain and the entire outline of where the brain had been. Some people wonder how they get all of the blood out of the body...well I have an answer for you! They place a large needle into the femoral vein and drain all of the blood out of the body. They then pump the conservation solution throughout the body in order to help preserve the tissues! Overall, this was a VERY humbling experience for me. I now have an entire new appreciation for life and the human body. Everything works perfectly together, no room left for error. It really makes me think about what I put into my body as well, as there are many negative effects to unhealthy choices. I am so appreciative and happy I had the opportunity to have this experience! It was truly life changing and one I will never forget. ![]() The H2 Pharmacy is a satellite pharmacy for the hospital, tower levels H2-H9. The primary job of the H2 Pharmacy is to dispense the first round of medications for patients on the H2-H9 floor and to also dispense medication for patients directly on the H2 floor throughout the day. When it comes to a H2 pharmacist, their job mostly deals with being on the computer. On the computer, the pharmacist is checking the medications being prescribed to patients on the H2 floor. This checking includes making sure the patient is receiving the medication for a valid reason, as well as making sure the dosage matches the patient’s weight and that there is not a double prescription of the same medication. ![]() Once the medications are double checked, the prescription is then sent to another worker in the H2 pharmacy to be formulated for the patient. These medications can be in any form- pills, liquids, inhalers, IV bags, etc. Once the medication is ready for the patient, the H2 pharmacist will again check the medication and make sure the patient’s name matches with the dosage and type of medication. After this is done, the medication has two possible pathways; either sent by tube or picked up by a nurse. The only medications that need physically picked up by a nurse are those that are controlled substances, higher ranking medications that have a high possibility of possible abuse. All other medications will be sent by tube to the desired location. ![]() Another aspect of the H2 pharmacy is the lab portion of it, where there are hoods for compounding. There is always one worker in the hood, compounding different medications that patients need. These combinations must be completely sterile, resulting in the worker having to fully scrub in (like one does for surgery). The first part of scrubbing in requires you to place booties over your shoes, put on a face mask, and put a hair cap over the head. Scrubbing in then requires completely scrubbing your hands for a minute, washing every part possible. You then must wipe your hands with paper towels and let them air dry. One important aspect is to not wave your hands around in the air, as dust and particles from surfaces around you may be stirred up and stick to your freshly washed hands. Once your hands are dry, you must put on a gown to cover up underlying clothes. It is also important to try to not touch any other part of your exposed skin, as bacteria spreads easily. Once the gown is on, the application of gloves is next. There is a specific way you must put on the gloves, as these are usually what primarily is touching the different medications inside the hood. Once the gloves are on, they are sprayed with alcohol and you are now already to enter! There is a separate room that houses the hoods that is also completely temperature monitored. One cool aspect is the H2 pharmacist can see the hood and medications they must check without even entering the separate room! They can do this through high-tech cameras that are placed behind each hood. When on the computer, the H2 pharmacist can zoom in immensely to see the writing on the prescription, making sure everything matches. There are times when the H2 pharmacist is required to enter the hood room, such as when they must deal with the compound machine. The compound machine is exactly what it sounds like- a machine in which a variety of liquid medications are hooked up that are commonly compounded together. A well-known example that the compounding machine would be used for would be the formulation of an IV bag. The H2 pharmacist will go and recheck the compound machine, making sure all of the correct medications are hooked up to their corresponding tubes. I got the chance to scrub in and watch my H2 pharmacist do this! I had a great shift today and was very excited to have the opportunity to scrub in. It was definitely something new and I enjoyed every part of it! Fun fact of the day: Inpatient pharmacies will heat seal, close a plastic bag with heat, certain medications like inhalers. Therefore, if a nurse or doctors decides the patient no longer needs that medication before it is opened, they may send it back to the pharmacy for another patient’s future use. ![]() There are many different buildings and departments that are apart of Nationwide Children’s Hospital, one of these being the Primary Care center located down the street from the main hospital! The Primary Care center works with a variety of patients and their families to help provide long-term care. Patients may come for all types of visits- an easy way to think about it is another alternative to having a pediatrician. Primary Care visits are based on appointment, however any family can make an appointment for their child(ren). Many Nationwide Children's Hospital Primary Care centers are located throughout central Ohio- many inner city and in “under-served” areas. Primary Care pharmacists work with a variety of different people, ranging from social workers and nurses to medical residences and clinical psychologists. The main job of the pharmacist is to check clinic prescriptions and make sure the insurance covers as much cost as possible, as many of these patient's families have a low income. The pharmacists also work directly with the patients and see them when they come in for appointments. They will discuss medications with the patients and can also give vaccines, such as the flu shot. There are many misconceptions with the flu shot, as a majority of people are not fully educated on what the flu shot actually is. Many people believe they will end up having the flu if they receive it and parents who have not had the shots themselves are weary to give it to their child. While the flu shot is not required by the Primary Care center, it is highly recommended. Some private practice pediatricians will even require their patients to receive the flu shot as they do not wish to expose their other patients to possible illness. If families refuse, the pediatricians may “fire” families and refuse to provide service. The Primary Care pharmacist I observed also works closely with residences, helping to guide them when it comes to different medications. She loves her job and emphasizes just how many different directions pharmacy can take you in! ![]() Today I was in the Blue Pharmacy, which is the biggest pharmacy in the hospital! It is one of the two outpatient pharmacies in the hospital, the other one being the Orange Pharmacy, and is responsible for getting medications for patients who are no longer in the hospital. Being the biggest pharmacy in the hospital, the Blue Pharmacy dispenses almost 500 scripts per day! There are multiple different sections in the Blue Pharmacy in order to make the process from medications in the bottle to the counter as smooth as possible. These different sections include putting in prescriptions for clinical review, clinical review, actually making/putting the medications in the bottles, checking the medications in the bottles, and the multiple different people at the front working with patients who would like to pick up. The beginning of filling medications starts with workers entering in the different prescriptions for clinical review. This includes first seeing the script (whether it be physical paper or electronic) and entering it into the computer system. Physical paper scripts are required to be scanned into the computer system, as the hospital keeps track of every script filled. When entering scripts into the system, they must include all patient information along with the medication information; type, dosage, and the doctor who prescribed the medication for the patient. These workers also deal with the insurance aspect, making sure the insurance covers as much of cost as possible and seeing if any information is missing. When dealing with certain drugs, there are two types: brand and generic. Brand drugs are those who are made and formulated by drug companies, and are often expensive. They are usually expensive due to the fact that drug companies spend millions of dollars studying and formulating the drug. Once the brand drug has been out for a certain amount of time, it can then be released to other companies to be made into a generic drug. These companies include what are known as “off brand”- such as CVS and Walgreens. Generic drugs are known for being much cheaper than brand drugs. When working with scripts, workers can take any amount of time to enter into the system depending on how complicated the script may be. Once entered into the system, the script then moves along to the clinical review aspect. ![]() The clinical review aspect is a very important part of this overall process, as it is here that the pharmacists double check the medications being prescribed. When checking the medication with the patient, the pharmacist looks diligently at the patient's file to see the reason why the specific medication was prescribed. When it comes to higher rank medications, those often apart of medication abuse, the OARRS system is used. The OARRS system is the Ohio Automated Rx Reporting System, which houses every patient in Ohio who has ever had medications prescribed to them. The pharmacists check these files to make sure the patient has not had a continued amount of high risk drugs and also does not have any currently in use (if the same drug). Another aspect of this job also includes double checking the dosage with the child’s weight, in which websites and online resources like LexiComp are often utilized. Once everything is set and the information is confirmed correct, the next step is for the script to be physically filled. There are always two people filling the prescriptions, with help from interns for combinations. When filling the scripts, the workers look at the monitors and see what type of medication is needed, along with dosage. It is VERY important to triple check when grabbing drugs from the shelf, as there are many with similar names and different strengths. The workers then put the drugs into the different bottles, whether they be pills or liquid. At times, a drug combination is required (the making of a drug by using other drugs). This is performed at a separate station by interns, students who are almost finished with obtaining their PharmD. When dealing with higher rank medications, the pharmacists are required to go to a specific machine in which they are locked up. They must input personal information and give a fingerprint in order to reach the database, in which they then input the patient’s name and desired drug. They then record the amount of drug being taken from the bottle and write on the bottle how much is left. The DEA, US Drug Enforcement Administration, is VERY strict when it comes to dealing with controlled substances. DEA numbers, unique numbers given to doctors, must be included in the prescription when prescribing controlled substances. Doctors are required to know their DEA numbers by heart, such as a social security number. ![]() All medications are apart of the Controlled Substance System, in which they can be ranked from a Schedule 4 to a Schedule 2 drug. Drugs are ranked according to how strong they are, the risk of addiction and withdrawal, etc. The lowest rankings are Schedules 3 and 4, as they are allowed 3-5 refills. Schedule 2 drugs are the highest legal drugs allowed to be prescribed in the United States. These are allowed no refills, and include opioids such as Oxycodone and Fentanyl. Schedule 2 drugs have the highest risk when it comes to possible abuse. There are drugs that are labeled Schedule 1 as well, however these are illegal to prescribe in the United States. The only use Schedule 1 drugs have are for study when it comes to experimentation with drug companies who are discovering new drugs. Schedule 1 includes drugs such as Heroin and Marijuana. Once the prescriptions have been physically filled, they are sent to the last checking of the medications. It is here that the workers check the medication once again. When it comes to pills, they look at the pills from the original bottle and the ones currently in the prescription bottle, making sure they match. When it comes to liquids, they smell the original medication and then smell the liquid in the prescribed bottle, making sure they smell the same. The workers are then required to put the prescribed medication into bags and apply any information stickers (I.E. fruit punch taste, keep refrigerated, etc) to the prescription bottles. Once the drug has been triple checked, it is placed in the pick up area. Interns, those obtaining their PharmD, are usually in the front at the window. When a patient approaches, the interns put in the patient’s information, accept payment, and grabbed the patient’s ready prescriptions. A pharmacist is also available to consul a patient on their medications if needed. Counseling is when a pharmacist will go over the patient’s medications with them, including discussing dosage and time of day, possible side effects, and also may answer any questions the patient may have. The patient now has their medications in hand and is ready to go! As one can see, this is quite the process! The workers also rotate stations every couple of hours to prevent work fatigue with one certain job. Throughout this entire process, it is very important that every worker is trusting one another that they are doing their job correctly and to the best of their ability. I definitely have a new appreciation for pharmacies and the amount of work they are required to do! ![]() ED- Emergency Department here I come! At first I really did not know what to expect, but I soon learned the Emergency Department is really not like the one you see on Grey’s Anatomy. There are not 10 doctors and nurses running around like crazy trying to save dying patients every other minute. And while there are times of yes, indeed crazy emergencies, the Emergency Department is much more relaxed than I originally thought it would be. During my time in the Emergency Department, no traumas actually came in. Traumas are codes for incoming patients who are severely hurt, with most in life-threatening conditions. While I was happy to see that no one was close to dying during my shift, it is hard to gauge what the actual ED pharmacist job is like (as their job’s adrenaline comes from running around and saving patients in trauma situations). While it is hard, I shall try my best to describe what I have gathered about the job. ED pharmacists spend the majority of their time on a computer. On the computer, they are verifying medications for different patients prescribed by doctors on the ED floor. This takes up the majority of their time- however when there is an incoming trauma, the ED pharmacist springs into action. ED pharmacists must be good on their feet- physically and thinking-wise! While they are running all around the place trying to get different drugs, they must also be thinking on their feet as to what medications they believe the patient needs. At times, this may be very difficult due to the fact that there is usually a limited amount of information known about the patient. There are at times “mystery guesses”- guesses that must be made with a limited amount of information known. As adrenaline and pressure are at their highest, the ED pharmacist must stay relaxed under this high pressure while thinking as fast as they can. Once the patient is stabilized, the ED pharmacist usually will not see this patient again. Patient contact is very brief once past the point of stabilizing them and keeping the patient alive. Interns, those who are almost done obtaining their PharmD, will help the ED pharmacists out with miscellaneous tasks. These tasks can include going to the different rooms on the ED floor and checking with families about current medications the patient may be taking, in order to make sure there are no conflicting medications. While my shift was not adrenaline filled, I was happy to be on the floor around patients! Fun fact of the day #1: Newborn babies breathe primarily through their noses! So when a baby has a stuffy nose they must rely on mouth breathing (in which they don’t have a ton of experience with), which can at times make feeding hard. Fun fact of the day #2: When a person has a UTI, Urinary Tract Infection, their White Blood Cell (WBC) count is often sky high! This is due to the fact that white blood cells rush to the infection site in order to try to get rid of the infection, which then results in an extremely high WBC count. ![]() Pharmacy- here I come! I had my very first shift at the hospital and I could not have been more excited! Today I shadowed Colleen, a Patient-Care Pharmacist who is stationed on the Cardio (heart) floor at Nationwide Children’s Hospital. There are two main types of Patient-Care Pharmacists. One type does rounds on patients in the morning and then has the afternoon off to solely focus on research and projects. The second type does rounds on patients in the morning as well, however spends the rest of their day on their computer doing a variety of things. Colleen is this second type of Patient-Care Pharmacist that I shadowed today! During rounds, there consists of a team of a variety of different people- ranging from social worker to nutritionist to resident. It is this team's job to look at every patient and analyze their newest stats and condition to see if anything needs changed or if a chemistry needs ordered (a lab blood-work test that analyzes the nutrients in the body). This group of people are completely reliant on teamwork, as they must trust one another with the advice and decisions they bring to the table in order to try to heal the patient. ![]() When on the Cardio floor, it is the pharmacist’s job to see the chemistries and newest stats and come up with a change in plan if needed. This includes critically analyzing the chemistries to see trends in the body's different nutrients. Based on an increase or decrease in nutrients, the pharmacist can then change the amount of nutrients going into the TPN bag. A TPN bag is a Total Parenteral Nutrition bag- what most people refer to as a food bag. It is white in color and is the primary source of nutrition for a majority of these heart patients. The pharmacist can also change medication for the patients and is a heavily used source for the doctors when it comes to specific medication knowledge. The amount of medication in pediatrics (children) is solely based on the child’s weight (and at times height). This involves A LOT of math, therefore all pharmacists carry a calculator on them! ![]() After rounds, Colleen makes her way down to her office. The time after rounds is mostly spent on the computer, as it is critical that she is always in contact with the medical records and latest patient updates. The pharmacist is mainly in charge of verifying medication for their patients, which happens quite frequently. This verification requires the pharmacist’s fingerprint, therefore it is only them who can verify the incoming medication request. This also includes double checking dosage (amount being given) and that the new medication will not interfere with any medication already in use. Discontinuing medications is also important, as old medications may no longer need to be used. It is also the pharmacist’s job to make medication charts with the different medications, side effects, dosage, frequency, and usage for the patients. So once they go home, they know exactly what they have and when they need to take it (or when the parent needs to give the medication). When calculating the dosages of medications, the final numbers in the end can go to as many as 3 decimal places. Colleen likes to try to readjust some of the medication amounts in order to make the dosages for the patients, or parents, easier to give (I.E. It is easier to dispense 5.50 milligrams rather than 5.455 milligrams). If the pharmacist has time, they will also help consult the patient and their family on the different types of medications they are receiving and going home with, in order to know the correct medications are being given at the correct time and correct dosage. Patients on the heart floor can be there from a couple of days to a couple of weeks. Recurring patients often show up on the cardio floor frequently, as they have many severe complications with their heart and body. Therefore, the pharmacist usually gets to know the patient and family very well. Today I learned that being a pharmacist includes sometimes thinking outside of the box when it comes to finding the right medications and also involves MATH, MATH, and more MATH! But that’s alright, I like math :). Who do I wish to be? I find myself asking this question quite often- probably more than most teenagers. I go to high school everyday and see the people who surround me, how every person has their own story almost no one will ever know. As I look around, I realize something. I wish to be a person who makes a difference, who can go to sleep knowing that I helped someone that day. I wish to continue to grow everyday, refining my flaws and using my best qualities to help those around me. Negative thoughts must be washed away, as I want to wake up everyday with a CLEAR MIND and a HAPPY HEART. This world is already filled with far too much negativity and hate, therefore I wish to do everything to spread kindness to everyone I interact with. I wish to, as cheesy as it may sound, live without any regrets- no actions left undone, no words left unsaid. Kindness. Generosity. Strength. Positive mind, happy heart. Forgiveness. Being humble. These are the characteristics this future person must possess, the person I wish to become. This person must become resilient to the bad in the world and take every day on with a positive outlook on life. As cliche as it might sound….I know I want to change the world in any way I possibly can! Even if that means starting with just one person. ![]() IMPACT: Helping to make a positive difference on people and the world, one good deed at a time. Starting the journey to eliminating hate and negative vibes, while filling the space around me with positive thoughts and actions. Commitment and a positive outlook are required, never stopping to make a positive IMPACT on everything and everyone I possibly can. This is my one word. Ever since I was a little girl, I have always looked up to my grandfather. The way he held himself never failed to amaze me. I knew he was involved in many things, but I never realized how big of an impact he made. It wasn’t until his funeral that I, and everyone around me, realized how big of an impact he had made on the community and those around him. The part that astonished me the most was how he had never bragged or talked about just how big of an impact he had made. He had bought the local, run-down, school district access to wifi and computers. He was heavily involved in the Princeton alumni. He even tutored a 8 year old in math and english. Education was very important to him, and EQUALITY of education meant more to him than words can described. My grandfather has shown me just how impactful one person can be, while the secret to this lays with a giving heart and a willingness to try. This is who I wish to become, a person who makes an impact on the people who surround me. No recognition needed, just my own satisfaction knowing I have helped something, someone. This year I hope to pursue this passion, this one word. How? By incorporating it into everything I do- 365 days a year. At a grocery store, on an airplane, when walking passed a stranger, and eventually at college. While there will be times of awkwardness and being uncomfortable, I know no one ever impacted and changed the world by remaining silent. No matter how small the deed, no matter how big the commitment. I am ready to write my story, one IMPACT at a time. |
What am I doing 2nd Semester?Second semester, I will be mentoring at the main campus of Nationwide Children's Hospital. I will be shadowing clinical pharmacists in a variety of departments (ER, NICU, Cardio, etc.) around the hospital. This will hopefully allow me to obtain an overall grasp on clinical pharmacy and what department I like the most. I am so excited to start this adventure!
"As one person I cannot change the world, but I can change the world of one person."
~Paul Shane Spear |