Recap: First Year (and a half) as a Pharmacist
I get asked about my career path a lot (probably because I work in a hospital without a residency…) so here’s a little bit about what I do!
I work at Brigham and Women’s Hospital, a large academic medical center in Boston with a diverse patient population and TONS of specialties. I went to Northeastern University, which was an accelerated six year pharmacy program (two years undergrad, four years pharmacy/professional). I was involved in a lot of extracurriculars (ski team, sorority, several pharmacy clubs) and managed to do all of my coops at Brigham as well. Coops are where you work for four months (or six if you aren’t a pharmacy student) and do not take classes - the entire time is dedicated solely to gaining work experience. In the case of pharmacy students, it also counts as IPPE time (and you get paid! Even better!)
I did apply to residencies during my sixth year, but unfortunately only applied to mostly ambulatory care residencies, which I didn’t love (not a fun thing to find out on interviews…) I could (and will) write a whole blog post about the process / being rejected another time! Anyways, I was lucky enough to have been a student at Brigham for several years and basically begged the director of pharmacy to hire me right after I graduated; luckily, he agreed! I was hired on as a senior pharmacist in August 2018. Originally, I was hired to be an operational pharmacist, which I was not SUPER psyched about at first, but it’s actually a really good way to learn how to do a bunch of different jobs, as well as diversify yourself. I’m really lucky that I work half the time in operational areas and the other half as a transitions of care pharmacist.
Operational pharmacists are typically trained in a wide-variety of areas and are more “behind-the-scenes” compared to an inpatient clinical pharmacist. Brigham is a MASSIVE hospital, so I realize that these will vary from hospital-to-hospital. The areas that are considered operational are the following:
IV Room: We check all of the IVs that the technicians make, triage phone calls and dilution questions from other pharmacists, and also help with the daily flow of the IV room. There is one technician making patient-specific medications and another 1-2 making IV batch items; we check it all.
TPN: We receive TPN (total parenteral nutrition) orders from the hospital dieticians for adults and neonates. The orders are double-checked to make sure that all of the doses and concentrations are correct, and then we input the orders from our hospital system into a website that makes the TPNs outside of Boston. This company delivers then TPNs to us and are then brought up to the floor by technicians.
OR Pharmacy: I love the OR! Our OR department is massive. There are two pharmacists that staff this position in the morning and one in the evening shift. We verify intra-op orders for patients (a lot of antibiotics, blood factors, and anticoagulation), answer a lot of drug questions from anesthesiologists and surgeons, hand out medications at our window (like a retail pharmacy!) and are in charge of the workflow of the OR pharmacy. Our technicians help out at the window, bring medications to the different operating rooms, and restock the Omnicells in the rooms (as well as receive all of the medications needed for the pharmacy).
Infusion clinic: Brigham has a clinic where many patients come to receive IV infusions. This is a relatively new position - the pharmacist preps and checks all of the infusion medications. During the day shift, a technician makes the IV medications, and during the evening, the pharmacist also makes them all and is assigned floors later in the night as patients leave the clinic. Generally, all of these medications are also super expensive.
Vault: The vault is a small room where all of our narcotics and CII-CIV medications are stored. I think that it is the most stressful operational position because numbers matter A LOT - if anything goes missing, it’s on the pharmacist (even if the tech is the one that misplaces something). We send up patient-specific narcotics from a report that we run each morning, check all of the batch items going up to the floors, receive all of the controlled medications into the vault, and take care of any issues that come up. There is also a second vault pharmacist who is in charge of running reports strictly for patient-controlled analgesia, continuous infusion medications, and a few other high-risk items.
Most of the operational pharmacists are also trained in the PACU and Labor + Delivery.
In the PACU (post-anesthesia care unit), the pharmacist verifies all of the pre-op orders before the patient goes into the OR (operating room). They sit in the unit and are asked many questions by nurses and doctors. They also verify all of the orders for patients AFTER they come out of the OR. It can get overwhelming especially when covering other floors as well (evenings and weekends).
Labor and delivery is unique in that a lot of the orders that the pharmacist needs to verify are in order sets based on how they give birth (c-section, vaginally, etc.) It’s relatively straightforward, but sometimes there are more complicated patients who have a lot of comorbidities, etc. The nice thing about this position is that the pharmacist gets their own office on the floor (most other pharmacists do not).
Whew! If you’ve made it this far, CONGRATULATIONS. Now I’m going talk about the other part of my job: Medication Reconciliation / Transitions of Care.
This part of my job is newer to me as I started this summer. There are two full-time pharmacists who rotate within this position and then another per-diem pharmacist helps us on busy days (usually Monday / Friday). We have pharmacy students that perform an initial medication history with patients admitted to the hospital via emergency room, and then the pharmacists follow them during their stay in the hospital (and perform multiple medication reconciliations). Per our study that just started, the patients that we follow are geriatric and on 10 or more medications. We communicate directly with the inpatient team for changes in their medications, interview the patient for adherence barriers, counsel on new medications, talk to their PCP / outpatient providers, address medication issues (like cost, side effects, etc.) and follow-up with the patient after they have been discharged. We are based in the emergency department, and we go all over the hospital to follow-up with patients. My favorite part of this job is finding solutions for patients that will prevent readmission and increase quality of life.