Hospital Placement 2017: Self Assessment

As I completed my hospital placement at Lakeridge Health in Whitby/Oshawa, I gained some valuable experience. I found it significant to learn how hospital pharmacy is run both at a smaller hospital in Whitby, and on a larger scale in Oshawa. In Whitby, two Registered Pharmacy Technicians (RPhTs) were responsible for all aspects of pharmacy, from filling refill lists and orders of traditional stock, to compounding, restocking, computer entry of orders, and restocking MedSelect machines. In Oshawa, there were as many as 20 RPhTs working in the pharmacy, and all had an assigned area with specific tasks to complete that shift. I realized that not every shift at a bigger hospital do you get to be hands on with dispensing meds, or filling the MedSelect machines, however every job that must be completed is an important part of a whole team that works together to provide patients with much needed treatment.

While working at both hospitals, there were many similarities to the theory taught in class at Fleming College. For example, as discussed in class, I saw the use of unit dose packaging, picking stations, and the need for prepackaging meds into smaller quantities. I witnessed the use of automated systems, such as MedSelect, as well as traditional systems, as with refills and orders for stock not carried in MedSelect machines, and the use of ward stock in medication rooms on the hospital floors. I also noticed the use of only generic names in the pharmacy, and not the use of Drug Identification Numbers (DIN) when selecting or checking drugs, which means extra care must be taken when picking a drug to fill a prescription, as some medications have many different strengths, and durations.

I feel that I was able to gain more practice filling prescriptions, as I filled many refill lists and orders for traditional stock items. I also became more familiar with medication names used in hospital pharmacy. I found the use of automated systems fascinating, and I’m pleased to now have the skills to restock MedSelect machines, and become familiar with the use of unit dose packaging. I thoroughly enjoyed observing sterile compounding, especially at the Durham Regional Cancer Centre, and hope to gain more experience in aseptic techniques. I also enjoyed having the chance to do non-sterile compounding, practicing the skills I learned in class.

I am grateful for the experience I had at Lakeridge Health. I found it rewarding to have a hand in patient care for so many people on a daily basis, which in some instances could have been life saving. I am excited to take the next steps to becoming a RPhT, and I see hospital pharmacy as where I would like to pursue my future career.

Hospital Placement 2017: My Last Two Weeks

My last two weeks at Lakeridge Health Oshawa, I completed the following:

Monday

I helped check certain hospital floors for their iv bag stock (NAPRA 4). I replenished drugs for the operating room trays (NAPRA 3). I also processed returns from hospital floors using the computer, and restocked the returns into traditional stock bins, as well as stocked shelves (NAPRA 4).

Tuesday

I worked at the fill counter to fill the traditional order refill lists for specific hospital floors, as well as filled some new traditional orders (NAPRA 3). I took note of sound-alike-look-alike drugs (SALADS), and of the proper handling of hazardous drugs (NAPRA 5; 9). I also saw how to fill leave of absence drugs (LOA), ensuring proper packaging (NAPRA 1; 3; 9). I recognized which drugs were running low in stock in the traditional unit dose bins when filling, so the unit dose packagers could make more, and I restocked returns (NAPRA 4).

Wednesday

I filled refill lists for specific hospital floors (NARPA 3). I barcoded meds for MedSelect machines, and prepackaged vials into smaller packaging (NARPA 3; 4). I helped fill narcotics into a MedSelect in the Durham Regional Cancer Centre wing (NAPRA 3), and signed documentation that I witnessed a discrepancy, as there were more narcotics in the machine than the computer’s inventory stated (NAPRA 1). I also assisted in unpacking a McKesson order (NAPRA 4).

Thursday

I was able to assist in the area responsible for sterile preparations. I helped gather completed iv bags to fill the refill list for specific hospital floors (NAPRA 3). I also helped prepare for sterile compounding by gathering drugs and appropriate iv bags, and creating a batch number and labelling bags (NAPRA 3). Later, I was able to properly wash and garb with the appropriate personal protective equipment (PPE), and enter the clean room to observe sterile compounding in a Laminar Airflow Hood (NAPRA 1; 3; 5; 9). Then, I unpacked a Baxter order of iv bags, barcoded them, packaged them into groups of 20, and put tamper proof foil on the ports of the narcotic iv bags (NAPRA 1; 4).

Friday

I experienced an evening shift, which began with checking the inventory of non-sterile compounded products (NAPRA 4), and then making a suspension (NARPA 3). The rest of the evening there was a Code Grey, which is loss of infrastructure, as Lakeridge Health was hit with a computer virus which ended up affecting nearly 100 countries. As a result, the evening was spent visiting hospital floors to see which MedSelect machines were not operating, and aiding nurses to find the inventory sheet of their MedSelect machines so they could manually open them with keys found behind an emergency kick plate, and locate the meds they would need (NAPRA 1, 6, 7, 8).

Monday

I had the opportunity to spend the morning in the Durham Regional Cancer Centre wing of the hospital. There, I garbed in the appropriate PPE, and entered the clean room to observe sterile compounding with cancer drugs (NAPRA 1; 3; 5; 9). I witnessed the use of a Class II Biological Safety Cabinet; the PhaSeal system used to create a closed system to withdraw drugs from a vial, and inject drugs into an iv bag; and pass through windows to deliver drugs to the adjoining cancer clinic and keep the clean room sterile (NAPRA 1; 3; 5; 9). I learned how the cancer centre takes place in many clinical trial, and how they assist patients with obtaining non Ontario Drug Benefit (ODB) drugs through various programs such as Trillium, the Exceptional Access Program (EAP), or the Compassionate Drug Program (NAPRA 1; 2; 5; 6; 8). Later, back at the pharmacy, I filled refill lists and traditional orders (NAPRA 3).

Tuesday

I barcoded sterile drugs for MedSelect machines (NARPA 4). I filled refill lists and traditional orders (NAPRA 3), including a LOA, ensuring proper packaging (NAPRA 1; 3; 9). I checked the expiry of meds in anesthesia trays, and replenished meds in the trays (NAPRA 3; 4; 9). I also helped stock shelves (NAPRA 4).

Wednesday

I filled refill lists and traditional orders for specific hospital floors (NAPRA 3). I checked the expiry of meds in emergency room crash cart trays, and replenished meds in the trays, and sealed trays in special bags (NAPRA 3; 4; 9). I also processed returns from hospital floors using the computer, and restocked the returns into traditional stock bins (NAPRA 4).

Thursday

I witnessed how to refill the list for the night cupboard, with the appropriate packaging and documentation, as well as how to open and restock the night cupboard (NAPRA 3; 4). I filled refill lists and traditional orders for specific hospital floors (NAPRA 3). I also restocked returns into traditional stock bins (NAPRA 4).

Friday

I filled refill lists and traditional orders for specific hospital floors (NAPRA 3). I restocked returns into traditional stock bins (NAPRA 4). I unpacked a Baxter order of iv bags, barcoded them and packaged them into groups of 20 (NAPRA 4). Also, I stocked meds on shelves (NAPRA 4).

 

Hospital Placement 2017: My First Two Weeks

I have now completed two weeks on hospital placement, one week at Lakeridge Health Whitby, and the second week at Lakeridge Health Oshawa.

Lakeridge Health Whitby is a smaller hospital, that provides continuing care, Geriatric Assessment and Rehabilitation (GARU), a regional dialysis unit, home hemodialysis and an ambulatory rehabilitation centre. During my first week, I completed the following:

Monday

I was introduced to filling MedSelect machines on hospital floors, and witnessed stocking MedSelect with narcotics by two Registered Pharmacy Technicians (RPhTs) so there is a double count (NAPRA 1). I stocked patient specific bins on hospital floors with traditional stock drugs (NAPRA 3). I witnessed compounding of drugs, order entry, and tech-check-tech of orders entered (NAPRA 3), and completed runs to the hospital floors throughout the day to check for orders and deliver additional traditional stock items (NAPRA 3).

Tuesday

I picked drugs off the shelf for traditional orders to be filled (NAPRA 3). I helped fill MedSelect machines on hospital floors (NAPRA 3; 4). I witnessed the process of signing in narcotics to the narcotic safe on the hospital floors, with the need for a nurse to sign as a witness that she received the narcotics (NAPRA 1). I practiced deciphering orders (NAPRA 3). As well, I completed runs to the hospital floors throughout the day to check for orders and deliver additional traditional stock items (NAPRA 3).

Wednesday

I selected drugs off the shelf to be packaged for the traditional order refill list (NAPRA 3). I helped fill MedSelect machines on hospital floors (NAPRA 3; 4). I witnessed the process of signing in narcotics to the narcotic safe on the hospital floors, with the need for a nurse to sign as a witness that she received the narcotics (NAPRA 1). I helped return unused unit dose drugs to the pharmacy shelves (NAPRA 4). I witnessed how to return narcotics from the hospital floors to the Centrack cart, and how to document narcotics that are to be discarded (NAPRA 1; 4; 5; 9). I helped take inventory of ward stock on the hospital floors, and put away a McKesson order in the pharmacy (NAPRA 4). Again, I completed runs to the hospital floors throughout the day to check for orders and deliver additional traditional stock items (NAPRA 3).

Thursday

I filled drugs on the traditional order refill list (NAPRA 3). I observed picking narcotics for the hospital floors from the Centrack cart in the pharmacy (NAPRA 3; 4). I unpacked the order from Lakeridge Health Oshawa of unit dose strips, put them into floor specific bins, and I helped fill MedSelect machines on hospital floors (NAPRA 3; 4). I checked the pharmacy traditional stock on the shelves for expiry dates, and made sure opened bottles of drugs were marked with a one year expiry from the date of being opened, as per Ontario College of Pharmacists (OCP) regulations (NAPRA 1; 4; 9). I made a suspension compound, and double checked the drugs and batch number of the RPhT who pulled the drugs (NAPRA 3). Also, I completed runs to the hospital floors throughout the day to check for orders and deliver additional traditional stock items (NAPRA 3).

Friday

I filled drugs on the traditional order refill list (NAPRA 3). I observed picking narcotics for the hospital floors from the Centrack cart in the pharmacy (NAPRA 3; 4). I unpacked the order from Lakeridge Health Oshawa of unit dose strips, put them into floor specific bins, and I helped fill MedSelect machines on hospital floors (NAPRA 3; 4). I helped return drugs from hospital floors to the pharmacy shelf if they were in sealed unit dose packaging, and discarded the rest into the appropriate container (NAPRA 1; 4; 5; 9). I observed processing returns in the computer to be sent back to Lakeridge Health Oshawa (NAPRA 4). I completed runs to the hospital floors throughout the day to check for orders and deliver additional traditional stock items (NAPRA 3).

My second week was at Lakeridge Health Oshawa, which is a large general hospital. In the pharmacy, each staff member is assigned a specific area and task each shift. My second week, I completed the following:

Monday

I witnessed filling MedSelect machines with narcotics on assigned hospital floors, as well as assisted filling MedSelect machines with non-narcotics (NAPRA 3; 4). I witnessed the process of signing in the narcotic methadone in tang to the narcotic safe on a hospital floor (NAPRA 1), and witnessed my supervisor catch a near miss (NARPA 9), as when signing in the next day’s dose of methadone in tang, she observed that the patient had only received a portion of the current day’s dose as the auxiliary label stating to drink all contents was not read properly. I also witnessed the operation of the unit dose packaging machine, and helped package the rolls of unit dose drugs into parcels for delivery to Lakeridge Health Whitby (NAPRA 3; 4).

Tuesday

I shadowed a RPhT who completed Medication Reconciliations in the emergency department for patients being admitted. I witnessed the process of using additional sources of medication history, such as Ontario Drug Benefit files and community pharmacy medication history, before interviewing the patient to obtain a Best Possible Medication History (BPMH) (NAPRA 2; 6; 7).

Wednesday

I worked in the unit dose packaging room, and helped organize rolls of unit dose packaged drugs from the machine into hospital floor specific bins, as well as added additional needed drugs from picking bins (NAPRA 3; 4). I saw how to replace unit dose paper into the machine when it ran out, and how to add drugs to the machine when they were low (NAPRA 4). I packaged narcotics with the table top unit dose machine, and I packaged blisters of drugs for the picking bins (NAPRA 3; 4). I helped stock unit dose drugs into the bins that were low in the traditional stock filling area (NAPRA 4). I attended a meeting on a new Pharmacy Order Verification Process that will soon be implemented, to eliminate the process of matching order hard copies with printed labels to be checked, as it will become computerized (NAPRA 4; 7).

Thursday

I observed the process of matching order hard copies with printed labels, and passing those orders to be either double checked against the printed labels, or filled if any traditional stock needed to be dispensed (NAPRA 3). I helped fill some traditional orders (NAPRA 3). I observed the use of the tube station to send orders to specific hospital floors (NAPRA 4). I helped stock MedSelect machines on certain hospital floors (NAPRA 3; 4). I attended a Pharmacy Technician meeting for staff addressing any problems or concerns and ideas on how to keep workflow at its best (NAPRA 7; 8).

Friday

I worked in the stock room, and helped pick drugs to add to hospital floor specific bins, to be put into the MedSelect machines (NAPRA 3; 4). I helped check ward stock expiry dates and inventory on specific hospital floors, and gathered drugs needed for ward stock from the pharmacy (NAPRA 1; 4; 9). I added barcode stickers to iv bags (NAPRA 4). Unit dose drugs that were returned to the pharmacy from the emergency department were processed, and I restocked those drugs into traditional stock drug bins (NAPRA 4). I also did a run to specific hospital floors for orders, and delivered some traditional orders (NAPRA 3).