We walked to the LUAS, then took it to Stillorgan, then walked over to Beacon! We made it perfectly on time, except I could not find the pharmacy...but the area has some really neat buildings and places to go!
Finally, I gave in and asked the hospital to lead me in the right direction! It was actually directly behind this sign through the revolving doors! They weren't kidding when they said right next too!! I assumed it meant the shopping plaza next to the hospital - serves me right for assuming!
When I arrived I introduced myself to Mary, the pharmacist, and the sales associate. They seemed not in the best of moods - and Mary told me she had a ton of paperwork, so I could just go if I wanted. I felt bad just leaving especially because I made the trek over - so being the good pharmacy student I am, I went to the hospital and asked if they needed any help! LUCKY ME, I got to go around with the clinical pharmacist. His name is Aissier - he is from Spain and goes to the floors to do clinical reviews.
WELL ..this is quite possibly the most dangerous chart set up I have EVER seen. It is 24 pages of hand written information. Half the medications I could barely read - the other half were missing doses, frequency, and important information. If the nurse gives the medication, she circles a time and initials it. But, its approximate times, not exact. Also, they continue basically all their medications through the stay. It was even more interesting because I told him I was interested in diabetes. He told me Lantus is linked with cancer & metformin was terrible for people with a GFR of 54... I found this interesting because the Levemir dose was 8 units every 24 hours and back home I would probably recommend Lantus for a dose that low. The pharmacist changed the metformin to a Dimicron (something similar to glipizide) and tried convincing me that in people that have renal problems a sulfonyurea is a "MUCH" safer alternative - even though their serum creatinine was perfectly fine. I told Liam this information and he asked if I taught them this - well I tried, but they have their own guidelines here! Soo interesting!!!
Another interesting fact is their pain procedures in the hospital. Here are their algorithms and how they assess pain. Pettudine is a short acting pain medication opioid I guess similar to Nucyenta he said...
One final observation I made: if someone has a orthopedic surgery...their medication choice is NOT dependent on guidelines or evidence based medicine...nope! You medication choices depend on which physician you have!!! This BLEW my mind that it is UPMC, and it not only has paper charts, but the pharmacist has to review this chart and what day they are on to decide what medications to start when as a preventative measure (for clots and antibiotics)! SO insane! I am still in shock!
The doctors do really rely on pharmacists here too!! A physician came in and asked what they can use for a patient who has epilepsy and hiccups. They went with donperidone since they could not use the Irish approved metoclopramide, baclofen, or nifendine.
After the clinical reviews, he documented his interventions in DocIt. Tomorrow, he will follow up with the physicians and if they did not do anything, he reports it to their med error person. Here are some of the errors he identified:
1. Ranitidine dose - there was none but the nurse had been giving it...
2. rifampin lab work and dose - they were on rifampin, but never got lab work and did not write a dose
3. Solpadene written as 2 - 2 grams 4 times a day?? this is really bad mistake, he is hoping they are only giving 2 tablets
Once I finished up, it was still a nice day out:) So I went home with hopes of going for a run then to city centre!
Well I napped instead and woke up to Cayla coming home and found out that the government released the Irish budget for the 2014 year. This led to bad protests in the city, so we stayed in to be safe! Thanks to the STEP program we enrolled in!
Cayla found this amazing sticker on the internet and it couldn't be more true:)
Irish word of the day: wanker = a person you do not like
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