Ok, so usually I keep up with my blog posts pretty regularly, but nephrology absolutely flew by! The last 3 weeks I worked with Marianna Leung and Fong Huynh at St. Paul’s at the Kidney Function Clinic and the Hemodialysis clinic, performing outpatient nephrology care. The first week, I mostly worked on the KFC, assessing and interviewing the predialysis patients coming in for outpatient care. I was able to pick up on some of the challenges a pharmacist faces trying to provide patient care with limited information from the chart and most of the information coming from the patient interview. However, just upon doing medication reconciliation in the interview, I was able to pick up on and solve some patient issues (ie. in one instance I had a patient on HRT since the early 90′s which we were able to advise her to follow up with her GP and d/c).
The second week and third week I mostly work on the hemodialysis unit with Fong. I was able to work up patients from their charts and then go and assess them as they came in for their 4-hour HD run. This setting is a bit more like inpatient care, in that you are able to see the patient frequently, since they are in 2-3 times per week. It can be challenging sometimes to handle some of the patients’ issues, since it involves contacting their GP to change certain prescriptions, but handling the nephrology issues are easy enough because the doctors on the HD unit are all great to work with and easily approachable. Another great part of this unit is that the pharmacists actually handle ALL the warfarin dosing for the HD patients as well as ALL of the anemia and iron issues.
My very last day of residency I was also able to deliver one last case presentation, on a patient I ran into on the HD unit, whose main problem was her insulin dosing since she started HD. The presentation covered a lot of pathophysiological issues surrounding insulin dosing and diabetes management in HD, and although there was very little evidence to base my recommendations on, some of the pharmacists commented to me afterwards that they found the information very useful (thanks Os!).
Usually after one rotation, I make a comment about the next rotation I am headed to, along with some of my goals/expectations. This time around, however, my residency is over, and I am headed on to real life. On the agenda is the following: seeing Iron Maiden next week, moving to Whistler, working as a community pharmacist in a mountain community, learning the good fishing spots in the Whistler area, going salmon fishing in Ucluelet, and enjoying a (hopefully) snowy season in Whistler. A big thank you to Peter Loewen and all my preceptors who helped me along the way to survive my residency!
0 Responses to “Oh ya… I had a Nephrology Rotation”