Eric Poulin's ePortfolio

Oh ya… I had a Nephrology Rotation

ericpoulinresidency — Mon, 21 Jun 2010 04:57:33 +0000

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!

Committment to the Pharmacy Profession

ericpoulinresidency — Wed, 02 Jun 2010 23:20:12 +0000

Entering pharmacy school, many students only think of the community pharmacy role as the job they will end up in. As the years go on, new avenues of opportunity are exposed. The pharmacist has multiple ways to make a career these days: working in community, running their own store, working in hospital, working in hospital admin, working in research, and also taking a faculty position in research and education, not to mentino industry. The common aspect to all of these choices is that the focus should ultimately be on patient care.

You might not think about it as much in research, faculty, or industry positions, but all of your work does strive to achieve benefits for the patient. In community or hospital, the outcomes are seen firsthand, when you provide patient counselling, when you make an intervention to improve efficacy or safety for a patient’s therapy, the end result is that you are providing patient care. Coming out of school and soon to be out of residency, I find myself caught up thinking about where I will eventually end up… and the answer is providign patient care.

The bottom line is that we are health care professionals, and our job is to provide care that will benefit our patients, either directly or indirectly, through research that may someday benefit patients or education to future pharmacists. When considering committments, contracts, and obligations, our real only obligation is to provide patient care to the best of our ability, which I intend to do the rest of my working career, no matter what part of the pharmacy working spectrum I end up in.

Neurology Wrap-Up

ericpoulinresidency — Fri, 28 May 2010 21:19:53 +0000

Today ends my 4-week Neurology rotation, and it has been a great experience. The last two weeks I have been on the general neuro ward, following Dr. Briemberg’s team last week and Dr. Hurwitz’s team this week. It almost felt like culture shock starting to treat MS and Myasthenia Gravis patients with drugs I have rarely been exposed to (ie. pyridostigmine). In the end, I felt like I was able to learn a great deal about the long-term and acute treatment of these conditions, and was able to make many interventions to improve patient care on the ward.

I also had my poster presentation night May 19 at Children’s Hospital, which went off without a hitch (minus my graphs missing their y-axis labels!). An incredibly busy last couple of weeks, but very rewarding and enjoyable. Monday I start my final rotation of my residency, ambulatory nephro, with Marianna Leung at SPH, and I am very excited!

Lake Louise Wrap-up and Neurology Update

ericpoulinresidency — Fri, 14 May 2010 22:07:51 +0000

First of all, I’ll start off with Lake Louise… what a blast! From showing up Thursday night and finding out I had been signed up on Team Katal in a Shop Wars contest, it only got better. The pad setup was great, the only downside was that the big jump was not quite poppy enough (ie. not steep enough) to get doubles around, so unfortunately the double backside rodeo 1080 will have to wait. But I did learn a bunch of new tricks, including switch wildcats, switch frontside rodeos and backside rodeo 7′s. Great times overall!

On to work stuff (I guess that’s why I have this blog!), Neurology has been awesome. I work with Karen Tulloch on Monday-Thursday and then Penny Bring on Thursday afternoons and Fridays. So far, I have been working with the Stroke team, and have learned a lot about the management of acute stroke, as well as secondary prevention principles. Today I go home happy knowing I caught an error. A pt of mine had high TSH, low free T4, and the resident had prescribed levothyroxine 50mcg qid!!! After a couple quick calls and a bit of education, I sorted it out and got them to a once daily dose. All is well, and the weekend is here!

The double backside rodeo 1080

ericpoulinresidency — Mon, 26 Apr 2010 20:51:21 +0000

The above-mentioned title is my goal for the weekend, where I will be sessioning the Landing Pad out at Lake Louise with my friends Katal Innovations. The trick is somewhat commonplace these days, it was first shown in Mack Dawg Productions 2006 movie, “Follow Me Around”, when Eero Ettala ended his part with that trick (infact, he had the last part of the video, a coveted accomplishment, and so this trick ended the entire video) (see: http://www.mackdawgproductions.com/movies_page.php?1146). Since then, other riders have stepped up to learn this trick, including Travis Rice and Eiki Helgason.

Basically, to understand the trick, you need to understand the basics. A backside rodeo 540 involves a backflip with a backside 180 degree rotation, so the rider does a 540 rotation, but 180 of it is on a horizontal axis, and 360 is on the vertical axis (the backflip). Now if you do a backside rodeo 720, that is essentially a backflip with a backside 360. THEN, it gets spicy when you add in the double factor. Essentially, the trick becomes a backflip into a backside rodeo 720… hence, the 1080 degree rotation (360 on the horizontal axis and 720 on the vertical axis).

Now you might wonder just what the hell does this trick look like? In short, it looks SICK! If you visit my older posts, you might find a video link to a clip of me hitting the landing pad last year, where I tried a double backside rodeo 900, but didn’t quite make it around it to my feet. For a better view, check out Eero’s part on youtube (mind you, the original song, “Come on Eileen” was taken out for copyright laws, so someone put in some crappy song in it’s place). Go to http://www.youtube.com/watch?v=CVLHBq61cfM, and go to 3:33, and enjoy the show!

I’m heading out to Lake Louise this weekend to try this trick out on the Landing Pad, and I have a GoPro Helmet Cam to catch a bird’s eye view! Keep posted to see the results.

Dispensary: The Saga Continues

ericpoulinresidency — Mon, 26 Apr 2010 20:36:28 +0000

I am now into my final week of my dispensary rotation, and I am slowly but surely becoming competent at working independently in the dispensary. I’ve mastered the Hip and Knees, I’ve got the TURPs and the Gyne Post-Ops, the POPS orders, I’ve checked off the IV preparing and checking, and PCIS and I are getting along better every day. Tomorrow I will spend some time with Amy learning about dispensary management logistics, and then I will finish off the rest of my week with more plain-old dispensary work.

Next week I get into Neurology at VGH with Karen Tulloch and Penny Bring, which I am quite excited for. But before that, I am going to get some R’n'R this weekend at Lake Louise, wheremy friends, Katal Innovations and I will be having fun sessioning the Landing Pad (see next post)!

Dispensing Away

ericpoulinresidency — Tue, 13 Apr 2010 23:08:57 +0000

I am now in the middle of the second week of my distribution rotation, and things are going swimmingly. I am out at UBC, which is great because it is relatively slow and I have a lot to learn having no background dispensary training. Caroline Chin is my preceptor and she is teaching me a great deal about order entry, I feel like I am learning more everyday. The staff here are all very nice and welcoming too, which makes it a pleasurable environment to work in. This week I will be over at VGH for Thursday and Friday to learn how to prep IV’s, which should be fun.

All for now!

Management vs Leadership

ericpoulinresidency — Thu, 01 Apr 2010 21:10:02 +0000

Over the last 2 days I have been able to observe the responsibilities of pharmacy administration staff by shadowing Keith McDonald at Richmond Hospital. The differences between management and leadership, I think, are fairly clearly illustrated by the current situations going on in the pharmacy world, both locally and globally.

For instance, right now there is a consolidation going on between the health authorities. This is posing problems to job security, in the face of pharmacy budget cuts. Managment staff need to collaborate to control and problem-solve as to how they will manage this issue. It takes a fine balance to be able to cope with the complexity of this issue – where will the budget cuts occur, how many staff can they afford to hire, how many staff will go on a mat leave, for example, for which they will need to hire new temp staff – to achieve appropriate management of your organization to keep your staff happy and your business running.

On the other hand, the global picture of pharmacy is changing, and it takes a leader to be able to observe these changes, predict their applications to future practice, and lead his/her organization into this new paradigm, for lack of a better word. For instance, consider the fact that the mean age of the population is increasing, and the average amount of medications taken by a patient is increasing. Then consider the fact that 20-30% of ER admissions are due to medication errors. From this, it seems clear that proper medication management, particularly in our periatric population with multiple chronic conditions and multiple therapies, is paramount. Here at Richmond, Keith is part of a leadership team that is spearheading a movement to take medication reconciliation one step further, extending from hospital stay to discharge and ultimately to the patient’s home. They have piloted a program that uses case managers, clinical nurse leaders, and community pharmacists to achieve medication reconiliation from discharge to home with appropriate medication management and open communication from hospital to GP to community pharmacist. This kind of program extends from simple management to leadership, as it is anticipating change and adding an expanding role to the profession of pharmacy.

Admin Shadowing at RGH

ericpoulinresidency — Thu, 01 Apr 2010 20:41:06 +0000

Today is the 2nd day of my 2-day admin shadowing experience with Keith MacDonald. Yesterday we had some discussions, and Keith gave me a small project, which was to read a document entitled “Evaluation of the Integrated Medication Management Program”. This is basically a medication reconciliation project that focuses on outreach to the community. It involves hospital staff, case managers, clinical nurse leaders, and community pharmacists to streamline the medical management of patients from hospital to home and vice versa. I was to read the document, and provide my feedback on the issue. Today I was able to participate in a couple meetings (a Medication Reconciliation Committee meeting and a Medication Safety Committee meeting), where this issue was brought up. From reading the document, and my previous experience with the Med Rec pilot program at St. Paul’s Hospital, I was able to provide some feedback on the issue as well as some background on how we did things when I was involved in the project as a summer student.

Posted here is a text copy of the cover page, table of contents, and executive summary of the document. My contributions on this project were mostly vocal in my feedback and participation in the meetings.

IMMP Evaluation

It was a pleasure shadowing Keith these two days, he has loads of experience from which he has accumulated a wealth of knowledge, from having his general MBA and then his time invested in management of healthcare systems. From our discussions, and observing his role in an interdisciplinary managament and administration team, I have learned a lot about the role a manager has in the pharmacy world.

End of the Line

ericpoulinresidency — Thu, 01 Apr 2010 20:17:28 +0000

Wow! The last 3 weeks, I must say, have been the most intense and stressful of my entire residency, and I can easily say that I am very relieved to have those big tasks done with. In the last 3 weeks, I finished my Cardiology rotation, gave my Cardiology case presentation at SPH, gave my BC-Wide case presentation the next Friday, had my oral exam, and taught a 2 hr Academic Halfday on ventricular arrhythmias. After finishing the exam Tuesday and the halfday Wednesday (yesterday), I feel like I can finally relax.

I am now wrapping up my last project week, and just 5 minutes ago I received the last of my mycophenolate results from Mary’s lab. Early next week I will have all of the results put into my Excel spreadsheet, and I will be able to begin my LSS development and validation. I also statr dispensary next week, which will be light on the homework side so I will actually ahve time to work on my project.

Looking forward to it!