PRP Week 24 & 25 - Clinical (ICU)

ICU a.k.a Intensive Care Unit is where the most critically ill patients are admitted. Some conditions are life-threatening which requires them to be closely monitored. So, for the final two weeks in clinical department, I was attach in ICU. Although there are only 12 or less patients in ICU, however the treatment is far more complex than any other wards. The medications are usually given in high dose and some patients were on expensive antibiotics because apparently they are many microorganisms had become resistant to the common antibiotics. The emergence of MRO (multiple-drug resistant organisms) is very worrying in hospital setting.

Like usual, in the morning I will clerk case in ICU, updating the CP2 and then follow specialist round. I'm not sure why, but the specialist kept on changing day by day. It's confusing some time. Here, specialists from other teams such as medical, surgical, or ortho will also do their rounds around the same time. So which one to follow? Follow the anaes team. Usually there are around 3 HO, 1 MO and 1 specialist. Some staff nurse will follow the round as well.

Common cases in ICU include MVA, severe sepsis, acidosis, hypertensive emergency and many patients were transferred in from another ward because the need of ventilation and support. Post-operative patients who are in critical conditions are placed here too.

During my attachments here, there were paediatric patients as well. One with nosocomial pneumonia, one with dengue fever and another one I forgot already. 

Some patients were admitted for one or two days only in ICU, which they will be transferred out when their conditions improved.

Important point in becoming ICU pharmacist:

1. check the renal adjustment dose, because many ICU patients has deteriorating renal function

2. remind the doctor about the antibiotic frequency and the proper day to off it

3. suggest dose adjustment if required

4. answer inquiries especially which drugs are available in the hospital and the dosage form

5. drug interactions, whether any drugs should be stopped and removed from the treatment

6. some doctors will even ask about drug price

I already presented the ICU case this week, the case is about necrotising fasciitis or also known as flesh eating infection. The bacteria involved are sure very nasty one.

Me in ICU.. untuk kegunaan hospital sahaja.. lol

A very useful reference.. can download online too.. 

Sanford Guide

Were bored listening to talk

It was raining one day and the hospital form a swimming pool on the roof top.. :D

Everolimus, a drug used in cancer patient..

Alhamdulillah, out first Oovoo video conference since came back to Malaysia..

PRP Week 23 - Ward 8C (Paeds Renal & Onco)

Assalamualaikum, I hope everyone is in the pink of health. Almaklumlah, Malaysian weather is very unpredictable right now. Sometimes it is too bright and sunny and hot, sometimes it will rain with thunder storm. Plus, many people gets sick due to these kind of weathers. So, bertabahlah.. Take care of your health, drink a lot of water, keep yourselves hydrated and do not play under the sunlight too often.

So, two weeks ago I was attached to Ward 8C which handles paediatric patients with renal and oncology problem. It's very sad watching these kids having this kind of conditions. They are still young but yet their kidney isn't functioning well and some of them has cancers.

Like usual, in the morning I will read through the cases, then follow ward rounds and then check the medication trolley in satellite pharmacy. Plus, sometimes got assignment given by the FRP, usually I need to go back and find the answer if I couldn't find it on the spot.

During my time, the number of patient in the ward is quite less. The ward wasn't full. So I have to clerk every patient for CP1 and CP2 forms. The CP1 clerking was a bit different from the norm, this time I wasn't evaluating the patient for their compliance towards medications, but I counselled them on the type of medications, the indications, how to take and also the common side-effects.

celebrated They's birthday at satellite pharmacy

We also had to attend Pengenalan Perkhidmatan Farmasi kepada PRP which took place in our hospital, Hospital Sultan Ismail on Saturday. I got the chance to meet my batchmates from Strathclyde as well as from INTEC. :)

This course took one whole day from 8 am till 5 pm. 

with Ain from INTEC

from University of Strathclyde - CV, Jolene and Yunn Shuen.. :)

Anis & Mira also from INTEC

Ok bye

PRP Week 20, 21 & 22 - Medical Wards

Yuhhuuuu, dah lama tak update pasal kehidupan sebagai seorang Pegawai Farmasi Provisional (PRP). Ok, so after my attachment in 8D and NICU, I was attached to 3 medical wards, one week each. Firstly in Ward 3B, then 7A and finally 7B. 

Being in medical ward is quite okay, because I'm already familiar with drug doses due to my experience in satellite and OPD. However, in certain cases, the doses need to be adjusted due to patient's underlying condition such as renal impairment.

As usual, in the morning I will follow specialist ward round. Then, check the ward trolley in satellite pharmacy and do my CP1. If the discharge medications were already prepared, then I will send them to ward alongside with bedside counselling. Some device or medications need to be counselled such as inhaler, insulin pen, warfarin and aerochamber. So drug like Fosamax also need some special counselling as this is a once a week medication.

I presented 2 cases from medical ward. One was about SBP (spontaneous bacterial peritonitis) and another one is about hypertension emergency. I presented these cases in one day since I missed the previous week presentation due to emergency reason. I took emergency leave because my grandmother was admitted to hospital and my aunt passed away. 

So, what's important in medical ward?

Read these book and references:

1. Sarawak Handbook 

2. CPG Guidelines especially for hypertension, diabetes mellitus & asthma - these are the most common cases in medical wards - for management of the disease

3. Drug Info and Micromedex - to check for doses and interactions etc

4. Antibiotic references (Sanford, National Antibiotic Guidelines)

In the evening, aroung 4pm, I will once again send the discharge medications. After that, I will stay back untik 6 or 7 pm to clerk CP2 cases to achieve the target. 20 cases per ward in a week. Thus, in total 60 cases for CP1 and CP2 in three weeks time.

Posing kat surau

A few types of inhalers

CP2 forms

View from seventh floor

Sometimes I went back at this hour.. 

PRP Week 19 - Clinical (Ward NICU)

Yuhuuuuu, my second week in clinical was still dealing with kanak-kanak. This time, involved neonates. In NICU (Neonatal Intensive Care Unit), usually the preterm babies were kept here. Also for the term babies with some illnesses. NICU hold approximately 50 babies, which is more than any other wards. 

Every morning, I will follow the ward pharmacist to do ward round with the specialist. Some common cases in NICU are neonatal jaundice, respiratory distress syndrome (RDS), presumed sepsis and retinopathy od prematurity (ROP). It's sad watching small babies having these sort of illnesses. Poor babies...

Many medications in NICU are made into floor stocks, that means the nurses don't have to go to satellite pharmacy to pick their trolley. NICU don't have the medication trolley. Some common drugs used in NICU are C-pen and Gentamicin for presumed sepsis, aminophylline or caffeine for RDS, multivitamin, folic acid, vitamin b complex and many more. Other than drugs, other important supply for the babies include EBM (expressed breast milk), preterm formula and term formula. For babies who requires oxygen supply, they will be put under CPAP (continuous positive airway pressure) or nasal prong.

For babies who requires treatment for jaundice, they will be put under phototherapy, from single to even triple phototherapy for a least when their bilirubin level has dropped down to normal range.

For NICU, I presented a case of presumed listeriosis. Quite a rare case in NICU.

Ok, that's all.. =)

PRP Week 18 - Clinical (Ward 8D)

Hurrayyyy~ Finally I entered into clinical department. The toughest and the most exhausting dept ever.

Since this week was started with CNY breaks, thus I only attached to Ward 8D for 3 days only. Ward 8D is a paediatric ward which means the patients are mostly children. However, there is a case of patient age 15 years old who was admitted here because other ward didn't want to admit him.

During my attachment to ward, there are some routines had to be done throughout the day. These are what most of the ward pharmacists will do:

1. Clerk case in the morning to see whether there are new admissions into the ward.

2. Write down all the medications for each patients and their significant lab findings to see whether there is a need to make interventions.

3. Follow specialist ward round, usually started at 8.30 am or 9 pm depending on the specialist. Most of the time, house officer (HO) and medical officer (MO) will follow the round and they will present the case to the specialist. The specialist then will do some examination on the patient such as blood pressure measurement, pulse rate, saturation and others. Usually my job is to listen to the discussion and then write down if there's any change, addition or removal of medications. Also need to write down which bed will be discharged today. Any inquiries regarding medications will usually be asked to the FRP since they have more experiences.  

4. After round, I will go to Farmasi Satelit to check the medication trolley for the ward. If there's a change, I will checked the trolley, removing or adding the respective medications. However, there's no trolley for ward 8D, so I'm kinda free after ward round.

5. Since some paeds wards do not have medication trolley, I have to write down a list of patients who have CIVAS and then I need to print the labels out. Usually, CIVAS is for antibiotics except Augmentin, ampicillin, cloxacillin and c-pen. These 4 antibiotics are not stable to make CIVAS.

6. At 12pm and 4 pm, I will call satellite to ask if the discharge medications are ready or not as I need to send those medications the the patients. 

7. Some patients need counselling on certain instruments or medications such as insulin pen (Novopen), MDI (metered dose inhalation), warfarin or others. The most common counselling in ward are insulin and MDI.

8. Clerk case is one of the requirement in clinical dept. For adult ward, 20 cases per week while for paeds 15 cases per week. For ICU, 15 cases per week. Thus I have to fill in the CP2 and CP1 form everyday to make sure I have met the requirement. I will usually stay back after work to do the clerking until 7 or 8pm.

That's all for the first week of my clinical attachment.

Takde gambar, sorrehhhh.. XD