Publix #1349 at Lee Crossings

Publix #0617 in Watkinsville (at Butler’s Crossing) and #1251 in Winder (at Winder Hill)

Five-week specialty care experience working in the Emergency Department (ED) as a fully-integrated healthcare team member. Overall, Archbold is a health system that has 4 hospitals and 4 long-term care facilities, and the ED is situated inside John D Archbold Memorial Hospital. This is the largest hospital in the system making it a flagship teaching hospital with accredited pharmacy and medical residency programs. This rotation took place in a <30 bed ED with three trauma bays situated at the front of the ED pharmacist’s workstation.Medication reconciliation was a major focus of this experience, as admitted patients in the ED are usually evaluated by pharmacy staff to generate/document an accurate list of home medications for their inpatient stay. Due to continuously evolving software and lack of full interoperability across technological systems, it is often challenging to get an entirely accurate medication reconciliation. Often times patients are started (AND discharged) on the wrong med, med strength, frequency, or with incorrect directions. Here, I was able to effectively create a medication reconciliation process that ensured 100% accuracy for all admitted patients.Responded to codes and assisted my preceptors with advanced cardiovascular life support (ACLS), rapid sequence intubation (RSI), resuscitative care,, and optimization of pharmacologic agents for emergent patients in the ED. Also helped with dosing for specifically indicated pharmacologic agents such as Alteplase, Succinylcholine, Rocuronium, Etomidate, Versed, Propofol, Ketamine, Vancomycin, Zosyn, etc. in the ED. Led one topic discussion per week for a total of 5 discussions:1. RSI/Post-Intubation Sedation2. ACLS3. Acute Ischemic Stroke4. Sepsis & Vasopressors5. Status EpilepticusLed a journal club for pharmacy staff on the PATCH Trial: Prehospital TXA for Severe Trauma PatientsMy rotation was primarily facilitated by Dr. James Holland III, PharmD, BCPS and Dr. Anna Beth Bowles, PharmD

Five-week advanced experience with an acute care clinical specialist at Phoebe Putney Memorial Hospital (PPMH). PPMH is a flagship teaching hospital with just under 700 beds, accredited medical residencies, and an accredited PGY-1 pharmacy residency. It is currently seeking Level II trauma center status verification from the state of GA, with three ICUs, and is ultimately home to SW GA’s designated neonatal intensive care unit (NICU).This rotation was mainly spent working in the Emergency Department (ED) at PPMH. Each day I coordinated with my preceptor to assist with order verification and consultation to the ER physicians about ordering, medication information, agent selection, PK adjustment, ABX selection/optimization, etc.I was also able to assist with microbiology culture follow-ups for patients that had come through the ED at some point and were discharged on empiric ABX. Essentially, their microbiological data would result within the hospital EMR (generally AFTER discharge around 3-5 days of the patient taking the empiric antibiotic[s]) which I then evaluated and made recommendations for optimization (e.g. 2/2 cxs identified gram-negative rods resistant to SMX/TMP, pt on day 5/7 of Bactrim) to the original prescribing physician. Also assisted with codes, trauma response, stroke alerts, general sedation (conscious or continuous), pharmacologic agent selection, and many intubations (aged neonatal to geriatric). Led a topic discussion on ACLS and the specific pharmacologic agents employed in the 4 algorithms. Also led a journal club on a trial in China that established the equivalence of Xarelto to LMWH in ACS patients that were either beyond the initial cutoff window for reperfusion therapy or were waiting for elective PCI. Delivered a final patient case presentation highlighting Sepsis Among Critically Ill Patients and overall adherence to SCCM’s 2021 SSC to Phoebe pharmacy staffMy rotation was coordinated by Dr. Kirbie Wells (Bostick), PharmD, BCPS

Five-week specialty care rotation focused on critical care and the integral role of the PharmD in the Medically Intensive Care Unit (MICU). This rotation was based in a <20-bed intensive care unit at Phoebe Putney Memorial Hospital (PPMH) in which I made evidence-based recommendations, participated in direct patient care, and developed lasting relationships with interdisciplinary team members while progressively improving the translation of clinical knowledge to practice.Each morning, I spent hours working up anywhere from one to five patients in preparation for patient presentations at “pre-rounds” with my preceptor and a PGY-1 resident. After “pre-rounds,” we would have actual MICU rounds with essentially all MICU personnel, including critical care intensivists, nurses, social workers, and pharmacists. At this point, I made my recommendations to critical care physicians for modification/optimization of pharmacotherapy and followed up with doctors when consulted or asked about anything. Learned PPMH’s order entry system and built an efficient way to put in accurate orders under the supervision of my preceptors. Documented therapeutic changes that were accepted from ICU rounds for each of my patients, and followed their progress, clinically documenting reviews of systems and treatment plans in Theradoc. Conducted and led a journal club evaluating the potential association between Dexmedetomidine (Precedex) and New-Onset Atrial Fibrillation occurrence in patients that are critically ill. Was given the chance to lead an elective topic discussion about alcohol withdrawal and its evolving identification, diagnosis, and management among patients in the ICU. Also led a final elective topic discussion on the management of Diabetic Ketoacidosis (DKA) in ICU patients with a focus on nuanced differences in practice when compared to the original 2009 ADA Guideliens for Hyperglycemic Crises Mangement.My rotation was coordinated by Dr. Anthony Hawkins, PharmD, BCCCP, FCCM

Five-week Advanced Pharmacy Practice Experience (APPE) spent at Genoa Healthcare located inside of Aspire Behavioral and Developmental Disability Services. My rotation was directly under the site manager, Dr. Amanda Black-Catrett. I spent time coordinating treatment regimens, closely packaging meds to increase compliance, and aiding in the general dispensing of specialized prescriptions catering towards medically complex patients. Encountered patients with schizophrenia, bipolar I and II, ADHD, insomnia, substance use disorders, movement disorders (TD, PID, akathisia, etc.), and other multi-factorial behavioral/mental health issues on an almost daily basis. I was able to provide medication education for a multitude of non-compliant psychiatric patients regarding different long-acting injectables (LAIs), Austedo titration, and other antipsychotic regimens. Delivered a patient case presentation highlighting clinical pearls about the importance of non-stimulant prescription medications for the treatment of ADHD in patients with concomitant stimulant use disorder(s). This presentation also had in-depth information and education about a newly FDA-approved non-stimulant indicated for ADHD, Qelbree (Viloxazine extended release)

Five-week advanced institutional pharmacy practice experience. Colquitt Regional Medical Center (CRMC) is a ~100-bed community teaching hospital that provides many different unique medical services to surrounding counties and rural SW GA. The inpatient pharmacy is decentralized, with a carousel, multiple packaging machines, a sterile room for any compounded meds needed in the hospital, and a sterile room for chemotherapy compounding, which supplies the Edward Cancer Center. Uniquely, the inpatient pharmacists (rather than BCOPs) are in charge of verifying compounded chemotherapies, so I was able to gain a lot of exposure to seeing oncological agents and therapeutics. I was able to directly see compounding for chemotherapy and I was given multiple scenarios to practice verification of a simulated chemotherapy (under the supervision of a pharmacist).During my rotation, I mostly spent time with different staff members of the hospital pharmacy, shadowing, and helping where needed. Each day, I was in charge of running medications to each of the units within the hospital. I most often ran specialized compounded chemotherapies to the Oncology center. My preceptor gave me the opportunity to work in the Colquitt County Jail, helping to coordinate the morning med pass to the current inmates. I was also able to shadow an ICU nurse, as well as a dialysis nurse, helping wherever I was needed. Helped serve as a mentor to two second-year pharmacy students on IPPE at the hospital. Also coordinated a topic discussion overviewing Anticoagulation and the use of Anticoagulants. My preceptor also allowed me to lead a second topic discussion in which we discussed antibiotics and antimicrobial coverage at great length. I gave a final presentation on Omadacycline (Nuzyra), a novel semisynthetic tetracycline that was only recently FDA-approved. My rotation was directly coordinated by Dr. Ashley Burt, PharmD, BCPS