HIV Ambulatory Care Objectives
30 Monday Jul 2012
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in30 Monday Jul 2012
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in30 Monday Jul 2012
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in 1) Death
2) Serious withdrawal symptoms (seizures, delirium tremens) &QOL
3) Less severe withdrawal symptoms: insomnia, anxiety, nausea/vomiting
21 Saturday Jul 2012
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inToday marked the half way point of our two week didactics sessions. It’s been kind of nice getting back in to the studious mode, but having to sit though 8 hours of lectures hasn’t been easy.
The majority of the things we learned this week were focused on pharmacokinetics principles, most of which many of us who took pharmacy 408 at ubc were very familiar with. We also spent about 2-3 hours going over statistical tools/ methods used in research, all of which I will need to spend extensive time this week reviewing considering that past 1 pm my brain would automatically go in to hibernation. Although, I was familiar with the majority of the pharmacokinetics material (amino glycosides, vancomycin, phenytoin and digoxin), it was helpful to have one last review before having to actually apply the concepts and calculations to real life scenarios/ patients. Below is a few of the points that have stood out to me at the end of the week:
Finally, we ended of this afternoon with the introduction to Evidence Based Pharmacotherapy with Dr. Tejani and Dr. McCormack. What I found intriguing during the session was that I began to critically assess my own thinking skills and the way I assess and should be assessing all things around me, aside from just evidence based literature. Although this whole week I’ve been wondering the hell there could be to talk about for 40 hours next week in regards to assessing evidence, after today, I’m actually looking forward to it!
06 Friday Jul 2012
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inToday I got a chance to complete the Med Safety Game. It was fairly straight forward. It has a few nursing questions and their roles in there as well. For example, I never knew that nurses were responsible for narcotic counts on the floor.
Overall, the questions were based on things that you see in everyday practice in the hospital and fairly easy to pick out if you think back to previous situations.
I enjoyed it!
06 Friday Jul 2012
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inMidway through residential care orientation and it’s been an interesting change up from acute care. I actually never knew that UBC hospital had such a huge residential care facility, consisting of about 200 beds. Basically they have 2-3 clinical pharmacists responsible for these 200 patients and over the week it has definitely been an eye opener to see how involved they really are in the care of the patients. From daily patient assessments, weekly med reviews with the nursing staff, all the way to yearly care conference with doctors, dieticians, OTs, physio, nursing and resident family members. When it comes to the med reviews, the pharmacist really is the person looked to for recommendations, changes in therapy and monitoring. In addition, the residents themselves have been quite interesting. You get a chance to see all sorts of characteristics, not to mention a good load of cursing!
In conducting med reviews and care plans for these residential patients this week, I didn’t expect to have to take the same kind of approach as I did for the dialysis patients. The similarity is that there really is no set standard of practice when it comes to the elderly. There is no specific routine in place for these patients to definitely be placed on particular medications after an event or to aim for specific monitoring goals/targets such as a BP/ cholesterol levels below a specific value because doing this is often unreasonable given their situation. For example, even with evidence of benefit, sometimes starting a statin in a 94 for year old, just doesn’t make sense.
One patient that has stuck out to me this week is a 92 year old female whose been experiencing continuous falls (close to 6 in the past 6-7 months). The falls seem to occur most often when the patient moves down, past her supporting rails on her bed, and then attempts to get off the bed. The problem over the past couple months is that nothing can really be connected to her falls. Although she’s on multiple sedating medications (lorazepam, trazadone, zopiclone) the patient is actually experiencing insomnia. Although she is on a beta blocker and ACEI, her BP and pulse have always been normal and controlled. The patient does however have quite moderately advanced dementia, which may be a contributing factor to her falls. Aside from these she is currently taking calcium and vit D for fracture prevention (no history of fracture so far) and is on a usual bowel protocol. Her care conference is being held next week, with the main dilemma right now being finding a connection to all these falls. Could it be that she is not falling asleep at night, getting agitated, attempting to get out of bed and falling? Would increasing her sleep medications improve her sleep at night and therefore decrease the risk of her attempting to get out of bed? Or will this further increase her risk of falls during the day secondary to increase sedation and decreased cognition?
03 Tuesday Jul 2012
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inTomorrow is the first day of my residential care rotation at UBC hospital and for the first time, in a while, I’m actually looking forward to the 99 B Line! I’m going to be spending the next two weeks at this rotation. I’m hoping to make it super productive both during my hours at work and outside of work.
Below are my residential care rotation objectives:
03 Tuesday Jul 2012
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inClinical orientation weeks have come to an end and this Canada Day long weekend has provided me with the perfect transition into my next rotation at Residential Care Facility at UBC Hospital.
Over the past two weeks, I’ve had the opportunity to gain a lot of experience assessing patient charts, electronic records, conducting patient interviews, and working with other health care professionals. It was nice to get back in to the routine of having a preceptor and conducting patient work-ups, like those during my SPEP rotation. In addition to all that, I had the opportunity to build further on my cardiology knowledge and have learned a tone of new abbreviations and diagnostic/ imaging methods. The dialysis unit was also a fantastic area to be exposed to, as I will not be having any other nephrology related rotations.
I can’t really pick out which area I favored throughout the two weeks, but I can say that both presented me with a lot of challenges. What I found most challenging in the cardiology unit was probably the complexity of the patients and the information overload that was presented in their charts. I not only found it more difficult to review charts as they were so detailed ( various diagnostic procedures, complications, imaging analysis, etc.) but, I also found more challenging to extract the right and most relevant information to present in my work- ups. In the dialysis unit however, I surprised to find that although the patients are just as, if not more, complicated than the cardiology patients, there was somewhat of a pattern in the way the patients were set up. All patients were analyzed for basically the same lab results and were only really on very selected number of medications.
Overall, I’m definitely grateful to have had a very enjoyable and educational start to my residency program throughout these two weeks!