An Alternative Rotation Delivers An Alternative Experience
by Brice Foose, P3, SSHP President, Southern Illinois University Edwardsville School of Pharmacy
July 15, 2011
I recently completed a three week alternative IPPE rotation at Illinois CancerCare in Peoria, Illinois.
As a childhood cancer survivor, this rotation meant a lot to me. Through my past childhood experience, I found motivation to learn each and every day at the site.
Illinois CancerCare is a private practice owned by twelve physicians that specialize in hematology and oncology. Five other doctors include a non-partner oncologist, one hospitalist, and three gynecological oncologists to make a total of seventeen physicians within Illinois CancerCare. There are eleven nurse practitioners and two pharmacists that also practice at the site. My preceptor, Dr. Michele Rice, Pharm.D., BCOP, is the clinical pharmacist at the Illinois CancerCare. The unique pharmacy setting includes a retail pharmacy very close to the IV prep area.
The majority of my time was spent in the IV prep area where I checked doses and the patient’s lab values to ensure proper medication safety. Once the doses and labs were checked, I printed the labels and delivered them to the technicians in the clean room for sterile product preparation. Once the dose was prepared, I was responsible for the proper delivery to the administration area, either via tube system or manual delivery depending on the drug.
Illinois CancerCare has fifteen off-site locations dispersed throughout central Illinois. I was able to visit an off-site clinic in Ottawa, Illinois. Ottawa is one of the busiest off-site clinics of the fifteen. The day I happened to work in the Ottawa clinic was no exception. The nurses brought the orders to the pharmacy area and I proceeded to check them. After checking the orders, I spikeed the bags and delivered them to the technician in the clean room for sterile product preparation. After the IVs were made I delivered them to the nurses for administration to the patients. The treatment room was located about fifteen feet away from the pharmacy area. This allowed for easy communication between the pharmacy staff and the nurses. Throughout the day the nurses and the pharmacy staff communicated back and forth to ensure exceptional patient care.
As a second year pharmacy student at SIUE School of Pharmacy, I had not been through the oncology/hematology therapeutics course, which initially put me at a disadvantage for this rotation. However, to compensate for this disadvantage, I jumped at opportunities that came up in which I had previously obtained a wealth of knowledge through my education. One particular situation that was presented to me had to do with a patient that had undergone a Roux-en-Y procedure. The physician wanted to know if the oral medication, temozolomide (Temodar), would still be effective in treating the patient’s glioblastoma. I remembered back to a recent biopharmaceutics class in which we had talked extensively about the Roux-en-Y procedure and how it can affect the bioavailabiltiy of a drug. After reading a case report, as well as analyzing the structure and pharmacokinetic profile of temozolmide, I was confident in making a recommendation to the retail pharmacist who passed the information on to the physician. Typically in class we would talk about blood pressure or cholesterol medications used with the Roux-en-Y procedure. Making a recommendation involving a medication used to treat a brain tumor gave me a great sense of accomplishment.
Towards the end of my three weeks, I was fortunate enough to spend an unforgettable day with a nurse practitioner. I was able to sit in on several follow up visits. One particular patient had breast cancer that had metastasized to the brain and did not have a favorable outcome. Given the diagnosis, the goal for the patient was comfort rather than curing the cancer. Family members of the patient had made it very clear in the exam room that they wanted to keep fighting the cancer and did not want to even consider hospice. This conflict was handled very professionally by the nurse practitioner.
The nurse practitioner had two bone marrow biopsies scheduled for the afternoon. After my past experience of nearly passing out during a blood glucose lab in school, I realized that witnessing a bone marrow biopsy was not going to be easy. The first patient was extremely laid back and nearly fell asleep during the procedure. Although I did have to sit down at one point during the first biopsy, I was able to watch the whole process. The second patient was very nervous and at one point, it was just the patient and me in the exam room before the procedure. Trying to comfort the patient before the procedure was a task I was not used to dealing with. Luckily, I was able to talk to the patient about the first procedure I had witnessed and how well the patient tolerated it. After talking about the first procedure, the patient seemed much more relieved and this gave me a great feeling as a health care professional.
Illinois CancerCare offers a unique rotation that is a very educational and extremely interesting experience. I would recommend this rotation to any student on rotations, especially any student wanting to pursue a career in oncology pharmacy. Even if a student has no interest in oncology, this rotation offers a great refresher in the oncology topics that will be on the NAPLEX exam. I feel very privileged that I was able to complete a rotation at Illinois CancerCare and will forever remember some of my experiences I had there. ΓΆβ€"Β