ER Pharmacy – Lovin 8th Block!

Emergency Dept!

Emergency Dept!

I’m just starting my 3rd week on rotation in the Emergency Department (my patient care rotation), and while the ED in general is not like television depictions, it definitely is a really awesome setting to work in. It is one of the newer and growing areas for pharmacy practice, and a lot of studies show our worth at improving patient outcomes, decreasing costs, and serving as a valuable member of the healthcare team.

As the ER is a main source of hospital admissions, a part of the pharmacist’s role is similar to anywhere else in the hospital

Essentia Saint Mary's Medical Center in Duluth (so maybe I borrowed this picture from online)

Essentia Saint Mary’s Medical Center (okay so maybe I borrowed this picture from online)

—to review all orders for appropriateness of selection, dosing, administration, timing, etc. However, they are very involved in a lot of unique roles, which mainly involve working as a full-time troubleshooters and consultants to the doctors, nurses, and other clinicians on the critical care team. The goal is to improve patient care and reduce costs. They make dosing recommendations, follow-up on antibiotic recommendations, help provide toxicology information (including herbal medications, an important source of OD’s and medication interaction-related admissions), medication counseling, medication reconciliation interviewing, and much more. They are also helpful in reducing costs by avoiding wasted medication, suggesting less-expensive drugs or pointing out less expensive ways to deliver the medication.

Codes really do basically look like this - room packed full of people taking care of the patient.

Codes really do basically look like this – room packed full of people taking care of the patient.

Of course, probably the most interesting aspect IS being involved in traumas. Pharmacists are trained in advanced cardiac life support medication algorithms and are

extremely effective at accessing medications, anticipating what will be needed, communicating with the provider calling the code, pulling up doses, being aware of exactly how long it takes agents to start working, how quickly they will wear off, and thinking ahead to have the next dose ready or make recommendations. This frees the nurses and providers to focus on things that are happening bedside. Examples include Rapid Sequence Intubation (RSI), MI’s, strokes, arrhythmias, etc.

I have learned a few things I have learned about the ED in general that make complete sense but that hadn’t necessarily

Not my most flattering ID Picture

Essentia!

occurred to me before—One is- how many of the cases are psych-related, from suicide attempts to erratic behavior, intoxicated patients, threatening patients, etc. Another: The patients either have more mild problems that can be addressed and then discharged, or more major ones that get admitted to the floor—but basically, they don’t stay in the ED. That’s not surprising, but it is a different kind of patient care, in which you only see people for short periods of time, as opposed to seeing them for a few-to-many days when working in-patient, or for repeat appointments or medication-fills over long periods of time such as in ambulatory care or community/retail practice. It’s also an interesting setting in which you really do see a little bit of everything, from pediatrics to geriatrics, heart issues to infectious disease to trauma. Finally- It really is a bustling place where everyone is constantly moving in a kaleidoscope of business. I think also with the pace and lifestyle down here comes a very unique, close knit (and AWESOME) crew.

So happy to be back in this gorgeous city.

So happy to be back in this gorgeous city.

So far I am loving this rotation, even though I haven’t actually been in the ED that much yet. Starting now, I will be much more often, but I’ve had a lot of excellent opportunities arranged by my preceptors to do shadowing opportunities- I followed the IV-Team, the respiratory therapy team, a chaplain, watched a surgery (laparoscopic hysterectomy using a da Vinci surgical robot—very very cool), spend time with the OR pharmacist, shadow a nurse anesthetist, shadow the ER Care Coordinator RN and Social Worker, shadow the ER psychiatry nurse team, shadow the central pharmacy team from med distribution to IV team, etc. I also have a lot of cool independent articles to read, projects to work on, and patients to follow. From here on out, I will be working in the ER much more, and my shifts are noon-10pm to match the ED pharmacist as this is when the majority of traumas happen during the day. Hoping to really work on improving my Infectious Disease knowledge during it all.

Just another day loving life on rotations!! (SO so glad I’m not studying for exams like the rest of my fellow bloggers-may the multiple choice deities be with you all!)

Love,

BK

COPD HARLEM SHAKE!!

Click here to see the UMD CoP Harlem Shake - created partly for fun and mostly as a fundraiser for a mission trip in mexico!

Duluth CoP HARLEM SHAKE!

(In case you don’t get around to reading the below, at least watch CoPD’s Harlem Shake Video—Ridiculous and Awesome! Created both for fun and as a fundraiser for the Mission Trip to Mexico: http://www.youtube.com/watch?v=2Dwd6PbNrWY&feature=share. )

2012 edition of Movember, recognized by profs (yes, that's Dunham, and Swanoski too) and students alike!

2012 edition of Movember, recognized by profs (yes, that is Dr. Dunham in there- and Swanoski!) and students alike!!

Broomball 2

Pharmacy Broomball team wins Gold Championship vs the Med School- we were ludicrously happy, can you tell?

MAN we have fun in the “Northland”. I think one of the greatest realizations I’ve had during my 4 years (yeesh it’s gone fast) as a student at UMN is that the two campus are indeed different- not in terms of education, which is not only the same in both places but GREAT at that- but in terms of culture, and that that isn’t at all a bad thing, in fact it’s one of the college’s greatest strengths!! I absolutely adored every single thing about being on the Duluth campus, the absolute biggest reason being: the tight-knit, positive, supportive, creative, FUN culture. So many amazing things that happen as a direct result of being in setting where everyone knows everyone (we seriously do!) and we have a million events (I’ve listed just a few below) and traits that are totally campus-unique and not happening in both places:

2011 Ugly Sweater Party

2011 Ugly Sweater Party

Just a few of the AWESOME things that happen in Duluth:

Ridiculous close-knit culture creativeness, case-in-point: HARLEM SHAKE VIDEO!

Rappers at the Duluth Annual CoP Talent Show

Rappers at the Duluth Annual CoP Talent Show

Annual Talent Show (SO fun, people are amazing. Check out this original-composition all ABOUT going to Pharm School in Duluth by Taylor Hill from this January: http://www.youtube.com/watch?v=4-IydsWjX2Q&feature=youtu.be)

– Amazing whole-class bonding (on an assignment where the prof mistakenly told us we could work in any-size groups we wanted, my entire class banded together to turn in one single project- a class music video spoof of Ice, Ice Baby-A direct result of being a tight-knit culture: http://www.youtube.com/watch?v=3NUJ9qOQwz0&feature=youtu.be)

A Dean who knows all of us and cares a ridiculous amount. And that goes for the faculty too- vs in a larger campus setting.

The Commons—so much awesomeness, from resident flamingo’s to microwaves that have names… it’s always a party in there

CoP Polar Plunge Team 2013!

CoP Polar Plunge Team 2013!

Pharmacy Polar Bear Plunge (to raise $ for the Special Olympics- this year team went as waldo, last year as Party Rock, etc!)

Flannel Fridays

Any random Friday :D!

Any random Friday (every Friday is Flannel Friday) :D!

Annual Pharmacy Duluth Bonspiel

Intramurals (Duluth Pharmacy has TONS of teams, and we have a strong tradition of winning. Volleyball, soccer, curling, broomball, softball, tennis!)

PRESCRIPTION FOR DOMINATION!

PRESCRIPTION FOR DOMINATION! Awesome IM Soccer Team.

UMD PharmD Social Club (hosts tons of awesome events for everyone)

Ugly Sweater Party

– Wine and Cheese Party

– Duluth Days

– Party Bus

– PDX Pub Crawl in Superior (fun times!)

American Pharmacists Month Potlucks in the Commons (so delicious!)

UMD PharmD Event!

UMD PharmD Event!

Nights at Grandma’s, Mexico Lindo, Upbar, Dublin’s, Roscoe’s, etc

Masquerade White Coat Ball

Class Jokes (MEAT, Ain’t Nobody Got Time for That)

Class photos and t-shirts

– so so much more ridiculousness, from entering a member in the Universities Man of the Year competition , to beard-growing competitions that include the profs, to pajama days, a Men of Pharmacy Calendar, and so many other things.

Men of Pharmacy Calendar 2012

Men of Pharmacy Calendar

I can’t tell which comes first- Duluth somehow gets great people and we therefore are an amazing community to be a part of, or that the culture is so great that amazing people are attracted and/or made, but. I feel truly blessed, and for someone who had originally hoped to be on the Twin Cities campus- I can’t be more grateful that I ended up the amazing positive, supportive, friendly culture that I did.

Class of 2013-Duluth!

Class of 2013-Duluth!

As always! BK

Taking Pharmacy Passion to the Legislature! MPhA Leadership Rotation

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Cheers to Making A Difference!!

I’m currently on a leadership rotation (my 6th of 8 rotations this year) at the Minnesota Pharmacists Association. It has been wonderful!! MPhA represents all pharmacy avenues (community, hospital, MTM, industry, managed care, technicians, students etc) in one collective voice to promote and improve the profession of pharmacy and represent those concerns to the legislature. They also provide lots of great tools and resources to pharmacists, technicians, and students, including educational events, legislative updates, magazines on important issues, and fun social events like the annual Wine Tasting & Gourmet Dinner, which I was lucky enough to get to attend!!

With my Preceptors, Michelle Aytay and Julie Johnson at the MPhF Wine Tasting and Gourmet Dinner Event!

I feel like I completely lucked out on timing, getting to be here while legislation is in session has provided me with a lot of really unique opportunities to see the capitol in motion, learn a lot about current policy topics (an interest area of mine!), and see how MPhA and other pharmacy organizations are involved in protecting and advancing our profession. Here are just a few of the really awesome things I have gotten to do so far:

  • Tour the Minnesota Captiol building (Wow, it is beautiful! Super fun field trip!).

    MN Capitol Building! I have really enjoyed attending sessions there.

     

  • Attend a number of committee legislative sessions at the capitol, mostly on health and human services topics.
  • Develop the agenda and issue briefs for Legislative Day (Feb 19th) and discuss these with the UMN Students. Though we don’t have any bills in the senate, there are many awesome topics this year, including:
    • Pharmacy Practice Act changes: Speaking to our legislators about how the profession has changed, and recognizing pharmacists as patient care providers rather than medication dispensers.
    • Compounding: Reviewing the difference between compounding and manufacturing, where the boundaries are in MN pharmacy practice, the importance of this relative to the NECC meningitis outbreak, and any change the MN Board of Pharmacy is planning to make to language.
    • Biosimilars: Rreviewing what they are- essentially generic versions of biologic drugs, none are the market yet, but they are being presented to the FDA for testing and may hit the market soon, and issues to consider for future legislation regarding pharmacy substitution practices.MPhA!
    • Pseudoephedrine Reporting: Reviewing the pros and cons of the NPLEx system, an online reporting system with multiple states participating so  that purchases can be tracked nationally.
    • Board of Pharmacy updates: Including changes in language for immunizing, electronic prescription records, and the prescription monitoring program.
    • Help and enjoy the MPhF Wine Tasting event!
    • Attend and serve on MPhA Board meetings, team meetings, steering committees, etc, as well as attend a Board of Pharmacy Meeting
    • Weigh in with the awesome MPhA/Ewald staff on pharmacy topics ranging from developing the magazine to communication items!

Really looking forward to the Annual Meeting!

I’d like to say an extra big thank you to my preceptor Julie Johnson, my adopted preceptors- Michelle Aytay and Jacquie Jaskowiak, I am learning so much from you and  really enjoying working with you! Thank you also to the entire MPhA staff who are making me feel super welcome – I am so honored that they seek out and take my advice!!

Cheers from a very happy PD4-

Love, BK (as always, feel free to contact me! brittany.karns@gmail.com)

Allons-y!!

 

PS- Have been sucked into the Doctor Who reboot fan club. In case any of you are too, keep calm and don’t blink! 🙂 If you can message me what that’s in reference to -extra props.

Duluth Campus Rocks: Pharmacy Bonspiel

Duluth Pharmacy Bonspiel!

Duluth Pharmacy Bonspiel!

Everyone on Duluth campus knows that one (of many, many) of the most amazing campus-unique events of the year is the Duluth Pharmacy Bonspiel. It consists of about a hundred pharmacy students, pharmacists, family, and friends, getting together to curl at the Superior Curling Club. While probably about 90% of the crowd has never curled before or perhaps 1-2 times before (there are lessons and lots of

Greece!

PD1’s representing Greece!

support from everyone for newbies!), we also have a number of regular curlers and enjoy hosting some national caliber pharmacy curlers as well. The event consists of an initial game Friday evening along with dinner, music, and socializing. Then a full day of games on Saturday, consisting of two games of 4 ends for each team, 8 teams on the ice at a time, four rounds of teams per game. Again with a lot of amazing food, some great music, a lot of card and dice games, and raffle prizes. The 6-8 teams with the highest scores at the end of the three games compete in the championships for the big win (this year won by Team Vatican: PD2 Tony Olson (pope), PD2 Sean Navin (cardinal), PD3 Jared Van Hooser (priest) and PD1 Mark Nola (monk).

France, sweeping their stone into place!!

 

But the best part of the whole bonspiel? Everyone comes in costume!! Past themes have included the olympics, barnyard animals, and entertainment– This year? League of Nations!! We had many phenomenal countries represented (Merica, multiple Canada’s, Greece, France, Japan, Norway, Ireland, Scotland, the Galactic Empire, the Vatican, Mexico, and Germany to name just a few). M y team came as the league of nations, “preventing world wars since 1919” ( a little bit of dark humor)! Here are some pictures– Everyone is already excited for next year. Duluth campus knows how to have a good time!!

The Pope from Team Vatican!!

The Pope from Team Vatican!!

PD3

PD3 love

Team Mexico

Team Mexico

Team Canada wasn't afraid to get cold!

Team Canada wasn’t afraid to get cold!

League of Nations vs France

League of Nations vs France

Team 'Merica!

Team ‘Merica!

Even though our PD4 class is spread far and wide this year on rotations, we take every opportunity to get together and reunite. Class 2013D!!!!!!

Even though our PD4 class is spread far and wide this year on rotations, we take every opportunity to get together and reunite. Class 2013D!!!!!!

Scottland

Team Scotland, complete with home-made bagpipes!

Winning Team

Team Vatican receiving their trophy’s!

Canada

Another of the Team Canada’s

 

Wir Warren In Deutschland – Germany APPE, Truly the Trip of a Lifetime!

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I present to you: The Wolfsrudel (AKA Adam and the Amsterdam Seven). L-R: Emily Kranz, Neil Bland, Adam Shiell, Allison Scott, Brittany Karns, Steph Hacker, Ryan Galloway, Sarah Nagl. Germany APPE Class of 2012- the best one there ever was!

Adler Apotheke – Jochen Pfeiffer’s Pharmacy in Velbert, DE

There is literally not enough good I can say about this trip and no way to summarize it in one blog post. Or even many. I am so incredibly lucky to have gone and to have gone with such an incredible group of my friends. As Herr Foerster (Nic), one of the Adler Apotheke German professors is in Minneapolis this week to attend the German & American Healthcare Conference and members of each of the past classes of the Germany APPE are trying to meet with him, it seems like an appropriate time to write about my experience there. (This got a bit long winded, definitely check out the pics even if you can’t read all of it.)

THE TRIP OF A LIFETIME? YES!. Absolutely every single one of us came back saying so. 1000% worth the extra cost (many of us took out extra loans—and all agree it was totally worth it!).

WHERE WE WENT:

View of Berlin from the Reichstag Dome.

ON rotation hours: Velbert, Dusseldorf, Kӧln (Cologne), Wuppertal, Essen, Berlin (with phenomenal personal tours from our preceptors including the Brandenburg Gate, Checkpoint Charlie, the Reichstag, the 1936 Munich Olympics Stadium, the Fan Mile, Alexanderplatz, and so many of Berlin’s other sights), Potsdam, Hamburg, and others! Our home-base was Velbert, a smaller city between Dusseldorf and Cologne where Josh owns his pharmacy, the Adler Apotheke. We stayed at an amazing hotel (the Bürgestube) where the staff truly made us their friends and family and fed us more amazing food than we could ever possibly eat!

OFF rotation hours: We made gooood use of travel time! Amsterdam (Netherlands, Munich, Dachau, Salzburg (Austria), Rhein River Valley, Cologne, Dresden, Prague (Czech Republic), Copenhagen (Denmark), and we all traveled for a week after the end of our rotation, some in London, some in

View over Prague (Praha)!

Venice and Paris, some in Spain! We traveled quite a lot on-rotation, and even more with three-day weekends! Wish I could have stayed all summer!

It was heart-breaking to try to pair the photos I included down from the 5,000+ that we took on our trip. Feel free to flip through any of ours on Facebook to see more!! You better believe we came back with soooo many stories!! (What goes out the window in Munich stays in Munich…)

WHAT WE DID:

Das Pharmacists. On our way to Parliament.

Yes, we really did work amid all of that traveling and fun! The focus of our trip was two parts- the main one being learning about the German and American healthcare systems, focusing on best practice elements of both and considering them in the context of the cultures in which they were developed. The second part consisted of advocating for clinical pharmacy services, something we all are

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Our meeting with the presidents of the Bundesvereinigung Deutscher Apothekerverbände (ABDA), the Federal Pharmacy Board, and the Bundesverband der Pharmaziestudierenden (BPhD), the Student Pharmacy Organization.

taught and understand the value of from our curriculum and seeing pharmacy in practice here, but which is very new to Germany- traditionally pharmacy has been solely retail and industry focused- clinical pharmacy has only been recently added to the standard pharmacy school curriculum and MTM and hospital/clinical practice are not common (yet). We went to many many meetings during our visit, including meeting with presidents of the regional and national pharmacy organizations, regional and national medical associations, insurance groups, wholesalers, the Joint Commission (some similarities to the FDA), members of parliament, visited community pharmacies (including a Turkish one), two hospitals, a middle/high school (gymnasium), the pharmacy technicians association, and others! In each of these places we learned extensively about how the organizations are structured and operate  how they are a part of or govern the distribution of healthcare finances in the country, and how they work with pharmacists. We were officially received by the city’s political officials and got to sign the city’s guest book. We also visited three different colleges of pharmacy at which we discussed the differences

Presenting in a German College of Pharmacy

in our education systems and presented patient cases (various topics from hypertension to cystic fibrosis) to compare differences in solving them and differences in national guidelines. We also got to spend some time IN Adler Apotheke learning about how the pharmacy runs day-to-day, the differing roles of pharmacists and techs, the differences between chain and independent in each country, got to practice compounding and – one of the highlights – learned about herbal teas and got to make our own blends! We traveled on oh-so-many trains and buses to attend all of our meetings, it was a grueling (but fabulous!!) schedule.

WHAT WE LEARNED:

The Reichstag: Parliament Building of Germany in Berlin. One of the most interesting and beautiful buildings I’ve visited. Personalized tour of the interior and visiting the dome were highlights of the trip.

SO many things. I’m skipping the majority of the academic content (the health care system itself) and going for some of the other main take-home messages of the trip.  I was very impacted by seeing a culture that has been operating with what we might call a ‘socialized’ medical system for decades and see their reaction to America’s resistance to such a system. I will certainly carry this with me. I learned a lot about the struggles that all systems have – Germany’s is so different from ours, operates at a much lower cost and operates well, but has its own battles on the health care and political levels, just as ours does. I also learned a lot about the change process- I was reminded just how slow and long it takes to create true, lasting change. On that note though, it was also pleasant to see some very positive reactions to our visits and our advocacy for clinical pharmacy services and using pharmacists on the healthcare team and in the hospitals. It was also amazing to see how well our preceptors networked and carefully work to maintain their professional relationships.

We learned much about the differences between our pharmacy education and theirs – our education is so clinically focused, whereas theirs is currently comprised of mostly natural science and chemistry classes with a large industry component. Clinical pharmacy has just been added within the last few years and is only one class somewhere in your last didactic year with the option to take an additional elective course in it.

In front of the incredible Kölnerdom (Cologne Cathedral)- We got an amazing tour from professor Nic!

It gave me a heightened appreciation for the PharmD program and the opportunities to work clinically and operate in a highly cognitive career. However it also gave me new respect for the amount of knowledge I lack on subjects like herbal medicine (they learn extensive botany, including the active ingredients and mechanisms of a many, many plants, how to extract them and from what part of the plant, what region the plant must be from, what season harvested in, etc) and my utter lack of knowledge of industry (typical German students have over 20 hours of lab a week). This also illustrates a cultural difference which includes a large amount of historical plant and herbal tea use in Germany and reemphasized just how much pharmaceutical industry there is in such a small country (roughly the size of Minnesota!). Learning about the German pharmacy education system and meeting a few students from other countries also made me realize how many differences (and similarities!) there likely are between all nations who teach and practice pharmacy. I also realized how weak some of my chemistry skills have grown, topics in which our German

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Visiting the Lenin Wall in Prague, a famous graffiti wall born under Communist rule.

counterparts are completely proficient. I also made many contacts with German students at the universities we visited and hope to keep in some form of contact.

We also learned much about German culture and its people. We received an overwhelming amount of hospitality and kindness from absolutely everyone we met with and we learned a lot about how Germany’s culture has been shaped by its history. It was really only unified in the late 1800’s (1871- it’s a younger country than ours, even!), before having been composed of disparate Germanic Tribes. The central government system established in that time by Chancellor Otto von Bismarck was given to us as a huge explanation for the differences between German and US attitudes towards government funded health care today, as Germans have been accustomed to such provision for well over a century. We also got a feel for the impact that WWII had on German people including Hitlers rule and how slow things have been to recover and heal after. We were told that German Pride has really only resurged since 2006- before this people did not feel they could openly hang flags, cheer for their nation, or be proud of their people such as at sporting events- truly astounding that it has taken so long for such recovery. We also got quite a taste of communism- we saw firsthand communist-built communities and Checkpoint Charlie and got a feel for life in Eastern Germany under that rule, as well as how tricky but (it seems) successful the re-unification of Germany has been. While much of this is just of interest (I’m a slight bit of a history geek- but only a slight bit), much of it was genuinely important because it taught us just how much a

Overlooking Salzburg

healthcare system (as well as political and other) is impacted by the culture in which it is developed. This is taught us an important lesson- you cannot transplant one system into another place and culture. Even if  I thought the German system was the absolute best system that could ever be developed and America should adopt it- a straight transplant wouldn’t work because our cultures are too different, even though there are many similarities. Germany has been shaped by some very powerful historical events, just as every country is, and this goes on to shape how healthcare and governing are instituted and practiced. We might be able to borrow and integrate elements of their system that seem ideal if we wanted and change aspects of our system, but even these will

Socializing in the Biergarten with pharmacy students from the University of Bonn!

have to be done in such a way that they fit America and the American people, and vice versa. The mission of our rotation was

to examine both systems and pick the best practice elements of both, and while the lesson of how culturally developed healthcare and politics is sounds basic, it is extremely important and was very powerfully made on our trip. This is something that I will remember as I continue to watch the changes our system is attempting and developing my opinions and giving input.

We learned so, so much more- I could write about 5 more pages. Overall, it was *truly* the experience and trip of a life time.

We got to travel so much but also to interact and experience events that would never come from just travelling on your own as a tourist. Perhaps one of the greatest lessons that I will carry forward and share with others is the very fact that

Compounding in Adler Apotheke with Frau Zimmerman

it took going there to understand. Not that I fully understand their system and culture or ever could as a non-German, but I certainly could never have learned it staying here on American soil, or not even ¼ as well. And perhaps it also took going there and experiencing to realize that you can’t just learn that while staying here. I am so very grateful that this APPE was offered and that I got to attend- The preceptors were unbelievably knowledgeable and involved with us, we traveled and experienced things I will never have the opportunity to access again, we got to advocate for and learn about pharmacy, and I can only wish I got to do it again next year.

WHY TAKE INTERNATIONAL PHARMACY EXPERIENCES?:

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We took an amazing cruise down the Rhine River- saw a dozen or more castles and beautiful wine country!

During this time of change in American healthcare, it is more important than ever to look at other systems and consider their high and low points and the cultural context in which they operate to continue making wise decisions for ourselves. Completely separate from overt study of pharmacy or healthcare, though, international experiences, from traveling abroad to getting to know visitors who come to the US, are extremely important just to learn about people. Learning about other cultures, other philosophies, and other ways of thinking that remind us of our own context and how we fit into the world. They also expand our viewpoints and our understanding of, patience for, and interest in working with others. But perhaps most importantly, they help us to realize that all people are essentially the same. We all have common interests like health and happiness. The more international experiences you have the more you have the opportunity to know about the world and other people and the more open-minded you become and able to understand other people. The more such opportunities I have the more I realize I want to have! I hope to travel much and work with international guests often in my future, and completely recommend such experiences (and especially this APPE!) to others.

If you’ve made it this far, I thank you for reading! The only last thing I have to say is that Nic and Josh are AMAZING teachers, we are so lucky to have had their undivided attention for five weeks, and also that I could not have traveled with a better group of people. LOVE YOU, WOLFSRUDEL! Wolf-family for LIFE.
WOLFSRUDEL, VEREINEN!!!!!!!!!!!!!!

Cheers and tschu-uuusss,

BK

We spent a little time learning the BEERS list criteria in Berlin

The Wolfsrudel in Salzburg
Learning and sorting herbal teas
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Showing off our true selves…

4th Year Is Awesome… Except I Miss My Classmates!

ImageAmongst the many FABULOUS parts of being a 4th year there are actually a few sad parts, the main one being (in addition to writing the onerous PharmD IV Paper) not seeing my pharmacy family every day. We grew so very close over the past three years. First Year you meet everyone, get to know each other, get some class jokes going, make some good friends. Then Second Year you all live breath and sleep school together, you see everyone at their most sleep deprived, crabby, lowest stages (my classmates have seen me looking my absolute worst!) and suddenly– you become more than a close class, you become family. Finally you emerge  into Third Year where you find you have become old-souls and are sImagetuck toughing out the oh-my-word-why-is-there-still-so-much-school-left classes together. You and your peers take on leadership roles and accomplish amazing things, power through a boat load of assignments, and commiserate about classes together. In addition to this, I got to know and be close with so very many upperclassmen who have since left for their 4th years and graduated, as well as underclassmen who I now get to see oh-so-infrequently, not to mention the amazing faculty. I truly think I know almost every person in the classes above and below me and in the classes above and below those. I made some of the best and closest friendships of my life, and I miss all of these people!

This is one of the things I truly value most about having attended the Duluth Campus- the smaller class size and opportunity to know absolutely everyone in my class, and know them well. The Duluth College really has an amazing, fun, supportive, active, leadership-oriented close-knit culture, one that I am proud to have been shaped by and to have contributed to. This is not remotely a knock against attending the Twin Cities campus, because I know they have the same thing, but happening in subsets of the class. But the beauty, to me, of having been part of my smaller knew-everyone class is comparative to my experiences having been on sports teams and in orchestras-  There is really something important and amazing about being a part of one, unified group in which you all know each other and work together well. It is something that I have and will continue to very highly value, and something that I’ve heard most people in Duluth comment on. It amazes me how many students say, “I wanted to go to TC but now that I’m here I’m SO happy I got Duluth!” – This describes my own experience as well. And I find that students I’ve met from other, similarly sized colleges or disciplines say the same thing about the perceived value of small class size. On the other hand, you still also absolutely get to be  a part of the larger UMN CoP Culture and enjoy being part of a large school with an amazing program. So to me, it has been the best of both worlds!

Then, poof – Fourth Year comes and you’re on rotations and it’s exciting and you learn a ton… except you almost only ever see one or two family members at the same time! Tho to be fair, part of this awesomeness is because the Class of 2013D is probably the greatest class the CoP has ever seen in all of time…. I mean, what other class has made a class music video ;)!? And perfect opportunities come up to use all those inside class jokes but no one who understands is around (MEAT, extreme throat clearing, akathesia, splash zone, and tchuss, to name just a bare few!). So basically, this post is just a shout-out to all of my classmates, upper and lower, Duluth and TC and extra-especially the most-epic 2013D- I MISS YOU ALL! We have so far made good use of professional meetings and classmates events to get larger groups of us together, including the MSHP Midyear Meeting (some 20-30 of us were there, and about 14 of us were able to make it to dinner together after), College Board-sponsored Duluth Days, the APhA-ASP Midyear Meeting in Fargo, and different classmates weddings.Image I am very much looking forward to many more events to get back together with my classmates and the many underclassmen I miss, including PDX initiation in Duluth, MPhA Pharmacy Nights,  ASHP Midyear Meeting in Vegas, the Bonspiel in Duluth, the CoP Talent Show in Duluth, the APhA Annual Meeting in Los Angeles, the Pub Crawl in Duluth, and hopefully many many more!

MUCH LOVE! BK

Dear Kidneys, Thanks For Making Urine!

My Solid Organ Transplant rotation ended last week, and I’m really sad to leave it behind. It took me a while to get into the swing of how hospital works and understanding the transplant schedule. The more I work on transplant, the more grateful I am that all of my organs work, and I have started wanting to take very good care of them!! Time for an overview of being a 4th year student on the SOT and at Fairview, I think!

7:15-8:15: Look up your patients and write down all of their over-night lab values and medication changes. I was assigned 4-6 patients to follow at a time (the pharmacist, of course, manages to track all 20+ while I handled this amount).

7:30-9:30: Starting anywhere in that range, the organ transplant teams start rounding. At Fairview they are broken up into 3 smaller teams, Kidney, Liver, and Pancrease+Auto Islet Cells. Each rounding team consists of 1 surgical fellow, 1 NP or PA, the pharmacist, the social worker, sometimes the nutritionist, and any students. While other floors have regularly scheduled rounds (ex: Cystic Fibrosis floor rounds at 9am), these teams round whenever the fellow comes up to the floor and has a chance- they just swing past the pharmacy desk (located in the work room along with the SOT team members) and say, “Kidney is rounding!”. On rounds the team discusses each patient on their service, looking at recent lab values, any changes over night, determining therapy for the coming day (Ex: for a new transplant patient, what should the days cellcept, prednisone, thymoglobulin, and valgancyclovir doses be and is the patient ready to start a CNI? Which CNI?). They then go in the room and chat with the patient, find out how they are doing, if they have any concerns, and do a short physical assessment of breathing and the surgical sight (or other if they are not a new transplant patient). The pharmacist pushes a computer cart during rounds and is able to answer any questions about current or past medication use by the patient, and has access lab values especially infectious disease cultures and sensitivity data, and uses this opportunity to make therapeutic recommendations for initiation/discontinuation, as well as be tied in to understanding the treatment plan for the day. From my observations, the pharmacist was of especial utility to the team in recommending appropriate antibiotic therapy and noticing potential interactions in the proposed antibiotic plan. Each team has only about 2-6 patients on it’s service so rounds are not too long, but as pharmacy attends all the teams (as possible), they can be on rounds for some time.

End of rounds-12: Students have time to dig more deeply into each of the patients they were assigned. I got to read notes back through the entire visit as well as prior admissions, look at all electrolyte trends, analyze immunosupression trough levels, vancomycin trough levels, warfarin and heparin levels, check up on the medication plan for the day and if it followed the protocols, look for drug interactions, etc. I had a wonderful amount of time to do some independent study on things I have forgotten or never knew (Up To Date is such a nice resource!). I tried to also research any conditions in the PMH that I was unfamiliar with and get to know my patients as well as possible- The pharmacist told me, “These are your patients. You have to take responsibility for them.”

12:00-1:00: All Fairview APPE Students attend lunch lecture. Some weeks lectures are provided by Fairview pharmacy faculty members on topics from Hospital Aquired Pneumonia to Diabetic Ketoacidosis, other weeks they are student prepared case presentations. I am one of about 15 students currently at Fairview, and we each take turns presenting a patient of ours to eachother, which means we get a review of a number of topics as well as get to hear about the many services we are each on in the hospital, form ICU to oncology and BMT! I presented a SOT patient last block who had Post Transplant Lymphoproliferative Disorder.

1:00-2:00ish: You have a short time to come back and check up on your pateints one last time to see if anything new has happened – perhaps new ABX cultures have come back or new immunosupression trough levels. Review your patients and be ready to present.

2:00-Leave: Around 2/2:30 the pharmacist would spend time with me. I presented my findings on my patients  with a background if they were new, or just updates if they were not. It took me a while to get the hang of this, but instead of pointing out problems I found, I was asked to present my solutions to the problems I found, including a plan for how to adjust immunosuppresion doses, change blood pressure meds, etc, as well as an assessment of what medication changes had already been made by the providers, why they had changed, and if they seemed appropriate (indicated, appropriate, dosed appropriate and corrected for renal function, etc). Then we would also discuss my “homework” – topics that I was assigned the day before to look-up overnight. I would give a description of what I had found out and the pharmacist spent some time teaching me more on the topic including filling in details I had missed. Everything from IV iron therapies to different antibioitic coverages. Also during these discussions we often found new holes in my knowledge that I was then assigned for the coming evening. At the very end of it all, the pharmacist brought any concerns she had to the PA/NP team members, sometimes having me do so.

On this rotation I also had assigned textbook and article readings, a project to develop index cards on immunosupression drugs and protocols, and helped conduct medication histories. I learned and got to practice managing patient TPN (total parenteral nutrition, aka IV nutrition), adjusting immunosuppression, adjusting vancomycin and aminoglycosides, managing warfarin and heparin, and practicing my knowledge of antibiotic coverage.

While it took me a few weeks to hit my stride (and goodness knows I could have used at least a few more weeks to really get better), I ended up LOVING my time in the SOT. A fascinating patient population. It was amazing to see people who improved dramatically after their transplant, although also an opportunity to see and care for some very very sick people. You never heard so much talk about bowel function and urine in your life! Both of the Fairview transplant pharmacists were wonderful and I learned a lot from them. I still try to bump into them from time to time!!

At the end of 5 weeks of talking about peoples kidneys making urine, I just have to thank mine a little bit and I suggest next time you grumble that you have to get up to pee that you say the same: Dear Kidneys, thanks for making urine!!

BK

APPE: Solid Organ Transplant

Now officially 2.5 weeks into my first Acute Care Block working at UMMC (UMN Medical Center) Fairview Hospital on the East Bank. I’m on Unit 6D- Solid Organ Transplant (The S.O.T.). We see kidney, liver, and pancrease transplant patients. Going into hospital with essentially no hospital experience (worked at a Native Alaskan IHS Clinic for the past many years) has been a huge learning curve! Working on this floor is great- I’m learning a ton about transplant meds, obviously, but also about renal failure and disease states associated with renal failure, about liver failure and disease states associated with liver failure, as well as hemostasis, infecious disease, fluid balance, and so much more. It is a bit worrying how much I have forgotten since I left the classroom, but I’m getting it back in a hurry! I want to hit more on what being a pharm student at Fairview looks like, but for now  I better go read some things and get my homework done!

Cheers and much love! Always feel free to email me with questions-
BK

“Be kind, for everyone you meet is fighting a hard battle.” – Ian Maclaren

BK, Reporting for Duty!

Hey, I’m BK – for Brittany Karns, also known as Bradykinin, BK Value Meal, BK Stacker, BK Coups, B-Kizzle, BK Minaj, Brittania, and many other names that have been conferred on  me by my class over the past three years.

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I’m currently a 4th year on rotations, so that’s the majority of the perspective I’ll be brining to the blog. I’m also from out-of-state (Fairbanks, Alaska), attended the Duluth campus, was and am involved in a number of organizations including MPSA, College Board, UMD PharmD, GAPSA, and PDX, took the Leading Change in Pharmacy courses, am working on a Leadership Emphasis, and went on the Germany APPE trip, SO, I’m more than happy always to answer any questions on any of these topics! brittany.karns@gmail.com

AND, below is an awesome photo of the super cool 1st years in my and Joe Lahti’s group at the Orientation in Sandstone a few weekends back – thanks for a great time, I’m so excited for you guys! Saddest part about 4th year? Not getting to see my classmates (aka family), super cool underclassmen friends, and meet the newbies!

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Happy to be here! More coming soon!

CAN’T WAIT FOR DULUTH DAYS TOMORROW!!!

BK