Written By: Joanna Lyon, PharmD, BCGP, Clinical Pharmacist and Preceptor
As part of the School of Pharmacy’s Experiential Learning Program (ELP), student pharmacists are required to work with pharmacy preceptors at various clinical locations. These rotations vary in length and complexity depending on the time at which they occur in the four-year curriculum and provide student pharmacists an opportunity to observe the profession in action and assist in daily pharmacy activities.
Occasionally though, these educational opportunities become much more significant for both the students and their patients at these learning sites. This was the case for a group of students during one introductory pharmacy practice experience (IPPE) rotation this summer.
Lending a Second Set of Eyes
As the clinical supervisor at the MedStar National Rehabilitation Hospital in Washington, D.C., and a clinical pharmacist for ELP, I had an opportunity to create a student rotation in collaboration with the hospital that allows students to work directly with patients. It was during this rotation that third-year pharmacy students Deidre Peters, Vicky Zhu, and Rebekah Tesfaye had an opportunity to make a high-level clinical intervention that had a significant health impact on a patient being discharged from the hospital.
During the course of this particular rotation, these students discovered an “absolute drug-drug contraindication” — medications that, if used together, could cause serious harm — during their discharge medication reconciliation. The absolute contraindication occurred between the patient’s HIV medication and anticoagulant (blood thinner) therapy, which was initiated right before the patient’s admission to the hospital. This interaction, which was missed on admission and not caught during the patient’s stay, would have put the patient at a significantly higher risk for bleeding and possible readmission. In addition, this patient had a history of falls, with a major fall the previous day.
Protecting Patients from Harm
The students determined that this interaction would make the patient much more likely to experience a dangerous bleeding event if he were to fall again when he left the hospital. Unfortunately, by the time the students uncovered the interaction, the patient was ready to leave the hospital. The students and I decided that it simply was not safe for this patient to leave on his current medication regimen. As a team, we asked a provider at the hospital to review the patient medications and discuss them with us, since the patient’s regular physician was unavailable.
Together, the pharmacy students and I were able to work with this physician to change the patient’s anticoagulant to another medication that was still appropriate for the patient’s condition, but no longer carried an absolute contraindication.
Showcasing the Pharmacist’s Skills
As a result of the students’ hard work and diligence, not only was the patient able to leave the hospital on a much safer medication therapy, but the hospital’s perception of pharmacists was strengthened. The MedStar corporate office even recognized these students for their commitment to the hospital’s patients and their profession with a corporate medication safety award known as the “Monday Good Catch.” This system-wide recognition further drew attention not only to these students and the quality of the pharmacy program at the School of Pharmacy, but also to the value of pharmacists on interdisciplinary teams.
As their preceptor, I was highly impressed by the professional commitment that Deidre, Vicky, and Rebekah displayed for their patient and his safety. These students and their actions on my rotation demonstrate the best of what we are committed to at the School of Pharmacy, as we strive to collaborate with health care teams to provide the very best care for all of our patients.