Internship
Voyage at KIMS Hospital, Trivandrum: A Metamorphosing Experience
Abin
Chandrakumar
Pharm.D
Intern, Al Shifa College of Pharmacy
Every
Pharm.D student has to undergo 12 months of mandatory internship, which
involves rotational postings in speciality units, so as to acquire skills
necessary to ensure functionalindependency. Despite having the facility of a
750 bedded super speciality hospital, we the Pharm.D interns of Al Shifa
College of Pharmacy, were allowed to opt any hospital within India for 3 month
internship, provided it had an efficiently functioning Clinical Pharmacy
department. The institution I opted was KIMS Hospital Trivandrum, the premium
healthcare facility in my hometown of Thiruvananthapuram. I joined the
institution on October 1 2015 to embark on a 3 month clinical voyage. The
institution had 4 actively functioning clinical pharmacists with Ms. Pretty G
Tharakan as the in-charge. Ms.Tharkan, an M.Pharm (Pharmacy Practice) graduate,
could be accounted as one of the pioneer clinical pharmacists in the town, with
more than 7 years of clinical experience. She is actively assisted byMs. Anu
Albert (M.Pharm), Dr. Bittu Thomas (Pharm.D) and Dr. Teena Jacob (Pharm.D).
Although the department is not independent of the in-patient pharmacy, they
have operational independence, and efficiently carry forth a wide array of
significant clinical services for the institution. Their activities primarily
involved, but not limited to, clinical auditing, ADR monitoring and narcotic
auditing. Each clinical pharmacist is to audit all the files in individually
assigned floors on a daily basis and need to cover a minimum of 40 files per
day. Each file is evaluated to identify the appropriateness of therapy with
respect to dose, dosage form, indications, contraindications, drug-drug
interactions, drug-food interactions, i.v incompatibility, drug dilutions,
intending errors and recommended maximum dose. Any error that is identified
during this process is rectified in-situ and later entered into the online
incident reporting form. The serious interactions are also noted in the same
manner and immediately notified to the corresponding physician over the
telephone, thereby providing them with vital pharmacokinetic and
pharmacodynamic inputs to ascertain optimum therapeutic care. Interventions on
drug-food interactions not only comprise of taken food, but also covers
drug-feed interaction in the intensive care settings. The pharmacist make
amendments in the medication chart detailing the time gap to be followed
between nasogastric feed and administration of drugs such as phenytoin.
Contraindications to drugs are identified using detailed review of medical and
medication history of the patient so as to ensure that the patient is not
placed at a risk greater than the risk associated with his current pathology.
Clinical
pharmacist is involved in each and every phase of narcotic management ranging
from narcotic purchase to post-administrative documentation audit. The
narcotics medication orders are made in separate prescriptions and brought to
the clinical pharmacists, where, the prescription is verified with the online
intending made by the nurse. Prior to issue of the prescribed number of
ampoules, calculation is performed to ensure coverage over intended therapeutic
duration. The process involves narcotics purchase, dispensing, stock
management, dilution supervision, physical and computerized stock management,
cross-conformation with physicians and medical file audit to ensure that each
and every dispensed ampoule is used over the prescribed duration.
Drug
information services are an indispensable part of the clinical pharmacy
services as over twenty major and several minor query are addressed per day. To
cater for the ever increasing number of queries, the ward rounds are adjusted
in such a way that, at least one clinical pharmacist will be present in the
department to address queries from 8am to 6pm. The queries from the physicians
mainly involve those regarding appropriate dosing frequencies of novel drugs
and generic comparisons. The queries from nursing staff is more challenging
with questions ranging from vaccination regimen to reconstituted solution
storage conditions. Therefore, the clinical pharmacists have prepared a chart
comprising of details on dilution and storage conditions of all such drugs
available in the pharmacy, so as to provide prompt responses.
Although
this experience log could just qualify as a summary, the responsibilities of
clinical pharmacists at KIMS hospitals are ever-evolving due to confrontations
with newer and more demanding tasks every other day. The internship period at
KIMS hospital was a metamorphosing experience for me, as I was exposed to a
wide variety of on-field situations under practicing clinical pharmacists.
Under the lights of this experience, I feel that institutions having Pharm.D
students in internship year should ensure that they are getting a different
exposure in hospital than the past 5 academic years. Since internship period of
12 months is mandatory as per the curriculum, I feel that institutions without
practicing clinical pharmacists should permit their students to undergo entire
12 months of internships in institutions with practicing clinical pharmacists
such as Apollo, Fortis, KIMS etc. The method of internship training should be
more similar to B.Pharm training period, wherein the students are allowed to
choose from a list of institutions. Prudent thoughts can make us realize that
institutions without clinical pharmacists may just have not much to offer to
intern students, as their activities may just be limited to submission of
written assignments than in-situ experience, which is the real necessity in
this post-academic year. I sincerely hope that this article may encourage more
students to identify appropriate institutions and embark on similar internship
opportunities to complete their evolution from a +2 graduate to an efficient
clinical pharmacist.
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