Medical Admissions Unit, Transplant Unit, and some vomit...?!?

Elise and I split up today shadowing two clinical pharmacists on the Medical Admissions Unit at Wythenshawe. The MAU is essentially the initial triage location that patients are admitted to following discharge from the ER. Wythenshawe has a goal of getting patients out of the ER in 4 hours, which is pretty impressive! I'm not sure if we have a goal like that in hospitals in the states, but I think it would be helpful if we had a measurable target that we're trying to achieve.

The MAU sees a variety of patients, typically 40-50 new patients daily.
**Side note: Wythenshawe has recently introduced a new kardex card to help facilitate a patient's medications throughout their hospital stay. For example, the front of the card has emergent orders for medications, followed by IV medications then oral medications, VTE prophylaxis, antibiotics (IVs and POs), and then finally routine medications that are needed. I really like how their is a huge push for medication reconciliations and discharges. Pharmacists obviously are responsible for these but because it is a national standard set in place by the NHS, everyone makes it a top priority which is great. It does seem easier to get a medication reconciliation accomplished here than in the states since most patients are assigned one GP and that information is usually in the patient's chart; however, I think there needs to be a bigger push on the parts of all healthcare professionals (outpatient and inpatient) to successfully complete a med rec and a discharge. In my opinion, we are setting patients up for failure when we do not perform a med rec in a timely manner and then send them home without a proper discharge. Even though patients may know what medications they may be going home on - they are often not counseled on their new medications. It seems like we all pawn our jobs off on the next person...i.e. the community pharmacist will counsel the patient on this new medication. It never hurts for the patient to hear all of that information more than once!

So while on the MAU, I was able to see one patient who recently had an MI and discuss the new medications that he was going to be placed on as well as another patient who had just had a DVT.  I also helped to complete three medication reconciliation forms. All the while this was occurring, I was starting to feel a bit lightheaded. I thought maybe I was hungry...Then I started to have some tingling sensation in my face and I just felt extremely weak. Again...thought I was just really hungry. Typically, I can fight off the hunger pain, but then I got a raging headache. The pharmacist kept asking if I was alright because I kept trying to sit down every time we came by a chair or I was slumped over. Finally it hit me. I was about to vomit. I told her that I was fine but that I needed to use the bathroom and promptly threw up. I thought the worst was over but I still felt extremely weak. Elise informed me that I looked like a ghost. I told her that we needed to go because I might puke again! I managed to make it down the stairs and after finding the break room, I guzzled a powerade. I sat for a while with my eyes closed and began to feel better. I managed to eat my sandwich and then closed by eyes a little bit longer. Another bottle of water later, I was feeling much better. Due to my miraculous recovery, I think I was still pretty dehydrated from yesterday's fiasco. Happy to report that I do not feel like puking right now!

Elise and I met with a consultant pharmacist who is one of the main individuals on the second project we've been working on. The project looks at prescribing of physicians and involves both quantitative and qualitative data about the actual errors they made during a one week period pre and post a teaching/information session and their attitudes about prescribing errors. The project is actually really interesting and is a follow-up to a HUGE study called the EQUIP study. If you'd like to take a look at the EQUIP study, the link is below:

http://www.gmc-uk.org/about/research/research_commissioned_4.asp


The last part of our day consisted of a quick tour of the cardiothoracic transplant ward and an interview with a patient who had received a single lung transplant this past December.  The patient had been re-admitted due to a chest infection but prior to the infection had been doing very well. Despite having to be on oxygen, he was such a trooper when it came to telling us his story of how he progressed to lung transplantation. He also showed us his scar. SUPER COOL. Surprisingly, it was not as big as I expected it to be and it's almost entirely located on the back. I had assumed it would be on the torso. I was extremely touched not only by his story but also by who he is as a person......so here goes my shameless plug:  EVERYONE SIGN UP TO BE AN ORGAN DONOR - YOU WON'T REGRET IT!