April Lick
First Week at Redfield
Lauren and I arrived to the Community Memorial Hospital on Monday and excitedly moved our things into our “home” for the next four weeks. Our preceptor, Aly Howard, warmly greeted us with a small tour of the hospital and a welcome basket from businesses in the Redfield community. We were put into hospital rooms due to the remodeling taking place in the hospital. I was hesitant at first, but soon grew to love the convenient location and adjustable hospital bed!

I immediately felt welcome during my first day. The hospital staff seemed pretty excited for our visit from their friendly introductions. Michael O’Keefe, hospital CEO and administrator, welcomed us to CMH and briefly went over our goals and expectations during our time in Redfield. Aly then continued our tour of the hospital and drove us to a few locations around town. We ended our morning with tours of the nursing homes. One of the nursing homes had 3 separate units for complete care, assisted living, and independent apartments. I was impressed. Most of our afternoons were spent shadowing physicians in the clinic and observing their patient visits. Dr. Owens was the first physician Lauren and I had the opportunity to shadow. I thought it was interesting that he was the preceptor before Aly took on the position, and it showed in his eagerness to teach. On Wednesday, Thursday, and Friday I had the chance to follow a different physician assistant each afternoon. It was fun to compare their practice style and sit in on a few interesting patient visits.

Thursday was a busy day for us. We spent some time in the lab and set up our Meditech accounts so we would have access to inpatient medical records. This was exciting because we were then able to play a more active role in patient rounds and visits. Redfield is unique in that their pharmacy, clinic, and hospital are all located in the same building. Hugh and Cari Mack, who are the owners and practicing pharmacists at Randall Pharmacy, gave us our pharmacy tour. I thought it was cool that there was a Parata automated robotic dispensing system in the pharmacy. I hope to head back to the pharmacy in the next couple weeks to experience it more! On Thursday I was also able to experience the Sanford mobile MRI, which is an awesome service for areas like Redfield. Unfortunately, the 98-degree heat caused the generator to quit. The struggles of rural medicine are real! On Friday, Lauren and I spent the morning experiencing the busy life of a nurse and touring the South Dakota Developmental Center. I look forward to going back out to SDDC next week for a day with the psychiatrists. In our free time, we enjoyed walking and exploring the town of Redfield. One of our favorite stops was visiting the Chicago and Northwestern Railroad Depot Museum. Overall it was a great week in Redfield!

Week Two
Week 2 was a busy week at CMH! Aside from spending our afternoons in the clinic with different providers each day, we had a few new experiences this week. Providing outreach care to other facilities is one of the unique services that the doctors in Redfield provide to small clinics. Lauren and I were able to travel to Doland with Dr. Owens for an afternoon to see patients. We also spent a little time with the Redfield Home Health. On Tuesday, we sat in on foot clinics in the Home Health office, and on Wednesday we were able to travel with a couple of Home Health nurses to a few patient homes. The nurses travel as far as Doland to refill medications, provide foot care, and take vitals. I thought it was a great service for patients that aren’t able to leave their homes easily. On Thursday we helped with the anticoagulation clinic performed by the CMH pharmacist. Aly adjusted anticoagulation medications based on her patient assessment, which included vitals, symptoms, and current INR values. On Friday Lauren and I went to SDDC, where we were able to sit in on several individual care conferences with a psychiatrist, pharmacist, case manager, and the patient.

Dr. Falk was one of the new providers I was fortunate to shadow this week. He recently joined CMH from Avera St. Luke’s, where he worked in the emergency department for over 30 years. He utilized me quite a bit to check for medication interactions and suggest first line treatments for chronic conditions like hypertension and osteoporosis. It was fun to help make recommendations! Outside of the hospital, Lauren and I spent some time fishing with Dr, Owens and his family and going to the Relay for Life BeanBag tournament that Aly hosted.

Week Three
On Monday of my third week Lauren and I went to the Lakeside Assisted Living to do chart reviews with Tonee, who is one of the nurses at Lakeside. We spent our afternoon in the physical therapy department with one of the physical therapists. Neither Lauren nor I have had much experience with physical therapy, so we both thought this was pretty interesting.  On Tuesday we held a blood glucose clinic at one of the boutiques in town. Although we didn’t reach as many patients as we hoped, we enjoyed walking around the boutique and picking out treats! In the afternoon we headed the Carr Chiropractic to shadow Dr. Scott Hartung. Lauren and I were able to perform some soft-tissue instrument-assisted mobilization (the Graston technique) on a patient. Dr. Hartung explained that the technique is used to break up scar tissue and relieve pain. Many patients refer to it as “scraping.” Lauren and I were fortunate to also spend some time with Dr. Fouche from North Central Heart, who provides outreach cardiology services to Redfield on a monthly basis. We even got to sit in on a stress test! I was able to see a few telemedicine appointments this week, which I think is unique to a rural area. Patients were able to set up appointments with specialists through audio/video equipment and integrated medical devices. I thought it was awesome how the doctor was able to treat the patients through zooming in the screen and listening to heartbeats and lungs over the Internet. 

Lauren and I were able to see something exciting both nights that we were on call during our third week. The first case was seizure-related. Care flight from Aberdeen traveled to Redfield to transfer the patient to Avera Mckennan in Sioux Falls. We were able to observe the process of transporting the patient into the helicopter, which was really cool. The second ER visit was a cardiac case. After stabilizing the patient, Lauren and I were able to assist in the transfer and ride along in the ambulance to Sanford in Aberdeen. It was definitely the fastest, bumpiest ride to Aberdeen that I have ever experienced!

Week Four
Towards the end of the week Lauren and I gave our presentation of HPV cancer prevention and vaccine. Nearly all of the providers were able to come for our presentation over lunch, and most were receptive of the information. We also hung up our posters and placed handouts for more information around the clinic.

I spent Monday morning with the pharmacists at Randall Pharmacy. They let me help them with the filling process and scan out medications that were dispensed from the Parata. One of the pharmacists then brought me with him to the Eastern Star nursing home, were I was able to assist in destroying unused controlled substances, checking the emergency medication box, and doing the monthly chart reviews with him. Lauren and I were also able to stop back at SDDC this week for a med pass. We sat in the medication room with one of the med aides and enjoyed visiting with the patients when they came to receive their meds.

We spent another day with Dr. Owens this week, and we were excited that he gave us a lot more responsibility with the patients. Lauren and I were able to enter the room to assess each patient before Dr. Owens entered for the appointment. Lauren examined the patient (listening to heart and lung sounds), while I did medication reconciliation with the patient. It was a lot of fun to get some patient interaction on our own!

We did a few more activities outside of the hospital during our last couple of weeks in Redfield. Lauren and I continued to try out the different restaurants around town and loved our experience at both Leo’s Good Food and the Mexican restaurant. We also made it to both the Cottonwood and Redfield lakes to soak up some sun. There have been reports of 4-foot long water moccasin snakes around Redfield that were brought to the area with the pipeline, so we entered the lake with caution. Fortunately, we didn’t come across any snakes! We also spent some time at the Relay for Life event in Redfield. I was impressed by how many people contribute to such a good cause. The Mack family invited us to their home during one of our last nights in Redfield. The night was full of great food and company—we were very appreciative!

Words cannot describe how grateful I am for this experience. I am sure I will not get an opportunity to work so closely with this many different professions again. My time during my REHPS experience has not only increased my appreciation for other professions, but it has made me more excited about the idea of returning to a rural area to practice pharmacy. I’m excited to use what I have learned in my future interprofessional encounters and during my journey to my PharmD!