Kaylie Gabur
Week 1 at Redfield

MONDAY
-Toured the hospital and clinic
-Drove around town with Aly (our coordinator)
-Met with the CEO and Director of Nursing
-Met providers, nurses, and other staff
-Shadowed Aly during a Coumadin clinic. She sees patients and checks their INR levels then changes their Coumadin dose accordingly if needed. It is a very efficient and beneficial clinic for both the patients and the providers. Aly created a provider agreement with all the providers and got their permission to adjust Coumadin doses without having to ask the provider first. This saves time for the providers and patients and is also a financial gain for the hospital.
-Shadowed Andi, PAC in clinic.

TUESDAY
-Spent time in Randall pharmacy, which is connected to the hospital. This was a smaller retail pharmacy than one I had ever been in. It was interesting to see how the workflow was different compared to a larger chain pharmacy in a larger community.
-Clinic with Andi – saw a patient with appendicitis and watched the PA put an IV in.
-On call for the night and got called in for a patient who had a seizure and had fell and hit his head. The patient was stable so the PA took blood levels of the anti-seizure medications the patient was on and changed the dose of the drug based on the levels.
-Admitted a patient who was having left arm pain and checked some labs to make sure she wasn’t having a heart attack

WEDNESDAY
-Clinic with Lynn, PAC
-Went in with the PA student into a room to examine a patient with ear pain. PA diagnosed patient with otitis media and we chose an antibiotic to give the patient
-Went with Lynn to the ER to evaluate a child who fell and split her chin open to determine if she needed stiches. The PA decided she didn’t need stitches and glued her wound shut
-Went to a nursing home with Lynn and did patient evaluations and med changes if they were needed. I was very impressed with the level of care that Lynn provided to her patients. She spent time with each resident and helped with getting them up out of bed and repositioning. It is evident that she truly cares about her patients. This is an advantage of a rural community – the providers are taking care of patients who are their friends and family and they make sure to go the extra mile to deliver superior care.

THURSDAY
-Toured SDCC with Carol and Melissa (PA and pharmacist). Very interesting to see the entire SDCC campus!
-Went with the home health nurses in the afternoon to visit some of their patients at homes. Nurses did assessments on the patients and also organized their meds. This was another time where I could see that the nurses truly cared about their patients. Each patient was very happy to see the nurses and it is evident that the patients are like family to the nurses.
-Observed the dietician counseling a patient on healthy eating. Very interesting to see how this works and made me appreciate the services a dietician can offer. I now know that referring patients (especially those requiring special diets such as diabetes or hypertension patients) to the dietician is very beneficial. The dietician can give a much better explanation of proper eating and design an individualized plan for each patient.   

Week 2

TUESDAY
-Sat in on the SDCC quarterly conference with the PA, behavioral therapist, RN, and pharmacist. Reviewed patient charts and discussed any behavioral, weight, or medication issues. Was a very interesting meeting to sit in on! Got me thinking more about psych meds and how they are used. Also interesting to see how the staff keeps track of behavior issues and how the team approaches these issues

-Spent time with Dr Owens in clinic. He was very good about letting me off the leash. Even though it is not something I have ever done, he encouraged me to go in and talk to patients and see how things are going and ask them about their meds. I felt that I got better at this as the day went on and more comfortable talking to patients. He was very good at teaching while he treated and always included me when appropriate.  Got called into the ER with Mary for a patient who had pneumonia. This patient was allergic to a lot of antibiotics so it was very educational to observe how the clinicians worked together to decide which antibiotic to use. Also had a patient who had a very severe bloody nose.

WEDNESDAY
Amber and I rounded on patients in the hospital that morning – neat experience! Went to the local nursing home with Dr Owens. He had to return to the hospital to transfer a patient to another hospital so Amber and I got to go visit with a nursing home resident who used to be a physician. He was very sharp and educational, a real treat to talk to!

THURSDAY
-Training in Aberdeen. Went to storybook land J

FRIDAY
-Sat in at SDCC for psych consults. These included patients, physiatrist, behavioral therapists, case managers, PAs, the pharmacist, and myself. These were VERY interesting. I have not had psych experience prior to this and I can honestly say I learned a lot in this little time. The pharmacist (Melissa) gave us copies of the med list so we could follow along during the consultation. She has been very helpful about answering questions and making our experience at SDCC very educational. She answers all my questions and always explains the meds to me and how they fit into clinical practice. In the afternoon we returned to clinic with Heidi. She is an excellent preceptor. Very open to answering questions and let Amber and I talk to patients on our own before she came in. We saw a patient with a large scab on the right foot and Heidi let Amber remove it. We also saw an infant with pink eye and a patient who had kidney stones. Heidi is very welcoming to her patients and it is evident that they trust her and enjoy having her as their provider.

Week 3
Week three was off to a busy start with me heading to SDDC Monday morning to go around with the med aid to pass meds to the patients. It was very interesting to see how that process works and to be able to interact with the patients! SDDC in general has been an eye-opening experience for me. It is a very different environment compared to any that I have been in and the patients are also very unique. Melissa, the pharmacist, was excellent in teaching me the medications the patients are on and how the whole team approaches the care of the patients out there.

Tuesday I rounded with a nurse in the morning at the hospital to see all the tasks that they perform. It’s important to realize how valuable the nurses and the tasks they do are. They have the most contact of any health care professional with the patients and are a valuable part of the team! Clinic was also busy with physicals, otitis media, and an ER visit with a patient who fell on her hip. Ron also let me go in and talk to a patient about medications for management of allergies. Spencer, one of the Pharm D’s took me to the nursing home to show me how he does monthly med reconciles. Aly, another Pharm D and I discussed an interesting patient case to try to discover any potential medications that could be leading to a patient’s deteriorating liver function.

Amber and I went to speak with Adam Hansen, the Chief Financial Officer for the city for our community project and really enjoyed being able to see the courthouse and talking to Adam about the Redfield community.

Each week Lynn (PA) goes to Doland for clinic hours. I went with her on Thursday and discovered this is rural medicine, even compared to Redfield! The clinic in Doland is just plain cute. It reminds me of a traditional clinic where medicine all started. Even though it’s located in a very small town, Lynn still stays busy with patients and it is evident that the patients truly appreciate her services! She is a very impressive provider and very dedicated to quality patient care.

Friday was filled with more clinic time and another home health visit. That afternoon I took off early so I could attend the golf tournament that is a fundraiser for the hospital. I golfed with two PA’s from the clinic (Andi and Heidi), one of the clinic nurses and Heidi’s sister. It was a blast and fun to be able to participate! That’s a wrap for week 3!

Week 4
I cannot believe my time in Redfield is already up! Week four was filled with more great experiences in clinic and in the community! I went to the pool one day after clinic to spend time outside and even though I was the oldest person there it was still relaxing. On Wednesday Amber and I got to watch colonoscopies and that was quite the experience. It was fascinating to see which drugs were used for the light sedation and how they reversed the sedation when the procedure was over. Wednesday we also had a lunch and presentation with Cheri and various people from the sites that we were at during our time in Redfield. It was fun to talk about our experiences and I was happy to see so many familiar faces come to the presentation.

Thursday afternoon I was with Dr. Owens and we got to attend to a couple emergency room patients, including a young female with a leg injury. I learned how to pick out a fracture on an X-ray (even though this fracture was rather obvious!) We sat in on some telemedicine conferences and continued to follow an interesting case of liver failure in one of our inpatients. Dr. Owens was very good about letting me go into the exam rooms to talk to patients during clinic before he came in – for a minute I felt like I was a med student J

Thursday night we went to a local joint to have pizza with Dr.Owens, Aly, Mary and Spenser. It was fun to visit and hear some of Dr.Owens’ medical school stories! After that Amber and I went to Mary’s house to sit on the porch and enjoy the evening. Mary was really great about taking us under her wing and spending time getting to know us.

Friday morning I went to SDDC again for psych consults. I really enjoy sitting in on these and seeing the different medications that the psychiatrist chooses and the changes that he makes to the med list depending on different factors. Melissa was so welcoming and excited to have a student and was an excellent teacher and resource for me while I was at SDDC. The rest of Friday I went to clinic again with Heidi and Amber. We were spoiled with a pot luck taco bar for lunch and it was a great way to end my time in Redfield. I truly had a very rewarding and educational experience and feel that I have learned so much. I am grateful for this amazing opportunity to not only learn but meet the health care professionals that I did. After this experience I can definitely see myself in a rural area practicing pharmacy. One of the most valuable things I learned was to get out there and give yourself a shot. Some of the positions weren’t even open when these people started working at the clinic/hospital but they had the courage to reach out and it got them to where they are now. Aly was an excellent mentor for us and is an inspiration. She goes above and beyond what is expected of her and can light up a room with her intelligence and blissful demeanor. I am so glad for the experience I had and for all the opportunities Aly and everyone else created for us while in Redfield!