Week 1 at Miller
On Monday morning I arrived in Miller excited to return to my hometown for four weeks but unsure of what to expect. My partner Raychel and I met with some of the hospital staff for an introductory breakfast. I saw many familiar faces and some new ones as well, which was a common theme throughout the week. I spent the rest of the morning with Jody, an RN at the hospital. She gave me a tour of the hospital and attached assisted living facility, which had been completely remodeled since I left for my freshman year of college at SDSU. The hospital facility is modern and almost homey. We had some excitement when a patient came into the ER. Watching the interaction between staff members themselves and the medical staff on the telemedicine monitor was an interesting experience. What an awesome resource for the staff! The telemedicine is great because in a rural setting there are many issues providers rarely encounter, and the telemedicine staff provides additional guidance in these areas. That afternoon I went to Rexall Drug. Last June I completed my 3 week Introductory Pharmacy Practice Experience (a three week job shadow for school) at Rexall so it was nice to go back and see the patients and staff. Travis is very welcoming to students, and Rexall is a great place to gain retail pharmacy experience. Business is steady at Rexall, but Travis and his staff always have time to answer my questions and teach me about retail pharmacy when I am there.
Jody and I spent most of Tuesday together in the hospital. She has a wonderful rapport with her patients, and her concern for patients shows. She cared for several outpatients and a couple inpatients that day. One patient with a port came in that morning, and I was fascinated to see an actual port since we had just learned about them during the last month of classes. Raychel and I also attended a medical staff meeting over the lunch hour. The staff discussed many topics, and they even spoke about the change to value based medicine (another topic I recently learned about in school). Witnessing things I have learned about in class in a clinical setting really provides a fun, well-rounded experience.
Wednesday was a big day in Miller. We started out watching colonoscopies. Now this may not sound entertaining, but as a healthcare student I found the procedures interesting. Dr. Werth from Aberdeen travels an hour and a half to Miller monthly to perform procedures, which is convenient for patients in Miller. Dr. Werth was very helpful and explained each procedure and answered any questions we had. After the procedures were over, Cheri came and took us to lunch. It was nice to hear about the other facilities and talk more about our expectations for the REHPS program. After lunch Raychel and I accompanied Jody on an at home transition of care visit for a patient who had been discharged from the hospital the day before. The hospital visits homes of patients who have disease states with a high risk of readmission (congestive heart failure, chronic obstructive pulmonary disorder, myocardial infarction, or pneumonia). Jody spoke with the patient to ensure the discharge medication instructions were clear. Jody even called Travis at Rexall to clarify some instructions for the patient. Jody took the patient’s vital signs and educated the patient about ways to reduce symptoms like diet and exercise. The program’s goal is to reduce readmissions, and it seems like a great way to ensure patients are comfortable with and knowledgeable about their disease states.
Thursday morning the mammogram truck came to the hospital. Rebecca the technician allowed me to spend some time with her and watch a few mammograms. As with all of the individuals I have shadowed this week, Rebecca was great with her patients. She told me about her job and answered a few questions I asked her. The busy morning continued when I went to the radiology department to watch a couple CT scans and a wrist xray. I was also able to watch a DEXA scan, which is used to identify osteoporosis (another topic I learned about this past semester!) That afternoon I spent some time in the hospital’s small pharmacy redoing their inventory list to help make their inventory process run more smoothly. Raychel and I worked out in the gym after we finished for the day. After we were finished we were told there was another ER visit so we went to observe. Raychel is going to graduate as a PA soon so she was even able to examine the patient!
Friday morning I worked with Noelle, one of the physical therapists. She saw three patients with varied needs while I was there. Noelle was a lot of fun to work with. She had her patients doing exercises I had never seen, but after watching the exercises I can see how beneficial they are to patients. I returned to Rexall for the afternoon.
This week presented me with many experiences I would never encounter during my pharmacy education. I am excited to see what next week brings!
This week had some variety as I spent time both at the hospital and at the pharmacy each day. While at the pharmacy, I spent most of my time working on Medication Therapy Management (MTM) cases. This project is right up my alley! Insurance companies periodically request pharmacies to complete comprehensive reviews of specific patients’ medical conditions and medications to ensure patients are receiving proper care. These sessions are another opportunity for pharmacists to verify each medication a patient is taking has a purpose and to identify possible interactions and if a patient is taking duplicate or unnecessary medications. The pharmacist speaks with the patient or a caregiver to complete the assessment before making any recommendations. I really enjoy completing these reviews and speaking with patients. MTMs are a great learning opportunity because they allow me to apply my classroom knowledge to a real situation and to ask Travis questions about these cases.
Respiratory therapists (RTs) Kim and Marissa invited me to visit their department a couple times this week. I observed a WebX consultation between a sleep specialist and a patient. Kim showed a patient how to use a new CPAP machine. The RTs also showed BiPAP and cough assist machines this week. This was another wonderful experience I would not have gained through my schooling.
I also spent a morning with the physical therapist Amber. I observed an initial visit after a total knee replacement, and then I observed a different patient’s final visit after a total knee replacement. Seeing the difference between an initial visit and a 26th visit really showed how much of a difference physical therapy makes for a patient. The patient on the final visit told me that sticking to therapy really helps patients get back on track. I learned that therapy for total knee replacements does not stop at the patient’s last visit with the physical therapist. Patients must continue their exercises for about a year before the knee feels like it is actually part of them.
Raychel and I traveled to Aberdeen for a training session. We met with students from four other sites to learn about our project. It was nice to hear about the other sites. After we returned to Miller we both went to the pharmacy to work on one of the medication therapy management sessions.
We’re already over half way done in Miller! The past three weeks have come and gone quickly. During week three, I spent quite a bit of time at the hospital pharmacy. I completed the update to the inventory spreadsheet. I also began going through each medication a second time to check expiration dates. I made sure each medication’s expiration was recorded in the pharmacy’s outdate book. Each month staff members check that month’s list and remove medications that are expiring. Raychel was able to help me out with this project a couple times, which was really nice!
The hospital’s lab technicians spent a morning showing me their responsibilities. I had no idea what to expect when I walked into lab. I had not realized there would be so many machines in the lab. Nicole showed me each machine, including those that test chemistry panels, thyroid stimulating hormone, cardiac markers, urine, etc. She also explained they complete quality control tests on each of the machines at least daily. The checks and maintenance requirements seemed overwhelming to me, but the ladies in the lab handle all their requirements in stride.
The Avera SIMS truck stopped in Miller while I was at the hospital. They only come once a year so I felt pretty lucky to be here at this time! I observed nurses Rita and Bev while they went through a simulation with a SIM man. A SIM man is an excellent learning/review tool. The SIM man is a lifelike mannequin controlled by an observer who can adjust the mannequin’s stats and talk to the participants. The nurses knew just what to do with the “patient”!
I lucked out again one afternoon when I ran into RT Marissa and asked her if she had anything exciting going on that day. She was heading to a pulmonary function test at that very moment! This test checks a person’s lung capacity and helps diagnose asthma and COPD. The patient passed with flying colors!
One more week to go!
Our final week was filled with new opportunities. Raychel and I watched a movie at the drive in theater. We completed our REHPS public health project. I observed a patient exercising in the cardiac rehab program to improve endurance. Dr. Bormes allowed us to observe cataract surgeries. I spent another afternoon in lab. We gave our final presentation to a group of hospital staff and Cheri. It was nice to review our activities of the past few weeks.
Jody invited us on another at home transition of care visit. I really enjoy home visits, and this visit was even better because I was able to reconcile the patient’s medications. I compared the doctor’s discharge medication instructions with the medications the patient is currently taking to make sure everything is correct and the patient is taking the medications correctly. Respiratory therapist Kim invited us to go on a home visit to a Hutterite colony. I also watched a follow up appointment with a sleep specialist.
This week there were more ER visits. We observed the flight team come in to the facility to transport a patient. Miller’s airport is under construction so patients are transported by helicopter or via ambulance to Huron for a fixed wing flight to Sioux Falls.
On Friday, I spent some time in the morning with radiology. Following my time with Lisa and Heather, orthopedic specialist Dr. Sanchez allowed me to observe his appointments. He read the xrays I had observed Lisa and Heather take. He met with several patients, mostly dealing with pain.
On our final afternoon, we visited the Millerdale Hutterite colony. I grew up in Miller, but I had only been to the colony a couple times. Our guide was very nice. She showed us the dining hall, kitchen, church, laundry facilities, and even her own home. Learning about the Hutterite culture was interesting. About 140 people live in Millerdale, and most go to Miller for their healthcare.
Throughout this opportunity, I have really appreciated the kindness of the staff members. It was so nice to feel welcome during my time back in Miller. Everyone I worked with was wonderful and very informative. They were more than willing to explain their careers and answer my questions so I would have a better understanding of their responsibilities. The REHPS program in Miller has provided numerous opportunities I would never have seen during my pharmacy education or my career. I have been impressed by the quality and breadth of care the rural healthcare system in Miller provides to patients. I would definitely recommend other health professional students participate in this program!