Week 1 at Chamberlain

On Sunday, I arrived at Mindy’s around 5:30pm and spent the evening with her family.  Mindy and Tony have 3 boys, and they are all full of energy.  Their house is right across the street from the river, so we walked down to the river’s edge in the evening.  I also found out they have two pets, a cat and a salamander.  I even petted the salamander.

On Monday, I arrived at the hospital at 9:30am and met Dotty Hieb and Jess Neilan.  Then, Jess took Sara and I on a tour around the Sanford facility.  We met many new people along the way.  I found myself thinking that the Sanford facility is very large and updated for a town the size of Chamberlain.  After our tour of the facility, Jess took us on a tour of the town.  There are so many places I want to visit and activities I want to do while I’m here.  Being on the river, Chamberlain has so much to offer to its guests.  After the tour of the town, we had lunch with Cheri at Al’s Oasis, a western-themed restaurant/gift shop across the bridge in Oacoma.  The food was delicious and I would like to go back to the gift shop to look around more on another day.  After our lunch, we had a conference with Dotty about our time here, and then we were free to go for the afternoon.  Sara and I went to the River City Fitness Center to work out, and then in the evening we took a walk together through Chamberlain and out to the marina and campground area where we hope to spend some beach time.  On our way back, we had ice cream at the McDonald’s in town.

On Tuesday, I watched cardiac stress tests being done in the hospital.  There were two types; one test used exercise, and one test used a LexiScan (regadenoson) to simulate exercise.  Regadenoson is administered IV and is often used in older patients who are unable to reach their target heart rate via exercise.  After the tests, I visited with the nurse practitioner about what she looks for when reading the stress tests.  Then, I followed a nurse around to patient rooms where she completed medication reconciliations and short interviews with the patients.  Around 2:00pm, Sara and I met up at an employee’s retirement party in the cafeteria, and then after that I was able to shadow Dr. Stys (cardiologist).  This was my favorite part of the day.  I saw him conduct two appointments with patients, and Dr. Stys and I visited about medications.  I learned which beta blocker to use for certain cardiac disorders.  To end my day at the hospital, I visited with a woman in administration about her role in the facility.  She enters medical records and doctors’ notes, types birth certificates, etc., to ensure that information flows smoothly through the chain of staff in order to most efficiently help the patient.  I went for a run that afternoon, and then in the evening, the Donovans took Sara and me out on the river with their boat.  It was a great time!  I am from the Mobridge area, which is close to the river, but I had hardly ever been on the river before, so this was lots of fun.

On Wednesday, Sara and I met with the financial consultant for the hospital at 8:30am.  She did a presentation about her role in the hospital.  It’s great that she is there to help people obtain financial assistance with programs such as Medicare and Medicaid.  After we listened to her presentation, we went on the new employee bus tour.  We were driven around to towns in the area- Kimball, Gann Valley, Fort Thompson, Lower Brule, Reliance, and Oacoma.  While we were driving, Jessica, the respiratory therapist, gave us a background on the town’s history and facts such as population, average income, and other unique aspects.  When we stopped in Kimball, we witnessed Governor Dennis Daugaard cutting the ribbon to symbolize the opening of the new clinic there.  I am glad a small town like Kimball is able to have such a new healthcare facility.  We ate lunch at the casino in Fort Thompson, and we learned much about Native American culture when we were visiting this town, as well as Lower Brule, Oacoma, and Chamberlain.  When we got back to Chamberlain, we stopped to tour the museum at St. Joe school.  There, I gained much knowledge about the Lakota culture.  It is good to be able to understand their background and ways of life, as much of our population in South Dakota is Native American.  That night, Sara’s cousins were playing on a co-ed softball team, and I offered to play.  It was great to play softball again, since it’s my favorite sport and I hadn’t played in about three years.

On Thursday, I worked at Lewis Drug on Main Street in Chamberlain.  At first, it was overwhelming to be in a new pharmacy, but I was surprised how quickly I got the hang of things.  Jim Bregal, the pharmacist in charge there, is a great pharmacist to work with.  He was there to answer my questions and help me when I needed him.  I filled prescriptions, counted inventory, filled medication cards for nursing home patients, and learned the basics of using their computer system.  I was surprised how easy their computer system is to use, as the computer system at our pharmacy in Mobridge is quite old and difficult to use.  The pharmacists in Mobridge are thinking of updating, so I will suggest this computer system.  I was also impressed with the workflow at Lewis Drug.  The technicians there are responsible for entering the prescriptions and the pharmacists are responsible for checking the work of the technicians and counseling patients.  This is different from my pharmacy, because the pharmacists enter the prescriptions into the computer and don’t spend as much time counseling.  When I visited with Jim, I was interested in his encounters with patients.  They have many questions about medications and insurance, and I think I would enjoy helping these patients like Jim does.  I could definitely see myself working at a pharmacy like this one, and I look forward to spending another day at this pharmacy next week. 

On Friday, Sara and I attended nursing huddles at 9am.  This is where the nurses talk about the patients in the hospital that they will be tending to throughout the day.  After the huddle, we shadowed Dr. Santos while he was doing his vascular clinic.  I really enjoyed this part of the day.  We saw a lot of swelling, varicose veins, and foot sores, but I learned much from watching Dr. Santos examine and treat these patients.  I was able to ask him quite a few questions, some which pertained to pharmacy.  After lunch, I went up to the hospital pharmacy to shadow there.  The pharmacist and I talked about IV dosing and entering orders and we also filled medication orders for patients.  I was also able to watch nurses administer anesthesia to prepare a patient for intubation, and I handed them the medications the pharmacy had filled for the patient.  All in all, this was a very interesting, informative day.

On the weekend, my parents visited and I was able to see more of Chamberlain, such as the South Dakota Hall of Fame.  I also enjoyed seeing all of the river activity around this town.  Chamberlain seems like a nice getaway for river lovers.

Week 2
7/20/15- On Monday, I came to the hospital at 8am to observe surgery.  I was able to watch a surgery in which a 21-year-old’s gallbladder was removed.  This was an amazing experience for me.  I was able to see the patient before surgery, during surgery, and after surgery when the patient was in recovery.  Throughout the surgery, the nurse anesthetist, Garrett, explained which drugs he was administering and why he was administering them.  I would ask him questions throughout, and I feel like I learned a lot from him.  At first I was leery about watching the surgery, but once it began, I became interested in what the surgeon was doing and quickly forgot my fear.  The surgery was conducted by making a few small incisions around the belly button so it was minimally invasive.  The TV monitor showed what was happening inside the patient’s body.  After the procedure, I met up with an obstetrics nurse and watched her monitor a woman in labor.  I wasn’t able to see the baby being born, but it was interesting to learn about the monitoring of contractions and drugs given to the patient.  Then, I shadowed JerriAnn, the pharmacy manager at the hospital, for the rest of the day.  She let me check the work of the technician filling prescriptions, which I enjoyed doing.  I was also able to go to several care conferences with JerriAnn, the physical therapist, and the social worker.  These are weekly conferences with patients in the hospital about the patient’s present and future well-being.

7/21/15- On Tuesday, I worked at Lewis Drug in the morning.  I met Cynthia, another pharmacist there.  Besides filling prescriptions, I was able to watch the pharmacists, Drew and Cynthia, counsel patients.  This was helpful to me because I want to improve in this area.  I also watched Cynthia demonstrate how to use a diabetic meter, lancets, and test strips.  Then, in the afternoon, I met Jim Bregal at the assisted living center in town where he conducts monthly drug reviews.  There, he inspected patient charts for new and changed medication orders.  He wrote comments about the patients’ medication therapy when needed.  It was great to see another type of pharmacy practice.  I think I would like to work in a rural area similar to this one because the pharmacists are able to practice multiple types of pharmacy.  In the evening, Sara and I attended a hospital advisory board meeting.  This is a quarterly meeting where the Board discusses issues the hospital and surrounding area are facing.  Officer elections were also conducted at this meeting. 

7/22/15- On Wednesday, Sara and I watched a Coumadin clinic in the morning.  We observed INR testing and counseling of three patients.  I enjoyed this because it applies to my field of pharmacy.  I will need to be able to recommend a new dosage regimen for the patient if the INR reading is too high or low.  After the clinic, I visited with Nikki at the hospital admissions desk about the work she does.  It is interesting to follow the path of the patient’s chart through the healthcare system.  Then, Sara and I met with a social worker that deals with dialysis patients at this facility once a month.  It was sad to hear about the patients’ situations and how dialysis affects a person’s whole life plan.  Next, we were given a tour of St. Joseph’s Indian School.  I learned so much about how the school is run, and I think it’s wonderful that there is a safe place for Native American children to attend school.  Many of the children come from unfortunate family situations, and the school helps them to get back on track with life.  After we toured the school, we returned to the hospital for lunch and listened in on a meeting for the local EMTs and Paramedics, which was conducted by nurse Deb Hamilton.  I learned a great deal of information about emergency medical services at this meeting.  I am so grateful to be gaining so much knowledge on this REHPS experience, and I know this internship will benefit me in my future career as a pharmacist.

7/23/15- On Thursday, Sara and I interviewed Deb Johnson, the Superintendent of Chamberlain High School, for our community project.  Then, I was able to view a colonoscopy done by Dr. Tucker.  During the surgery, two polyps were found and biopsied.  The patient also had an abnormally high amount of arterial venous malformations (AVMs), which put the patient at risk for bleeding.  Afterwards, I watched Dr. Tucker complete the documentation of the colonoscopy, and this helped me understand the findings better.  Next, Sara and I listened to the psychologist for this area, Dr. Weimers, talk about her work in this area of South Dakota.  She is on call for patients 24/7, and sometimes the workload becomes a bit overwhelming.  I was able to ask her about when she feels prescribing medications for patients is necessary and which medications she typically sees prescribed for certain mental conditions.  This visit was very interesting to me, as I do not have a background in psychology.  In the afternoon, we watched the work of physical therapists.  I also enjoyed this because we were able to see patients make progress throughout the session.  In the evening, Sara and I helped decorate and set up tables in the Community Center for Relay for Life, which will happen tomorrow.

7/24/15- On Friday, Sara and I shadowed the health coach, Jess Roskens.  She saw two patients, both which came in seeking advice on losing weight.  She first listened to the patient’s background story, and then she tried to identify the source of the problem.  Then, she counseled both patients on how to count calories and advised them to use a diet journal to write down their weekly intake before the next appointment.  Both were referred to a dietician.  I was interested in this information on healthy eating because it is applicable in my life too.  I hope we are able to shadow some appointments with the dietician.  For the remainder of today, I shadowed Dr. Pena, a family medicine doctor, in the clinic.  Knowing my background in pharmacy, he tried to teach me about the reasons for choosing certain medications.  I really enjoyed my time with him and felt like I learned a lot.  At 4pm, I went downtown to help set up Relay for Life.  After helping outside and in the kitchen, I listened to the speaker and watched some of the other activities.  It is awesome to see a community come together for a great cause.

7/25/15- On Saturday, a friend of mine visited from Yankton and we enjoyed some of the other activities the area has to offer.  We went to the beach at American Creek campground and also kayaked there.  I had never kayaked before, so this was a new, fun experience.  Later that evening, we went to Pukwana to watch the lawn mower races.  I never thought lawn mowers could go that fast! 

Week 3

7/27/15- On Monday, we didn’t start our schedule as planned.  We found out we had to complete some HIPAA training for our trip to Fort Thompson IHS later in the day, so we began our day by watching a video about HIPAA.  After the video, we went to the clinic to help with a photo shoot for the hospital.  A family with three kids volunteered to have their pictures taken for a health system brochure.  Sara and I helped by assisting the parents while they completed the necessary paperwork and entertaining the kids while the photographer worked her magic.  It was fun to watch a photographer work with the kids and providers to take some nice pictures.  In the afternoon, we drove to IHS with Jerri Ann, the hospital pharmacist at Sanford.  When we got there, pharmacists explained how this IHS pharmacy is different than a normal retail pharmacy.  This pharmacy combines both retail and clinical aspects by giving the pharmacist access to a patient’s medical chart.  So if the pharmacist were to dispense a new prescription for a diabetic medication, she or he would first look at the patient’s A1C reading, among other lab results, to make sure the medication is right for the patient.  I think this would be an enjoyable career because I like the environment and pace of a retail pharmacy, but I like using my clinical knowledge as a pharmacist does in a hospital setting.  Erica, a pharmacist at IHS, also talked to us about the many benefits of joining the Public Health Services.  I learned a lot I didn’t know about IHS, and I’m glad we made the trip.

7/28/15- On Tuesday, Sara and I helped with Camp Fuel.  This is a two day camp for kids that teaches them about healthy habits, such as healthy foods and exercise.  In the morning, I helped in the gym by teaching the kids a couple games to play there.  I think they had fun playing them.  Then, we taught the kids some facts about foods by using the fit.webmd.com website.  For lunch, I helped serve chicken tacos to the kids, and then in the afternoon, we all rode a bus to Kimball to tour the popcorn ball factory there.  This was my favorite part because it was neat to learn about how the factory produces the popcorn balls and how the factory was started.  The business has been running for six years and it continues to grow.  At the end of the tour, we all received free popcorn balls.  When we got back to the Community Center, I helped clean up the facility.

7/29/15- On Wednesday, we began our day by shadowing at the Coumadin Clinic again.  We saw a patient with an INR outside the normal range, so the nurse and pharmacist adjusted the patient’s dose accordingly.  Since there weren’t any more patients scheduled until 10:00am, we then worked on our presentation for a bit.  After we saw another patient at 10:00am, we went to the radiology department and shadowed a radiologist.  We saw him interpret X-rays, an ultrasound, and CT Scans.  One patient had two suspicious spots on a mammogram, so the radiologist examined an ultrasound of the breast tissue and determined them to be benign cysts.  This was good news for the patient.  We also saw the radiologist look at a CT scan and X-ray of a patient’s lungs.  Infiltrates showed on both scans, so he dictated that the patient may have an infectious disease such as pneumonia or tuberculosis.  In the afternoon, I went to a meet-and-greet meeting for a new orthopedic doctor at the facility.  Then, Sara and I sat in on a Core QMI meeting.  This is a meeting where the head of each department is present to view and discuss the month’s statistics for the hospital.  If a department needs work in a particular area, the group discusses the issue and decides on a plan of action.  Then in the evening, Sara and I helped with a family care conference at the nursing home.  All family members of nursing home patients are invited to these meetings to discuss any issues they might have about their member’s care.  I helped by playing piano music for them before the meeting, and then Sara and I both helped serve barbecues for the meal.  Later that evening, Sara and I enjoyed playing softball on a co-ed team in town.

7/30/15- On Thursday, I worked at Lewis Drug.  I helped fill some prescriptions, cleaned the spouts on the ScriptPro machine, and then I spent the rest of the day filling pill cards for nursing home and assisted living patients.  I think I learn the most when I watch pharmacists counsel patients, and I was able to see a couple counsels by pharmacists.  Although I wish I could have learned more today, I did feel like I contributed to the pharmacy, and that is a good feeling.  I do enjoy working at this pharmacy.

7/31/15- On Friday, we were able to watch a C-Section in the morning.  This was an amazing experience.  It was so neat to see the whole process, from the patient sitting down, getting the spinal medication, being cut open and having the baby removed, to being sewn up and then taken to a recovery room.  I talked to the nurse anesthetist about the drugs he was using to numb the patient and block pain.  The surgeon was meticulous in his actions and the whole process was fascinating to watch.  The patient gave birth to a healthy baby girl with a full head of hair, weighing in at 7 pounds, 9 ounces.  I watched the nurses perform an after-birth checkup on the baby to be sure she was healthy.  Once mom and baby were happy, Sara and I left.  After lunch, we interviewed Mike Tyrell at St. Joseph Indian School for our community project.  Then, I shadowed Cassi, a hospital pharmacist, for the rest of the afternoon.  We found a drug interaction between methenamine and Bactrim DS, so we visited with the doctor about this.  The doctor decided to discontinue methenamine and only use Bactrim DS to treat an infection.  I also watched Cassi perform a monthly inspection of medications in the dialysis unit and review patient charts for the nursing home.  On Friday evening, Sara and I took tickets at the bull bash in Kimball for Desperado Days.  We were able to watch quite a bit of bull riding and kids’ mutton busting too, so we had a good time.

8/1/15- On Saturday evening, I went back to Desperado Days with Amanda, the physical therapy intern, in the evening for the Dustin Evans dance.  It was fun to get to know her well and meet some more new people.

Week 4

8/3/15- On Monday, I shadowed Dr. Pena in the clinic.  One patient had fallen off a bike and fractured her left thumb, so I watched him remove a wrap from the patient’s arm and then re-bandage the wound.  I also saw him examine a patient with a variety of symptoms- neck pain, body aches, sweats, and excessive tiredness.  He determined she probably had a virus.  Another patient presented with abdominal/flank pain and her blood work showed liver and urinary tract issues.  This was rare, as a patient usually does not present with both.  Dr. Pena had her admitted to the hospital on the assumption that she probably would need to have her gallbladder removed and also receive antibiotics for a urinary tract infection.  I enjoyed shadowing Dr. Pena today because I learn a lot about medicine when I’m with him.  I am interested in pharmacy, so he also discusses reasons for choosing certain medications.  Among other appointments, I was also able to see Beau, a physician’s assistant, perform a sports physical.

8/4/15- On Tuesday, we started our day observing nursing huddles.  There were some interesting patients- one with cellulitis, one with severe ascites, one with a possible UTI and in need of gallbladder removal, and one with hallucinations and a raised heart rate and blood pressure.  After this meeting, we went to a Lake Francis Case Development meeting at Upper Crust Pizza.  This was interesting, as the board members talked about new businesses coming to town as well as the progress of businesses previously started.  I learned about the success of a new dentist in town as well as the progress of projects such as building a lighthouse and dinosaur park in Chamberlain.  Then, we returned to the hospital and I shadowed Cassi in the pharmacy upstairs.  I visited with her about the possibility of the patient experiencing hallucinations having serotonin syndrome as a reaction to drugs taken.  We also reviewed other patients’ charts and discussed their drug therapy.  We dosed vancomycin for the patient with cellulitis.  Later that day, Sara and I went to the movie Inside Out with the Donovan family. 

8/5/15- On Wednesday, Sara and I interviewed Greg Powell for our community sector interview for our project.  Then, we watched some patients at the Coumadin clinic.  Next, we went to a resident council meeting at the care center.  This is where nursing home patients on the council are able to discuss any problems or concerns they are having with the facility.  Events are also planned at these meetings.  It was interesting to see some residents come together to plan their outings.  At the end of the meeting, I played piano for the residents while they sang a couple hymns.  In the afternoon, Sara and I attended a department manager leadership meeting, in which the department managers informed others about what is happening in their departments as well as their personal lives.  After this meeting, Sara and I went up to the laboratory department to tour there.  Marsha, the department manager, informed us about the different tests performed in the lab.  I thought this was very interesting, as pharmacists have to interpret lab results for patients in order to determine correct medication therapy.  That evening, Sara and I played in a co-ed softball tournament.  Our team won two games and lost two games.  We played late into the night and didn’t get back to the Donovan house until after 1:00am.

8/6/15- On Thursday, I worked at Lewis Drug in the morning.  I filled prescriptions and listened in on some patient counseling.  I also saw a prescription for metronidazole suspension that was compounded in the pharmacy.  At noon, I met Sara and Mindy for an Olli meeting at the Community Center.  Mindy (dietician) informed the group about healthy eating habits such as how to read food labels and substitute healthy ingredients in cooking.  I really enjoyed this session, because I am interested in cooking with natural, healthy ingredients.  After this meeting, Sara and I toured the Home Health building in town.  I am happy Home Health is available for patients so they are able to live in their homes comfortably as long as possible.  That evening, Sara, Mindy, and I went out to supper at The Back 40 in Kimball with Dr. Tucker (surgeon) and Dr. Pena (family medicine).  This outdoor restaurant struck me as a hidden South Dakota treasure.

8/7/15- On Friday, Sara and I went to nursing huddles at 9am, and then we worked on our presentation until 11am, when we presented it.  I thought our presentation went well, and I am really thankful for the whole REHPS experience.  I learned so much about the whole healthcare system in a rural community, and I believe this will help me to be a competent pharmacist in my future career.  I enjoyed learning so much each day and I’m thankful to all the people who helped me along the way.