2018 REHPS Holly Polack

Final Reflection:

I am so grateful that I had this opportunity to come work, learn, and live in Platte for four weeks. The people I met were so welcoming and so eager to teach and share their knowledge and their experiences with me. I was such a wonderful way for me to broaden my understanding of how interdisciplinary health care really is, and how we all must work together to provide the best care and outcomes for our patients. I was moved by the wonderful connections that the health care teams had with their patients, and I am excited for the opportunity to explore more rural pharmacy opportunities during my clinical rotations starting in 2019!  Thank you, Platte, and thank you REHPS!

Week 1:

I was so excited to begin my experience in Platte! I knew that the diverse opportunities offered by REHPS would be so different from what I am used to, being from Sioux Falls and working primarily in retail pharmacy. I was eager to see and absorb everything that Platte and its people had to offer to me.

I arrived in Platte on Sunday so I could get settled in my housing set-up. I am staying with the very welcoming Ruth and Harry, who are the parents of one of the nurses in the Platte Medical Center Avera. I got settled and ready for my next day, excited to see what would be in store!

My REHPS partner, Justine, and I met with Tera, a nurse who serves as the Director of Education. She gave Justine and me a tour of the hospital and gave us our schedules for the next four weeks.

I jumped right in and spent the rest of the day at the nurses’ station in the hospital. I got acquainted with the layout of the hospital and learned that the Platte Medical Center Avera is a critical access, meaning that it is one of the only hospitals serving Platte and the other small towns in the area. It was then that I realized just how important this hospital was to the community. That made me even more excited to learn from the staff and contribute whatever I could. I helped the nurses calculated doses and mix sterile IV medications for immediate administration to some of the patients, and it was very interesting to actually see the IV medications administered, since that’s not something we usually get to see as student pharmacists. I did that several times for different patients, and I also followed the doctor as he checked in with the patients during his afternoon rounds. Overall, I found the first day very interesting and different from what I am used to seeing in retail pharmacy!

I did a lot of the same thing the next day, helping the nurses with dose calculations and following the doctor on his rounds. I also had the opportunity to watch one of the nurses dress the wounds of a patient, and I had the chance to chat with the patient about local history. I found this to be a very rewarding experience, because not only did I get to see a medical procedure that I am not very familiar with, but I also got to use my own skills as a history major in a way that I don’t always get to as student pharmacist.

I also got the opportunity to watch an ED visit, as a patient came in from a car crash. The accident was not severe, and other than some bruising and a cut that required stitches the patient was not badly injured. I was very intrigued by the impressive skills the doctor had when stitching the cut. I was glad that I had the opportunity to see the doctor and nurses working in the ED, while still being in a situation where I knew the patient would fully recover.

I also got to see a few colonoscopies on Wednesday with a doctor who traveled to Platte from Mitchell, SD. I was very interested to see the procedures, since I don’t have many opportunities to see procedures like that. I had the opportunity to discuss the anesthesia medications with the anesthesiologist, which I really enjoyed. During one of the colonoscopies, the patient’s IV came out as some of the Propofol (an anesthetic) infiltrated into the IV site. I watched as the anesthesiologist consulted with Avera ePharmacy about the proper way to treat the infiltrated site and how to monitor it.

After those procedures Wednesday morning, I watched some of the Planet Heart screenings in the afternoon. I had heard of Planet Heart, but I wasn’t entirely sure what it entailed. I was very impressed with how thorough it was. The patients received a CT scan of their hearts to look for calcifications of their coronary arteries, which would indicate that blockages were developing in their arteries. The patients also received an ultrasound of their carotid arteries and their abdominal aorta to check for aneurysms. They also received a cholesterol level and glucose level screening. I was so impressed with the program and so happy to see how something so life-threatening as heart disease could be more easily detected through this screening program.

Wednesday afternoon I had the chance to help the hospital’s pharmacist load the hospital’s Pyxis machines. The pharmacist is not fulltime because he is also a farmer, and so the hospital uses Avera ePharmacy to verify their orders for their patients. I enjoyed being able to chat with him and get him up-to-date with a lot of the changes going on with SDSU’s College of Pharmacy and Allied Health Professions.

I spent time in the lab on Thursday. I watched some patients come in for routine blood work, but I also saw some patients come in for tests that would serve as diagnostics for illnesses. I watched the lab tech run the machines and listened to her as she explained what each one did. I was able to have a really interesting conversation about antibiotic stewardship with the lab tech as we looked at blood and sputum cultures. I was impressed with the machine that they had that could identify an organism on a culture with up to 99% surety, and then even recommend antibiotics to use for treatment.

Justine and I worked on our community project on Friday and I got to spend some time watching her and one of the physical therapists work on exercises with the patients. I liked seeing how much better some patients were doing, compared to how they seemed when I saw them with the nurses on Monday and Tuesday. I was excited to see Justine in her element and doing really great work!

To kick off the weekend, Justine and I went and had ice cream at Little Brick Ice Cream and we had some good laughs with the owner of the store. For Saturday, Justine and I had planned to go to the Mud Races, which was going to be an off-roading event, but it was cancelled due to thunder and lightning (although the rain we got probably would have made the event even more muddy and more fun). Not going to let our weekend be spoiled by the weather, we went downtown to check out the shops and we had a great time! There is a wonderful selection of antique stores and clothing boutiques, and we had a great chat with the one of the community pharmacists when we stopped to visit Hoffman Drug. Overall, my fun weekend was a great way to sum up my first experience with Platte. As I looked to the second week, I felt inspired by the city’s motto, “It’s Possible in Platte!”

Week 2:

The second week began with me spending time in the clinic. I was excited to see the providers spending more one on one time with their patients during these office visits because I knew I would have a better opportunity to observe the providers’ prescribing habits.

I really enjoyed being able to watch the interactions that the providers had with their patients. I could really tell that the patients had great trust in the providers, and I could tell that the providers enjoyed caring for patients that they knew so intimately because of the close-knit rural community setting.

Furthermore, I enjoyed being able to watch how the providers managed the chronic medications of the patients who came in. As a student pharmacist, I am currently thinking that I would like to work in a clinic helping to managing chronic medications, so I was excited to watch providers do what I would like to do. I found the experience very educational.

I did this in the clinic on Monday, Tuesday, and Thursday. The majority of patients were older and were in for routine check-ups, so I only saw one patient come in for an antibiotic. I enjoyed the chance to help the provider decide on an antibiotic for the patient, since she had numerous allergies. The most unusual patient we had was a pediatric patient that came in with abdominal pain that we worried was appendicitis! Luckily for the patient, after an x-ray, we were able to deduce that it was just constipation!

On Tuesday night, Justine and I had the chance to watch the city’s 4th of July fireworks display after the city’s amateur baseball team had a game!

On Friday I went to Sioux Falls to visit the Avera ePharmacy. I went in with assumptions that the ePharmacy program would provide services to a few rural Avera hospitals from a little basement room, but boy was I wrong! It was a beautiful building that housed not only pharmacists, but also doctors and nurses! They provide ePharmacy services to 11 states and over 100 hospitals! I was so impressed by the innovative services that Avera provided to rural communities and I had an amazing time working with the pharmacists and learning from them. I really enjoyed having the opportunity to see the process used to verify the medication orders for the patients at the Platte Medical Center Avera.

With the first two exciting weeks in the bag, I’m looking forward towards more time in the lab and the clinic, as well as a trip to one of the Hutterite colonies outside of Platte!

Week 3:

I spent the first two days of the third week in the clinic again, this time with a different clinic doctor. It was interesting to see the unique ways that different providers interact with their patients. I saw some pediatric patients, coming in with the usual childhood illnesses. It was interesting to see the ways that the care teams worked with the pediatric patients as compared to the geriatric patients that I had primarily seen up until now.

The most exciting patient that I saw at the clinic was a patient who came in to have an abscess lanced. It was exciting to see a fairly in-depth procedure like that, as well as be involved in choosing an antibiotic for the patient.

I got to follow up on that patient the next day, when I saw the results of the specimen being examined in the lab the next day. I got to see the lab techs run some batteries of tests, and I was again reminded just how vital everyone is to the health care system.

I was with one of the clinic physician assistants the next day, and we have a couple of interesting patients. I had the opportunity to look at one patient’s x-ray, and we found that the patient had a broken finger! The other patient had been receiving a birth control injection for a while, and the PA assigned me with researching the medication to see if there were any limits on how long the birth control could be used. I was excited to be able to use my knowledge and my research skills for a real patient!

I also had the chance to watch a patient’s cardiac rehab visit, and I was impressed with the wonderful program that the Platte Medical Center Avera had. I was impressed with the support and dedication that the nurses provided to help patients really improve their health and take the steps needed to ensure that their adverse cardiac events don’t happen again.

I got to see another pediatric patient who was coming in for their two month well-child check up and immunizations. It was an interesting opportunity to brush up on all the childhood immunization requirements and see a cute, little baby!

I was excited to continue on to my final week, but I couldn’t believe how fast time had gone by!

Week 4:

The final week in Platte began with a bit of a mystery patient. They came in with pelvic pain, and we had to had x-rays taken to rule out a kidney infection. It was interesting to see the steps that doctors take to rule out conditions when patients don’t present with simple, straightforward issues.

On Tuesday, Justine and I went to the Cedar Grove Hutterite Colony with some of the nurses and providers. We got to see the kitchens, German school room, and some of the animal barns and gardens on the colony grounds. It was exciting to see one of these Hutterite communities because it was something I had never seen before. I had enjoyed meeting many of the Hutterite patients in the clinic, so I was very excited to see where they lived. Some of the children were getting seen for their school immunizations, and it was exciting to see how happy they were to meet us new people.

I then spent the afternoon in the dental clinic. It was interesting to talk about the different local anesthetics and how some work better for patients with allergies, compared to others. I got to see some crowns be fit on, as well as some exams. It was something that I was excited to see from the opposite end of the exam chair!

Wednesday was spent in radiology. I saw some patients come in for echocardiograms, and the technician did a great job explaining exactly what she was looking for and what she was measuring the entire time. I was again impressed with how intense some of these other health disciplines were and how skillful these other health professionals were! I also saw Planet Heart screenings in the afternoon, and I was again excited by a lot of the lifestyle modification counseling and education that patients received. That is definitely an area of interest of mine, so I was excited to see more of it.

On Thursday, I was at Hoffman Drug downtown. Hoffman Drug has been owned by the same family for quite a while, so it was fun to see the dynamic of the staff, as well as the community members who have been able to work with and trust the same family for quite some time. Some of the services offered at Hoffman Drug were different than the ones offered at the Lewis where I work in Sioux Falls since the needs of Platte and the nearby communities were different. The Lewis where I work does not fill prescriptions for nursing homes, so I was excited to see that aspect. I got to see the process the pharmacists use to package each patient’s one-month supply of each drug in individual packages. Hoffman Drug also offers dispill packaging for patients who need extra help managing their medications. Dispill package is similar to the packaging used for the nursing home, except it has specific labels saying when each bubble should be opened and what time it should be taken. It was such a helpful service that really fills a need in the community, since it can simplify medication regimens for patients with multiple medications. This takes the burden off patients, their caregivers, and sometimes even lets them stay in their homes instead of being moved to nursing homes. I also saw the unique protocol that Hoffman Drug has set up with the SD Board of Pharmacy to fill starter packs of acute need medications, like antibiotics, to be stocked at nearby clinics. This was interesting and very helpful, since patients who live in those more distant nearby communities don’t have to travel all the way to Platte for their prescriptions when they are sick. Instead, they can pick up the first several days of their prescription right at the clinic, and then pick up the remainder from Hoffman Drug when they are feeling better or have time to get into town. A lot of the things I learned were unique to a small-town pharmacy, and I was very happy that I got the chance to see it all. I also had the chance to talk with pharmacists and hear their experiences about their clinical rotations, which was nice because I’ll be planning mine in the next year to come.

Friday was the final presentation of the wonderful experiences Justine and I had in Platte! I couldn’t believe how quickly time went, and I was humbled by how much I learned and how moved I was by the awesome people in this community.