April 14, 2016: A Post By Kassi
Today was Mengo Wednesday, which was unsurprisingly less manic than Mengo Monday. We spent most of the day back at Mengo Hospital and we reunited with our intern partners on Monday. I worked with an intern named Robin on both Monday and Wednesday. He is one of the smartest and brightest future pharmacists I have met, and his knowledge base and patient communication skills continuously amazed me.
We formed a dream team and did pharmacy rounds together in the Luke Ward, a male medical and surgical ward and we followed up on several patients we rounded on from Monday. On Monday we went through 3 patient charts and we were able to leave notes with recommendations for 2 of those patients. We had spent over an hour on one very complicated patient. This elderly male patient presented to Mengo about a week before we saw him on Monday with a working diagnosis of an asthma exacerbation and a possible pneumonia. Throughout his next few days at Mengo the diagnosis changed from an asthma exacerbation to a possible NSTEM (a mild heart attack), to peptic ulcer disease, and finally to a COPD (lung disease) exacerbation. During his week stay he had been prescribed several different antibiotic regimens, antihypertensive regimens and many different bronchodilators (drugs for lung disease).. His final diagnosis was a COPD exacerbation, however he wasn’t prescribed any inhalers. We left a note in the patient chart recommending starting the patient on a LABA/ICS inhaler and also giving him a rescue inhaler. We also recommended creating a consistent antihypertensive medication regimen because he was currently getting different antihypertensives every day and he was very confused about what regimen he was supposed to be taking.
When we returned on Wednesday to check on this patient, Robin and I were absolutely thrilled that the physicians took all of our recommendations and started the patient on Symbicort, a salbutamol inhaler and a consistent regimen of amlodipine and losartan/hydrochlorothiazide. We had a great conversation with the patient and his caregiver discussing all of the patient’s medications and also their concerns about his treatment. Robin and I also demonstrated appropriate inhaler use and the differences between a dry powder inhaler and a metered dose inhaler.
I don’t think I have ever been happier to see a physician accept my recommendations. In America, and especially during my rotations, I have rarely had a physician challenge or ignore my recommendations and they are accepted without hesitation. During my time here, it has become apparent that some physicians are very reluctant to clinical pharmacy and pharmacy recommendations and I have previously blogged about the healthcare hierarchy here. It was an incredible feeling to know that our work with the pharmacy interns at Mengo has led to the beginning of more collaborative practice between the pharmacists and the physicians.
To make this moment even better, we were actually consulted by a physician to review another complicated patient’s chart and to give our feedback. This patient was a 25-year-old male who presented with hypertensive emergency with a blood pressure of 220/160, and over the past week they found an intracranial hemorrhage and he suffered a STEMI. We reviewed the patient’s medications, specifically the antihypertensives, and we had a great conversation with the physician regarding the patient’s future treatment and possibilities for a home regimen.
After these rounds with Robin I felt extremely optimistic about the future of clinical pharmacy at Mengo. These pharmacy interns are so committed and dedicated to patient care, and I have no doubts that they will continue to use these skills after we leave Kampala. We leave for Masindi on Saturday and as much as I am looking forward to it, I am going to miss Kampala and working with all the wonderful pharmacy interns and students here.
We also spent time with a new member of our team, Dr. Melanie Nichol, who is a pharmacologist from University of Minnesota. She fits in incredibly well with our group and we have lovingly named her Doctor Doctor. She has been working on follow up research to a recent publication in the New England Journal of Medicine and my best friend Zack coincidentally presented the original research during a journal club this week. She is an excellent addition to our team and I am very excited to have her review antiretroviral pharmacology with us to help us study for the NAPLEX.
After we left Mengo, Casey and Lauren spent the afternoon at Gonsha Rehema’s community pharmacy and Makenzie and I went back to the Mulago Guest House to work on our lectures for tomorrow. We relaxed and had dinner at a local Mexican restaurant called Que Pasa and it was surprisingly very good. We ended our night at the Guest House watching our new obsession on Netflix, proving that despite being half a world away, some things never really change.
I can’t wait to present my lecture on appropriate rounding behavior tomorrow to the students at Makerere and I’m sure there will be a blog post tomorrow describing how we did so be sure to check it tomorrow! I have also really been enjoying your emails with questions, comments and feedback so please continue to email me – firstname.lastname@example.org.