November 16th - 18th
Guess who got Thai nicknames?
Janie, AKA Jun-Jao...which means shiny moon
Kelly, AKA Ku-Larb (rose)
Liz, AKA Ma-Li (jasmine)
Over the last few days, we have been shown several different pharmacy departments. Our first stop was the in-hospital drug information center where two pharmacists and two pharmacy interns staff. This center functions much like those in the U.S. -- as a resource when difficult drug questions arise. For example, the nurse calls with a question about stability of a drug that is usually mixed immediately prior to administration, but delivery needs to be delayed -- will it still be safe and effective to give?
One thing interesting that we noticed about this department is that not only can physicians and nurses call with questions, but patients also can. This gives patients direct access to pharmacists if they have questions about their medicines or even if they need help identifying a pill. In addition to online resources, they also had a binder full of labeled tablets (arranged by color) to help identify medications. We also spotted an all too familiar copy of DiPiro (our main textbook our third year of school)!
Next, we visited all four wards of the pediatric and neonatal intensive care units and got to see the role pharmacists play on the floor. This included managing drug therapy for their patients and daily rounds with a team of nurses and doctors.
An interesting case we were able to observe involved a patient with DRESS syndrome (drug reaction with eosinophilia and systemic symptoms). Up until this point, DRESS was a syndrome we had only read about in school.
Our next stop was the dispensing unit (what is traditionally considered a community pharmacy) within the hospital. We were able to observe a very well organized and efficient system that serves both in-patients and out-patients. Of note, their system for organizing drugs allows pharmacy technicians (referred to as assistants here), to stand at a station and remain relatively stationary. This is quite different from our experience with community pharmacies in the U.S. where drugs are alphabetized (by brand name or generic) and the technician runs all over the pharmacy pulling drugs. Other than the organization system, their pharmacy ran much like ours, right down to having the same goal wait time (less than 15 minutes for each patient)!
The picture below is a snapshot of one of the shelves in the pharmacy to orient you to their organization system. For example, a prescription label might read "1Cd." The number "1" refers to the location in the pharmacy, i.e. which specific station, the capital letter "C" refers to the column on the station, and lowercase letter "d" to the row within the column.
See picture below for the variety of snake venoms kept in the ER pharmacy!
Unlike in the U.S., here medications that are commonly prescribed are pre-bagged (not in vials) and labeled so they're more easily dispensed to patients. Thailand is known to minimize waste, so they mostly utilize plastic bags to dispense medications.
The pharmacy has one pill-counting machine which is manned by a pharmacy technician.
At the end of the week, we toured the oncology ward. Here's what we found to be really neat about this unit: - The pharmacy is located very closely to where patients are administered chemotherapy and because of the proximity, the pharmacists have an established relationship with the nurses who work there.
- When compounding chemotherapy, garbing up to make the medicines is very similar to the U.S. Face mask, hair cover, gloves, gown...until you get to the feet (see picture below).
- The hospital also has wigs for cancer
patients to borrow.
We also got to meet the dean of the pharmacy school, Dr. Pinsuwan! She has been elected to serve two four year terms, unlike the dean at our school of pharmacy, who doesn't have a limit on how long they serve.
So now for a recap of our lunch breaks this week:
We got to visit the Natural History Museum on campus! It was large and AIR CONDITIONED!
We walked to the reservoir on campus - a breathtakingly beautiful lake with a walking track around it.
We ventured to the traditional Thai medicine hospital for Thai massages! Very different from other massages we have had, but still very refreshing.
Lots of pictures of the fun we had this weekend to come soon!
JKL
