If you’re preparing for pharmacy school or prepping to go on your first rotation with no pharmacy experience, you’re probably scared as heck. I was in a similar boat. Although I did volunteer in an independent pharmacy, all I did was help with pick up. After toiling through my community pharmacy IPPEs and working in a retail pharmacy, I picked up a few stuff! For rotations, since you’re not really an employee, you’re pretty much limited in what to do. But there are very common things that come up and tasks you can do as a student. The first two tips are before starting rotations, the last four are things you can do during rotations. Hope these help!

Do all the require paperwork and training! Very, very important! A few days prior to your scheduled rotation, you may get an email with a username and login asking to complete some modules before you start. The modules teach you common information about the pharmacy’s workflow as well as their computer system.

Reach out to your preceptor a week ahead! Contact your preceptor before you start. Introduce yourself, what school you are coming from and ask if you need to bring anything the first day. Usually, they ask you to bring a copy of your intern license as well as your immunization certificate. You can also ask general stuff such as if you get a locker in the break room to store your belongings or if you can utilize their fridge and microwave. 

Know your sigs! A common task you may be given is to type scripts. You should be familiar with reading sigs and the names of drugs written on there. Also remember to match the patient (name and birthday) with the name on the script, and the doctor’s DEA # and their office address (since most when have multiple practice sites). Also, insurance is another thing you have to tackle and they don’t really cover it in school. If the patient is new, be sure to ask for ID and their insurance card. Insurance can be a hassle to figure out. Your best bet is to ask a tech for help if you’re stuck (ie you can’t bill their insurance). This takes practice and it’s okay if you mess up. The pharmacist checks the entry before the medication is filled. 

Learn to fill fast! The majority of preceptors will ask you to help fill. Again, this takes practice. It’s not hard counting by 5′s and sometimes they may have a counter for you. I find that the hardest part with this is locating where the drug is in the pharmacy such as fast movers, fridge, liquids, reconstitution etc. Although you may know where certain drugs are located, you have to be familiar with which drug is in which class or how it is formulated (ie: HTN meds are usually fast movers, insulin products are in the fridge, CII are in safes etc). Your preceptor may give you a tour of the pharmacy and where they store different medications on your first day but if they don’t, you can always ask the techs. Techs usually have been working at the pharmacy for a long time so they’re a good source if your pharmacist is busy. Don’t worry about grabbing the wrong medication. The majority of pharmacies have check points where a label won’t print if you grabbed the wrong drug. The pharmacist will also check the medication before it is given to the patient.

Understand the computer system. After the first day, you should be able to navigate the computer system decently. You can help lesson the team’s workload if you help answer phones. The majority of the calls I received are either: “Is my medication ready?” or “Can I refill my medication?” If you can look into their profile, you can quickly answer these questions. Be sure to ask for their name and birthdate. I find that birthday is the quickest way to search a patient. A quick note, if they don’t know the medication name for a refill, ask them what they are taking it for. You can normally figure out which medication it is based on their disease state such as Metformin if they say it’s for diabetes. If they ask a clinical question, ask them if they would like to speak to the pharmacist and then put them on hold. Normally the pharmacist is busy so inform them that they are helping a patient, on the phone with a doctor etc and will get to them as soon as they can. If your preceptor allows you to consult over the phone but you don’t know the answer, ask if they would like to be put on hold while you ask the pharmacist.

Know common consultation points! When you first start rotations, you have very little clinical knowledge. Your preceptor knows that. But the most common medications that get prescribed that require a consultation are usually antibiotics and NSAIDs (or other pain meds). Maintenance meds are common but patients usually have been on it forever so you most likely don’t need to consult them. During the winter months is when you’ll see LOTS of antibiotics. Here’s what you need to know to say even if you haven’t taken Infectious Diseases/Self Care yet:

name of the med and that it is an antibiotic/pain med used to treat bacterial infections/pain/fever/inflammation

how to take it (antibiotics are usually dosed BID, pain meds are prn)

storage (ie: recon antibiotics are usually refrigerated, pills are okay at room temp)

with or without food (you can check the patient pamphlet or ask your preceptor, NSAIDs are ALWAYS with food)

COMPLETE the therapy for antibiotics (some pts will try to save some pills after they feel better, tell them they have to complete the regimen!)

common side effects (ie: stomach upsets, diarrhea, sun-sensitivity), it depends on the medication but most antibiotics and NSAIDs are generally well tolerated. Ask your preceptor if you need to mention anything specific (ie patient CANNOT consume alcohol when on Flagyl therapy even a few days after completion)

pretty cool day.

i've been filling from 7:30 till noonish daily in the employee pharmacy. then I head up into the hospital pharmacy. today i watched and helped out a pharmacy resident do levels, which until today meant nothing to me.

but apparently, a select few medications have to be monitored by taking samples. for vanco specifically, accurate levels, in this case it's a trough, is taken half an hour before the 4th dose of the medication. it's extremely nephrotoxic which is one of the reasons that it's monitored so closely - the second of which is that it's a broad spectrum antibiotic and it's used when the infection is relatively severe and the "bug" isn't known at the time. with elevated levels of vanco, the increase in ototoxicity and nephrotoxicity increases dramatically while depressed levels of vanco would increase the likelihood of creating resistance.

interestingly, most of the patients are pretty old (65+) and pretty much overweight or obese. there is a dramatic difference in the creatinine clearance at times - at times more than 50+ b/w the CrCl calculated with actual vs. ideal body weight. vanco dosing is one of the few drugs that you use actual body weight instead of ideal body weight. also, for certain bugs, vanco can be used for it's synergy with other antibiotics and of course another dosing regimen and level criteria exists for that. 

i also had the opportunity to watch, listen and contribute to pre-and post-operation medication orders.