Most students begin to feel like pharmacists after completing rotations out in the field. However, Marjan Sepassi, a 2010 PharmD graduate, felt more like Sherlock Holmes during one of her experiences.
Sepassi spent six weeks in the emergency department psychiatry unit of University Physicians Healthcare Hospital at Kino Campus in Tucson. Her primary preceptor was Martie Fankhauser, clinical professor with a specialty practice in psychiatry. Sepassi worked with a team of attending psychiatrists and residents who allowed her to interview and assess patients with psychiatric emergencies.
“I was being a detective, finding out every medication they’ve been taking in the last few months, calling agencies, pharmacies…” she says. “You have to know what medications to put them back on, putting them on the right dosages. Administering them appropriately for the correct problem is really important.”
Sepassi, who completed her internship in December 2009, got to work in an emerging area of pharmacy. Because of the high-stress environment and lack of patients’ medication and medical histories, the emergency department is a vital area in the patient care process to detect and avoid medication errors.
Nearly six out of 10 emergency department patients experience at least one error during their stay, according to a study led by Asad Patanwala, clinical assistant professor at the College of Pharmacy. And more than half of those occur while prescribing. Often patients cannot remember the names and doses of their medications, so they may be omitted or not continued at the correct dosages. Continuity of care from outpatient to inpatient status requires that pharmacists take a major role in medication reconciliation to assure accuracy and safety for prescribing, and to avoid drug interactions.
Sepassi’s work was always approved by her superiors and she often got to work directly with the patients.
“We’re usually flies on the wall, shadowing the other health professionals. People will ask you questions and you sort of memorize information,” she says. “Here, I was seeing the patients on my own. It was a great learning experience, and having that autonomy made a big difference.”
A typical day in the emergency department had Sepassi doing mental status exams on patients (many of whom presented with drug abuse or mental health issues), writing up her assessments and then discussing them with the health care team. From there, they could all decide if the patient would be discharged with changes in their medication therapy, or admitted to the hospital.
Sepassi is the 12th pharmacy student to complete this emergency room psychiatry rotation at the College of Pharmacy in the past four years. Her friend, Elisa Vogel, completed the rotation in October and was also highly involved with patient care activities.
“This is a unique rotation in the country,” says Fankhauser. “I am not aware of any other college of pharmacy that has such an intensive training program in emergency psychiatry practice. All of the pharmacy students have done such an excellent job in improving the continuity of care for psychiatric patients coming through the emergency department, and are important members of the psychiatry assessment team.”
Sepassi says she enjoyed the rotation because she was never bored.
“Not that I liked the stress of the E.R., but it was interesting,” she says. “I like the flow, because there’s so much happening and at UPHH, it’s very much a team effort. It taught me what I really would like out of a clinical position once I graduate.”