Reflections on Residency & Learning

NICU Reflection

The past month has been an exciting one in NICU. I was privileged to work with a department that highly values evidence based medicine and interprofessional collaboration. During this month I followed a series of patients (most of them were there for the entirety of my rotation). Though some of my patients were medically simple – e.g. feeder/growers, I learned to incorporate interseting aspects of neonatal care into my thought process. For example, fluid and nutrition is a large aspect of what we as pharmacists monitor for. Also, as it came up in most of my topic discussions, deprescribing is a valuable aspect of what we can provide, as many of the medications can act as risk factors for a variety of neonatal conditions. This month I was eager to complete many topic discussions with my preceptor and other neonatal pharmacists and was able to have thorough discussions about: assessment of the newborn (healthy vs. sick neonates), anemia of prematurity, apnea of prematurity, chronic lung disease/bronchopulmonary dysplasia, hypoglycemia, patent ductus arteriosus, neonatal abstinence syndrome, necrotizing enterocolitis, osteopenia of prematurity and sepsis (and then some!). During these topic discussions we delved into everything from pathophys and risk factors to all the nuances of therapies. These topic discussions were useful and became quickly integrated into my thought process of thinking of new DTPs, and assessing risks of conditions in my patients (e.g. >32 weeker for apnea of prematurity = low risk).

During this rotation I worked closely with the entire NICU department and was grateful for all the interprofessional opportunities that I was presented with! I got to see a ton of things put in and taken out of these tiny bodies (PICC lines, UVC/UACs, PIVs, chest tubes, etc.)…if I ever was squeamish that is no longer the case. I also had the opportunity to have a 20 minute discussion with the neonatal dietician to pick her brain on all things fluid and nutrition and her role on the team. This was very helpful, and helped me have a better understanding of why some of my patients were on feeds additives (e.g. HMF, liquid protein, MCT oil, etc.) and why others were not!

After this rotation I feel more strong at certain aspects of my thought process (goals of therapy and monitoring plan), and feel like I had practice at alternatives and recommendations (but still have room to grow!). I am excited to take all that I learned in this rotation, especially with regards to my thought process and apply it to my future rotations.

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