Showing posts with label Sarah Sundin. Show all posts
Showing posts with label Sarah Sundin. Show all posts

Friday, September 28, 2012

Medical Air Evacuation in World War II—Part 3

I am so so pleased to host amazing author and fellow research hound, Sarah Sundin, back to Redwood's this week. Sarah is a fabulous historical author whose novels highlight the WWII era. This week she is discussing her research into medical air evacuation and flight nursing.

Sarah has also graciously agreed to give away one copy of her newest release, With Every Letter, to once commentor on any of this weeks posts. Simply leave a comment with your e-mail address. Must live in the USA. Drawing will be midnight, Saturday September 29th. Winner anounced here at Redwood's Sunday, September 30th.

Welcome back, Sarah!



The broad grin on the private’s face didn’t reveal how serious his condition was. “Hiya, nursey.”
“Lieutenant,” Mellie said, but she smiled back. “How are you feeling?”

“Depends. How many girls you got at that hospital in Algiers?”


“Oh, not one of them is good enough for you.”


“She wears a skirt, she’s good enough.”


Mellie clucked her tongue. “Too bad. All the women wear trousers.”


In my novel With Every Letter, the heroine serves as a flight nurse. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you might need to understand medical air evacuation.


On September 24th I discussed general principles of air evacuation, on September 26th we followed one patient in his flight experience, and today we’ll meet the flight nurse.


Training

The profession of flight nursing began in World War II. The US Army Air Force started the first training program at Bowman Field in Louisville, Kentucky in the fall of 1942. Training was haphazard at this point, and the first two squadrons (the 801st and 802nd) were sent overseas before training was complete. The formal program ran six to nine weeks, changing throughout the war. The first class of flight nurses graduated in February 1943.

The program was named the School of Air Evacuation in June 1943 and moved from Bowman Field to Randolph Field, Texas in October 1944. The US Navy started a flight nursing program in December 1944 in Alameda, California.


In training, the nurses studied academic subjects such as aeromedical physiology. They also learned field survival, map-reading, camouflage, ditching and crash procedures, and the use of the parachute. The program included calisthenics, physical conditioning, and a bivouac in the field with simulated enemy attack.


Organization


Each Medical Air Evacuation Transport Squadron (MAETS) was headed by a flight surgeon and chief nurse. The MAETS was divided into four flights, each led by a flight surgeon and composed of six teams of flight nurses and surgical technicians. A Headquarters section included clerks, cooks, and drivers.


Uniform

The typical Army Nurse Corps uniform of white dress or a skirted suit uniform did not work in flight. Although some resisted—including in ANC leadership—the women were allowed to wear trousers. The first few squadrons improvised uniforms, often cutting down the dark blue ANC service jacket and purchasing trousers. Eventually an official flight nurse uniform was authorized—a waist-length gray-blue jacket and matching trousers and skirt, with a light blue or white blouse. Depending on the climate, nurses also wore the combat airman’s heavy flight gear.

The official insignia of the flight nurse was a pair of golden wings with a maroon N superimposed. These wings were changed to silver later in the war.


Duties


The role of the flight nurse was revolutionary. No physician accompanied her on the flight, and she outranked the male surgical technician, who worked under her authority. She was trained to start IVs and oxygen, tasks reserved for physicians at the time. In addition, she was trained to deal with medical emergencies including shock, hemorrhage, and sedation. One flight nurse even performed an emergency tracheotomy using improvised equipment.


Dangers

The primary responsibility for the lives of the patients rested on the shoulders of the flight nurses. Their emergency training was put into use in many cases throughout the war. Flight nurses and technicians successfully evacuated patients into life rafts after a ditching in the Pacific, unloaded patients from a burning plane after crash landing in North Africa, and loaded patients under enemy fire in the jungles of Burma.

One flight nurse was taken prisoner briefly by the Germans after crashing behind enemy lines, and another parachuted to safety in the mountains of China. In one dramatic incident, a plane carrying a dozen nurses from Sicily to Italy was blown off course and crash landed in Nazi-occupied Albania. With the help of their survival training and Albanian partisans, the crew and nurses all evaded capture and crossed snowy mountains to be rescued at the coast—a two-month ordeal.


Seventeen flight nurses lost their lives during the war. Lt. Ruth Gardiner, 805th MAETS (pictured), was the first flight nurse killed, in a plane crash in Alaska.


Through professionalism and courage, the five hundred women who served as flight nurses in World War II saved many hundreds of lives and comforted over a million sick and wounded servicemen.


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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Wednesday, September 26, 2012

Medical Air Evacuation in World War II—Part 2

I am so so pleased to host amazing author and fellow research hound, Sarah Sundin, back to Redwood's this week. Sarah is a fabulous historical author whose novels highlight the WWII era. This week she is discussing her research into medical air evacuation and flight nursing.

Sarah has also graciously agreed to give away one copy of her newest release, With Every Letter, to once commentor on any of this weeks posts. Simply leave a comment with your e-mail address. Must live in the USA. Drawing will be midnight, Saturday September 29th. Winner anounced here at Redwood's Sunday, September 30th.

Welcome back, Sarah!


Mellie smiled at her patient. “Are you enjoying the flight?”

“Sure.” Corporal Fordyce stared at the fuselage curving over his head. Mud from the battlefield speckled his hair, and dark stubble covered his cheeks.


Mellie settled her hand on his blanketed arm. “How does your leg feel?”


“It’s gone,” he said through clenched teeth.


“I know,” she said softly. Now was no time for platitudes.


In my novel, With Every Letter, the heroine serves as a flight nurse. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you might need to understand medical air evacuation.


On September 24th I discussed general principles of air evacuation, today we’ll follow one patient in his flight experience, and on September 28th we’ll meet the flight nurse.


Pre-Flight

Let’s follow my fictional patient, Corporal John Fordyce. While retaking Sbeïtla, Tunisia from the Germans in March 1943, Fordyce steps on a landmine. Medics perform first aid and take him from the battlefield to the battalion aid station, where he’s stabilized. An ambulance carries him to a field or evacuation hospital, where his right leg is amputated below the knee. Since the corporal will receive a medical discharge, he will return stateside. An ambulance will take him to the airfield at Youks-les-Bains, Algeria. A C-47 will fly him to Algiers. Later he’ll fly to Casablanca in French Morocco, where he’ll take a hospital ship home for convalescence.

At Youks-les-Bains he arrives at a tent hospital at the airfield. The flight surgeon evaluates the patients to decide which are good candidates for air evacuation. Due to high altitude, the doctors prefer not to send patients with serious head injuries, sucking chest wounds, or severe anemia. Each combat theater has different policies on “neuropsychiatric” patients, but if they’re allowed, an extra technician will attend these patients.


At the airfield holding unit, the physician briefs flight nurse Lt. Mellie Blake on each patient. Mellie in turn orients the patients—most of whom have never flown—on what to expect. Corporal Fordyce wears an Emergency Medical Tag (EMT) which summarizes his condition and treatment. A large envelope with his medical records and X-rays rests beside him on the litter.


Loading the Plane


The surgical technician and medics from the holding unit carry the litter patients onto the plane. At the cargo door, Mellie checks the EMT against the list of patients on her flight manifest and directs the tech where to place each patient based on his medical needs.


The litters are clamped into aluminum racks along each side of the fuselage, stacked three litters high. Later versions of the C-47 will come equipped with lightweight web-strapping systems to hold litters. Fordyce is placed in the top tier with his bandaged stump facing the aisle for easier access. Lower tiers are reserved for patients with heavy casts or needing more intense care.


Flight


After the patients are secured, the C-47 glides down the runway. When the plane levels off, the flight nurse and technician see to the patients’ needs. They record Fordyce’s “TPR” (temperature, pulse, and respiration) on the flight manifest, and check for signs of bleeding and infection. Mellie is trained to treat shock, hemorrhage, pain, air sickness, and other medical emergencies, but Fordyce is stable and needs little care.

The flight team also provides water and food if needed. They converse with the patients, a voice of calm for the anxious and of encouragement for the depressed. If no patients are on oxygen, the men are allowed to smoke.


The interior of the C-47 is poorly ventilated and heated, and becomes stifling in hot weather and frigid in colder climates or higher altitudes. Smells can become overwhelming, especially when burn patients are aboard or someone becomes airsick. Surprisingly, air sickness occurs in less than 1 percent of flights. Corporal Fordyce is thankful his flight is in the 99 percent.


Unloading

After an uneventful two-hour flight, the C-47 lands at Maison Blanche Airfield in Algiers, Algeria. Mellie and the technician unload the plane with the help of men on the ground. A trained flight team can unload a full plane in 5-10 minutes, which is crucial in case of crash landing, ditching in water, or landing at a field under enemy fire.

An ambulance ferries Corporal Fordyce to a hospital in the Algiers area while he waits for the next step in his journey home.


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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.



Monday, September 24, 2012

Medical Air Evacuation in World War II—Part 1

I am so so pleased to host amazing author and fellow research hound, Sarah Sundin, back to Redwood's this week. Sarah is a fabulous historical author whose novels highlight the WWII era. This week she is discussing her research into medical air evacuation and flight nursing.

Sarah has also graciously agreed to give away one copy of her newest release, With Every Letter, to once commentor on any of this weeks posts. Simply leave a comment with your e-mail address. Must live in the USA. Drawing will be midnight, Saturday September 29th. Winner anounced here at Redwood's Sunday, September 30th.

Welcome back, Sarah!

“Do you have room for one more litter case?” the doctor asked. “Private Jenkins fell headlong on a landmine. The nearest hospital’s in Cefalù, a long ambulance ride over rough roads. By air he’ll be in Mateur in two hours. He needs a thoracic surgeon.”

Mellie stared at the unconscious patient. He lay on a litter, his torso swaddled in white gauze.
Bloody streaks painted his face, arms, and khaki pants. “We’re his only hope.”

In my novel With Every Letter, the heroine serves as a flight nurse. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you might need to understand medical air evacuation.


Today I’ll discuss general principles of air evacuation and share resources, on September 26th we’ll follow one patient’s flight experience, and on September 28th we’ll meet the flight nurse.


History of Air Evacuation

As soon as the Wright brothers took to the air, clever minds thought of ways to use the new contraption. In 1910 two Army officers constructed the first ambulance plane, and during World War I the Army experimented with transporting patients by air.

The advent of large multi-engine cargo planes in the interwar years made these dreams realistic. In November 1941, the US Army Air Force authorized the Medical Air Ambulance Squadron. Air evacuation was first performed informally early in 1942 during the construction of the Alcan Highway and in Burma and New Guinea. The first official air evacuation with flight nurses was flown on March 12, 1943 in Algeria.


Advantages of Air Evacuation


Speed is the primary benefit of air evacuation. Planes can also traverse inhospitable terrain or dangerous seas. The military came to see that air evacuation required less equipment than ambulance transport, aided recovery, and increased morale on the front.

However, planes were unable to fly in bad weather, and planes were not reserved for ambulance use. Since top priorities for transport planes were airborne missions and carrying supplies, medical air evacuation depended on availability. Also, dangers existed from crashes and enemy planes. Since transports carried cargo and troops, they were not allowed to be marked with the Red Cross and were legitimate military targets. Fighter coverage was provided in some combat theaters.


Use of Air Evacuation in World War II


Thirty Medical Air Evacuation Transport Squadrons served in World War II in every combat theater. In all, 1,172,000 patients were transported by air. About half were ambulatory patients (the “walking wounded”) and half were litter patients. Only 46 patients died in flight, although several hundred died in crashes. By 1944, 18 percent of all Army casualties were evacuated by air.


Planes


The C-47 was the workhorse of air evacuation. This dependable two-engine plane was used for shorter flights within a combat theater and could fly into forward landing strips close to the battlefield. A C-47 carried 18-24 patients, depending on how many were on litters.

For transoceanic flights, the four-engine C-54 Skymaster was used. The preferred load for a C-54 was 18 litter patients and 24 ambulatory. These flights carried patients from the combat theater stateside when the patient required 90-180 days of recovery or was eligible for medical discharge.

The C-46 Commando was used less frequently. Although it could carry 33 patients, the cargo door made loading difficult, and the plane had an unsavory habit of exploding when the cabin heater was used.


Medical air evacuation revolutionized the care of the wounded. Gen. Dwight Eisenhower credited air evacuation, sulfa drugs, penicillin, and the use of plasma and whole blood as key factors in the significant drop in the mortality rate among the wounded from World War I to World War II.


Resources:


Sarnecky, Mary T. A History of the U.S. Army Nurse Corps. University of Pennsylvania Press, Philadelphia. 1999.


Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Office of the Surgeon General, USAF. Washington, DC. 1955.


“Winged Angels: USAAF Flight Nurses in World War II.” On National Museum of the US Air Force website.
http://www.nationalmuseum.af.mil/factsheets/factsheet.asp?id=15457

The World War II Flight Nurses Association. The Story of Air Evacuation: 1942-1989. Taylor Publishing Co., Dallas TX, 1989. [Source of most of the photos used in this article]


Website of the World War II Flight Nurse Association.
http://www.legendsofflightnurses.org/ Contains photos, news clippings, and PDF of The Story of Air Evacuation.

Futrell, Robert F. Development of Aeromedical Evacuation in the USAF: 1909-1960. USAF Historical Division, Research Studies Institute, Air University, 1960. Available free online at
http://www.ibiblio.org/hyperwar/AAF/AAFHS/AAFHS-23.pdf


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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Monday, November 7, 2011

Top Three Most Popular Posts: #3

The one year anniversary of this blog was October 31st! Now that the zombies have been put to sleep for another year, it's time to celebrate by taking a stroll down memory lane and looking at the top three most popular posts of the last year.

I love hosting Sarah Sundin. She's a truly gifted novelist and I hope you'll check out her books. This post, ranked #3, struck a chord with people and I think it's the way Sarah painted the picture using her authorly ways to make this time period come alive.

Pharmacy in World War II—The Drug Store

In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—a personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. On February 14th, I discussed the role of the pharmacist in the 1940s, today I’ll describe the local drug store and how its role changed during the war, and on February 18th,  I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Welcome to the Corner Drug Store—1939

Perkins’ Drugs stands on the corner of Main Street and Elm, where it’s stood all your life. Large glass windows boast ads for proprietary medications and candy, and a neon mortar-and-pestle blinks at you. When you open the door, bells jangle. The drug store is open seven days a week, sixteen hours a day, so you know it’ll always be there for you. To your right, old-timers and teenagers sit at the soda fountain on green vinyl stools, discussing politics and the high school football game. The soda jerk waves at you.

You pass clean shelves stocked full of proprietary medications, toiletries, cosmetics, hot water bottles, hair pins and curlers, stockings, cigarettes, candy, and bandages. You know where everything is—and if you can’t find it, Mr. Perkins or his staff will be sure to help you.

The owner, Mr. Perkins, is hard at work behind the prescription counter with good old Mr. Smith and Mr. Abernathy, that new young druggist Mr. Perkins hired last year. Mr. Perkins greets you by name, asks about your family, and takes your prescription. He has to mix an elixir for you. If you don’t want to wait, he’ll be happy to have his delivery boy bring it to your house. But you don’t mind waiting. You have a few items to purchase, and you’d love to sit down with a cherry Coke.

Welcome to the Corner Drug Store—1943

Perkins’ Drugs still stands at the corner of Main Street and Elm. Large glass windows boast Army and Navy recruitment posters and remind you that “Loose Lips Sink Ships.” The neon sign has been removed to meet blackout regulations. The store is open for fewer hours since Mr. Smith retired and Mr. Abernathy got drafted. Mr. Perkins hired Miss Freeman. Not many people are thrilled to have a “girl pharmacist,” but if Mr. Perkins trusts her, that’s good enough for you. Perkins’ Drugs and Quality Drugs on the other side of town alternate evening hours so the town’s needs are met.

A placard on the door reminds you that Perkins’ Drugs is authorized by the Office of Civilian Defense as a pharmaceutical unit, meaning the store will provide a kit of medications and supplies for the casualty station in case of enemy attack. You pray the town will never need it.

Bells jangle when you open the door. The soda fountain is closed. Mr. Perkins can’t buy metal replacement parts for the machine, the soda jerk is flying fighter planes over Germany, and sugar is too scarce a commodity.

A barrel stands by the door. You toss in five tin cans, washed, labels removed, tops and bottoms cut off, and flattened. Mrs. Perkins at the cash register thanks you.

You pass clean shelves with depleted stocks. Proprietary medications, cosmetics, toiletries, and medical supplies remain, but rubber hot water bottles, silk and nylon stockings, hair pins and curlers, candy, and cigarettes are in short stock—or unavailable. Most of the packaging has changed. Metal tins have been replaced by glass jars and cardboard boxes. You pick up a bottle of aspirin and a tube of toothpaste, double-checking that you brought your empty tube. Without that crumpled piece of tin, you couldn’t purchase a replacement. Tin is too dear.

At the prescription counter, Mr. Perkins greets you by name and asks about your family. Miss Freeman gives you a shy smile and you smile back. There’s a war on and women have a patriotic duty to do men’s work so men are free to fight. Mr. Perkins frowns at your prescription for an elixir. He’s used up his weekly quota of sugar, and his stock of alcohol and glycerin are running low. Would you mind capsules instead? Of course not. Mr. Perkins phones Dr. Weber and convinces him to change the prescription. Mr. Perkins can’t have the prescription delivered—he doesn’t qualify for extra gasoline and he couldn’t find a delivery boy to hire anyway.

You and Mr. Perkins discuss war news as he sets up a wooden block with little holes punched in it, then lines the pockets with empty capsule halves. He weighs powders on a scale, mixes them in a mortar, then fills the capsule shells. After he sets the capsule tops in place, he puts the capsules in an amber glass bottle with the familiar Perkins’ Drugs label.

You buy a few War Bonds. Your wages are higher than ever with the war on, and with all the shortages there’s nothing to buy. Besides, War Bonds are a solid financial investment and your patriotic duty. On a poster by the counter, a smiling pilot leans out of his plane and reminds you: “You buy ‘em. We’ll fly ‘em. Defense Bonds and Stamps.”

Mr. Perkins thanks you for your purchase, and you thank him for his service. War or no war, you know Perkins’ Drugs will always be there for you.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist

Wednesday, November 2, 2011

Contemporary Pharmacy: Part 4/4

Today concludes Sarah's four-part series on contemporary pharmacy. I've certainly enjoyed having her back and can't wait for her return. Today she focuses on the hospital pharmacist.

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may need to introduce a pharmacist character or understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.

Today’s article discusses practice in the hospital setting. Previous articles discussed an overview of the profession, pharmacy education and training, and practice in the community pharmacy setting.

Hospital Pharmacy

About 22% of pharmacists work in America’s 5800 hospitals. These can range from the small community hospital with a few dozen beds, to large teaching hospitals with thousands of beds.

Setting

The traditional hospital pharmacy is “in the basement,” away from the main hospital area. As pharmacists have become more involved in patient care, some larger hospitals have opened satellite pharmacies on the floors. To deliver medications, hospitals use employees, vacuum tube systems, dumbwaiters, or even robots.

Access to the hospital pharmacy is restricted to pharmacists and pharmacy technicians, and briefly to nurses, administration, housekeeping staff, and delivery personnel under pharmacist supervision.

The typical hospital pharmacy is divided into work areas. One area contains computers and reference materials for pharmacists entering medication orders. A narcotics room contains all the controlled substances, usually in a secure cabinet accessible only by password or biometric scan. A “cart-filling” area contains medications as well as the large carts that will be filled with a daily supply for each patient. The IV room contains laminar flow hoods for sterile preparation of intravenous medications. There is also room for bulk storage and tables for breaks and meetings. Offices are provided for the director of pharmacy and others.

Work Conditions

In the inpatient setting, medications must be available twenty-four hours a day, every day of the year. Therefore, the largest hospitals are always open. Smaller hospitals may have off-site pharmacists enter orders electronically after hours, while nurses obtain the medications from automated systems.

On average, a hospital pharmacy employs ten pharmacists and about twice as many pharmacy technicians. Directors of pharmacy must be pharmacists by law, but they usually perform administrative duties only.
Opportunities for part-time or on-call work abound. Most employees work odd hours, including evenings, weekends, holidays, and graveyard shifts. Those in administrative or purely clinical jobs may work traditional hours.

Dress codes vary, but most pharmacists dress professionally—men wearing nice pants and shirt, with or without a tie, and women wearing a nice top with dress pants or a skirt. Technicians tend to more casual clothes, often jeans or scrubs. Lab coats may or may not be worn within the pharmacy, but are preferred when the personnel go to the floors. In the hospital setting, the long-sleeved knee-length lab coat is most common.

Work Flow

Physicians’ medication orders are transmitted to the pharmacy electronically or by fax. Many hospitals have the physicians enter the orders themselves to prevent errors due to illegibility. A pharmacist checks if the drug and dose are appropriate for the patient’s condition, age, and weight, and checks for potential problems due to allergies, drug-drug interactions, or drug-disease interactions. Many hospitals have protocols that allow pharmacists to adjust doses for certain drugs.

Technicians then pull a day’s supply of the new medications to send to the floors. Most medications in hospitals are “unit-dosed,” with each dose individually packaged in blister packs and labeled with drug name, strength, manufacturer, lot number, expiration date, and bar code.

Most hospitals supply medication on a 24-hour basis. Large carts contain drawers for each patient, which are filled with a 24-hr supply of medications and delivered once a day. Intravenous medications are batched, with a 24-hr supply sent up once a day. Exceptions are made for drugs with low stability or high cost. As medications are changed, only the new medications need to be sent up. Automated dispensing machines on the floors provide nurses access to emergency medications, stat doses, or after-hours doses. These machines are also used to dispense controlled medications, as they require passwords or biometric scans.

IVs and TPNs

One special function of the hospital pharmacy is mixture of intravenous (IV) solutions and total parenteral nutrition (TPN). These require calculations, training in sterile technique, and the use of a laminar flow hood.

Clinical Pharmacy

A growing and cherished role in hospital work is clinical pharmacy, the direct interaction with physicians, nurses, and patients to optimize pharmaceutical care. Pharmacists in a clinical role monitor lab values, read patient charts, analyze the patient’s condition and current care, and make recommendations individualized for the patient. Clinical pharmacists can improve patient care, reduce length of stay, decrease side effects, and even reduce costs.

The Hospital Pharmacy Experience

Hospital pharmacy personnel work behind-the-scenes in a fast-paced, often-interrupted, and frequently stressful environment. However, they take pride in working with complex medications for critically ill patients, knowing they do their best to improve patient care and reduce medication errors.

Sources:

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Pharmacists, on the Internet at http://www.bls.gov/oco/ocos079.htm (visited October 17, 2011).

American Pharmacists Association http://www.pharmacist.com/

American Society of Health-System Pharmacists http://www.ashp.org/

American Association of Colleges of Pharmacy http://www.aacp.org/
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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Wednesday, October 26, 2011

Contemporary Pharmacy Practice: Part 3/4

Sarah Sundin continues her four-part series on contemporary pharmacy. Today she focuses on the community pharmacist. This series is providing a lot of great background information for these health care professionals and potential fictional characters.

Back to Sarah....

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may need to introduce a pharmacist character or understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.

Today’s article discusses community pharmacy practice. Previous articles gave an overview of the profession, and discussed pharmacy education and training, and the following article will discuss practice in the hospital setting.

Community Pharmacy

About 65% of America’s pharmacists work in retail pharmacies inside drug stores, supermarkets, or mass merchandisers such as Walmart, Costco, or Target. There are approximately 23,000 independently owned pharmacies in the U.S., and 39,000 chain stores.

Setting

In the typical American drugstore, the pharmacy is toward the rear of the store, with over-the-counter (OTC) medications stocked close to the pharmacy. A counter divides the pharmacy from the rest of the store, usually with prescription drop-off and pick-up in separate areas. The secure pharmacy area is set further back, usually behind bulletproof glass. Access is restricted to pharmacists and pharmacy technicians. Other persons are allowed inside briefly to make deliveries or for housekeeping, and only with a pharmacist present.

The pharmacy area includes a main counter with computer workstations. Shelves hold bulk medications divided by type—oral tablets and capsules, oral liquids, suppositories, topicals (creams and ointments), eye and ear medications, inhalers, and injectables, plus bulk storage. Each pharmacy has a refrigerator for temperature-sensitive drugs and a locked cabinet or safe for the most heavily controlled substances (C-IIs).

Traditionally, the owner pharmacist ran the complete store as well as the pharmacy, and this configuration still occurs in smaller independent stores. However, in most situations, a store manager runs the main store, while the pharmacy manager runs the pharmacy. The pharmacy manager must be a pharmacist and performs administrative as well as dispensing duties.

Working Conditions

Most community pharmacies employ one or two full-time pharmacists, plus on-call or floating pharmacists to cover absences. Several pharmacy technicians work each shift as well. Most pharmacies are open from morning to early evening to cover the after-work rush, as well as shorter hours on weekends. Therefore, most pharmacists and techs work odd hours—morning shifts, afternoon to evening shifts, and alternating weekends. Larger pharmacies may be open twenty-four hours.

Pharmacists and technicians work on their feet. Pharmacists are required to dress professionally—a dress shirt and tie for men, a nice blouse and dress pants or skirt for women. Technicians tend to dress “business casual.” The traditional pharmacist’s short-sleeved lab coat that buttoned up the side to a high neck is rarely worn nowadays. Most pharmacists and techs wear a white hip-length lab coat with short or long sleeves.

Work Flow

Pharmacy technicians are allowed to do many duties, but those requiring professional judgment are restricted to the pharmacist. The precise division of labor varies between stores.

The prescription is taken in by a technician, who checks to see if the prescription is complete and that the patient’s information in the computer is current. The prescription is then entered in the computer. A pharmacist checks if the drug and dose are appropriate for the patient’s condition, age, and weight, and checks for potential problems due to allergies, drug-drug interactions, or drug-disease interactions. Sometimes the pharmacist needs to call the physician due to illegibility, errors, clinical interactions, or to verify a controlled substance prescription. The correct medication is pulled from the shelf, and tablets or capsules are counted on special counting trays. Larger stores often use automated systems to count and fill. The pharmacist performs a final check, and the medication is dispensed to the patient.

Patient Consultation

As accessible and visible health-care professionals, pharmacists often advise patients on proper treatment of ailments needing over-the-counter medications, including when to see the physician. Also pharmacists consult with patients when medications are dispensed to make sure the patient understands the proper use of the medication and side effects to watch for.

Immunizations

Offering immunizations is a growing role for pharmacists, with 147,000 certified to give vaccinations. Pharmacists enjoy this chance to serve the community and improve public health.

Controlled Substances

Many of the medications used for legitimate medical purposes are also drugs of abuse with high street value. Therefore, pharmacists must balance two conflicting community needs—to provide health care to those who need it, and to prevent diversion, fraud, and theft. High security, locked cabinets, background checks, and multiple counts are used to prevent outright theft and in-house diversion.

However, fraudulent prescriptions are often phoned in or written on stolen prescription pads. The pharmacist must use professional judgment to determine if each prescription is authentic. Does the prescription use improper medical jargon? Unusual and large quantities? Is the patient paying cash for a high bill? Do they come in after the physician’s office is closed? A pharmacist can legally refuse to fill any prescription for any reason. However, recently patient advocates threaten lawsuits if they believe access to medications is blocked.

The Community Pharmacy Experience

Overall, working in a community pharmacy is fast-paced and often stressful, especially when dealing with insurance companies or when disgruntled patients or irritated physicians vent their frustrations. However, most pharmacists can overlook these issues, knowing they’re providing excellent health care and helping patients get better.

Sources:

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Pharmacists, on the Internet at http://www.bls.gov/oco/ocos079.htm (visited October 17, 2011).

American Pharmacists Association http://www.pharmacist.com/

National Community Pharmacists Association http://www.ncpanet.org/

National Association of Chain Drug Stores http://www.nacds.org/index.cfm

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Wednesday, October 19, 2011

Contemporary Pharmacy Practice: Part 2/4

Sarah continues her four part Wednesday series on contemporary pharmacy. Today, she focuses on education and training.

Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may find the need to introduce a pharmacist character. Or if medications play any role in your story, you’ll need to understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.

Today’s article discusses pharmacy education and training. Last week’s article gave an overview of the profession, and the following articles will discuss practice in the community pharmacy setting and practice in the hospital setting.


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Entry Degree

The first four-year Bachelor’s of Science degree in pharmacy was offered by Ohio State University in 1925. The four-year program became mandatory with the incoming class of 1932. The doctor of pharmacy (Pharm. D.) degree was first offered by the University of California, San Francisco in 1955. As the clinical focus of the Pharm. D. degree became more desirable, the bachelor’s degree was phased out. As of 2000, the Pharm. D. degree was required for initial licensure.

Pharmacists with a bachelor’s degree sign their names with an “RPh” afterward (Registered Pharmacist) and are addressed as “Mr.” or “Mrs.” or “Miss.” Pharmacists with a doctorate sign their names with a “Pharm. D.” afterward and are addressed as “Dr.” However, it is common practice in modern pharmacies and hospitals for pharmacists to be addressed by their first names—this is controversial within the profession. Please note, the degree is a doctorate in pharmacy not pharmacology. Pharmacology is an academic discipline not a clinical profession, and pharmacologists receive the Ph.D. degree.

Length of Education

To gain admission to pharmacy school, students must complete the prerequisite undergraduate courses in math and science. A dedicated student can complete the prerequisites in two years and apply straight to pharmacy school. However, most students obtain their undergraduate degree first. Common majors of entering students include biology, chemistry, and biochemistry, but any degree is acceptable as long as the prerequisites are filled.

Pharmacy school is a four-year program. Therefore, the typical time from high school graduation to receipt of the doctorate is six to eight years. At graduation, students attend the traditional hooding ceremony. The lining of a pharmacist’s doctoral hood is olive drab.

Course of Study

During those four years, pharmacy students undergo a rigorous course of study in basic science and clinical practice. Studies in the basic sciences include organic chemistry, biochemistry, physical chemistry, anatomy, physiology, and microbiology. More specialized courses include pharmaceutical chemistry, pharmacokinetics (how the body processes medications), and pharmacology (how medications act on the body). The highlight of the academic experience is an intense series of courses in clinical pharmacy, where students learn about disease states and the proper of use of medications. The final year of pharmacy school is spent in the clinical setting. Students work on hospital floors, rounding with physicians and medical students. There they monitor patient care and recommend changes in therapy. Students (called interns) work under the supervision of experienced pharmacists, called preceptors.

During pharmacy school, students also take part-time and summer jobs to obtain their required internship hours. Interns must fulfill a certain number of hours both in the inpatient (hospital) and outpatient (clinic or retail pharmacy) to sit for pharmacy boards.

Licensure

Upon graduation from pharmacy school, completion of internship hours, and a background check, graduates can take the NAPLEX, the North American Pharmacist Licensure Examination. Each state also administers an exam in pharmacy law, since regulations vary from state to state. Since the NAPLEX is now accepted by every state, pharmacists enjoy reciprocity. To move from one state to another requires sitting for a new law exam but not the pharmacy boards.

Pharmacy licenses must be renewed every year or two, depending on the state. Continuing education is required for renewal. Since pharmacists work with controlled substances, pharmacy licenses may be suspended or revoked for crimes involving controlled substances, including driving under the influence. Pharmacy licenses may also be suspended or revoked for other crimes, malpractice, or professional ethical violations.

Residencies and Fellowships

As medications and therapy become more complex, so does pharmacy education. Many graduate pharmacists choose to do a one-year general pharmacy residency—essentially a continuation of their fourth year of pharmacy school. Pharmacists may choose to take additional residencies or fellowships to gain more specialized experience, especially if interested in an academic career.

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.