Reflections – Surgery

The following are my objectives for surgery:

  1. Continue to develop a systematic thought process to assessing and managing infectious diseases
  2. Continue to develop my ability to practice antimicrobial stewardship (e.g. assessing when therapy can be narrowed, for IV to PO stepdown)
  3. Continue to develop my ability to effectively perform therapeutic drug monitoring on medications such as vancomycin, aminoglycosides and anticoagulation
  4. Develop my ability to effectively manage anti-coagulation (e.g. pre- and post-op management, duration of treatment or prophylaxis)
  5. Continue to develop my ability to write concise and clear chart notes

Another great rotation at RCH! Bruce was incredibly knowledgeable and helped to build my thought process regarding patients in surgery. This rotation definitely gave me a lot of experience with infectious diseases, especially intra-abdominal infections. Bruce also helped schedule a shadowing opportunity for me with one of the antimicrobial stewardship pharmacists. One key thing I will always keep in mind when managing infections is the importance of source control! Unfortunately, I was not able to get any experience with aminoglycosides…but was able to get lots of experience with anticoagulation (e.g. VTE prophylaxis for patients who have abdominal surgery for cancer – requires 28 days of LMWH). Generally, VTE prophylaxis is started on POD 1 with dalteparin if eGFR > 10. With Bruce’s guidance, I was able to write clearer chart notes. Writing concise and clear chart notes will definitely be a goal that I will continue in future rotations.

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