A day in the life of a pediatric pharmacy technician

By Harumi Hope, emergency department pharmacy technician at CHOC Children’s

A pharmacy technician works under the direct supervision of a licensed pharmacist and perform many pharmacy-related functions.

At CHOC Children’s Hospital, pharmacy technicians prepare, dispense and deliver medications and make sure required administrative work is kept up to date. They take on these responsibilities so the pharmacists can focus on assisting patients and healthcare providers to ensure patient safety and satisfaction.

In addition to CHOC’s inpatient and outpatient pharmacies there are three satellite pharmacies—the operating room pharmacy, the emergency department (ED) pharmacy, and the intensive care unit pharmacy.

This is a typical day in my life as an ED pharmacy technician.

6:45 a.m. — My alarm goes off. I make breakfast, get my kids ready and choose colors for my scrubs (my favorite is maroon!), and drop kids off before work.

8:25 a.m. — Arriving at work a little bit early, I stop for a cold brew to jump start my day. My shift as an ED pharmacy technician starts at 8:45 a.m. Before heading to the ED pharmacy, I spend a few minutes catching up with my colleagues in the main pharmacy. Getting handoff from the morning crew helps me plan and prioritize my work.

8:45 a.m. — As soon as my shift starts, my first priority is to determine if there are any urgent medications to dispense. Keeping a watchful eye over the programs we use to manage these is essential to preventing delays in drug delivery. My first order to fill today is an IV antibiotic that is commonly used to treat infections.

As soon as the pharmacist verifies the order, I start preparing the medication in our sterile hood. Mixing ingredients together to prepare a medication is known as compounding. It is a specialized skill that requires clean technique, strong math skills and attention to detail. This is a very important task that can help to save the lives of sick or injured patients. I find this part of my job as a pharmacy technician especially rewarding and satisfying. After compounding this medication, I deliver it to the nurse who is taking care of the patient.

9:15 a.m. — I go to the MRI suite to replenish emergency medication trays and replenish them. Ensuring that emergency medications are available is an important function of my job.

10 a.m. — An emergency code is called, and I grab our emergency medication cart quickly and go to the patient room along with the ED pharmacist. A patient is seizing and needs a rescue medication immediately. After the pharmacist receives an order from the doctor, I draw up the dose have the pharmacist double-check prior to handing the medication to a nurse. Thankfully, the patient responds to the medication quickly. Once the patient is stable, we return to the ED pharmacy.

11 a.m. — Throughout the day, I check inventory and replenish medications stored in the two medication rooms and medical supply carts to ensure the medical team has the supplies they need to take care of patients.

Harumi_ED pharmacy
Harumi, a pharmacy technician, checks medications in the ED pharmacy.

12:15 p.m. — A patient in the ED who takes multiple medications at home is going to be admitted to the hospital, so I stop by her room for medication reconciliation. This is where we take a thorough medication history in order to make sure the appropriate medications and doses are continued while the patient is in the hospital. .   .

1 p.m. — I try to eat healthy, so I pack salad with homemade dressing, spaghetti and fruits. When there is not a lot of time for cooking, pasta is always the answer.

1:30 p.m. — When I return to the ED pharmacy, I continue with drug preparation, inventory replenishment and medication reconciliation.

4 p.m. — While my priority is ED patients, I try to help the main pharmacy whenever I can. This time is usually the busiest time in there as they have the biggest medication batch for the entire hospital.

5 p.m. — The ED pharmacy receives a page of an incoming trauma patient. The pharmacist and I go to the assigned room with our emergency medication cart and wait for the patient to arrive.

When the transport team arrives with the patient, a paramedic explains what happened, and I try to catch all the important information in case medications are needed. Although the patient has some wounds on his forehead, fortunately, he is stable and doesn’t seem to need any medications at the time.

6:30 p.m. — After several orders and a medication reconciliation, I start cleaning my work station, IV hood, and other areas in ED pharmacy.

7 p.m. — The night shift ED pharmacy technician comes in, and I update him on the day. After making sure everything is clean and stocked up, I head home.

7:50 p.m. — My kids have already eaten dinner, so I quickly eat when I get home. Before tucking the kids to bed, we spend some precious time reading together. They both like to read a lot, and I am very proud of them especially because I never liked to read as a kid. Although there isn’t much time with them around this schedule, I do my best to support them in different ways, and I really appreciate my family for understanding my work.

8:30 p.m. — After preparing lunch for tomorrow and giving the kids a shower, there is finally some time to myself. I enjoy unwinding with music. It is my favorite time of day.

In bed, I think about what I can improve the next day for a better patient care. Sometimes, I dream about making medications.

Although the days can be hectic, I enjoy being a mom and working as a pharmacy technician. There is so much to learn every day and so many opportunities for growth in the pharmacy. It can be stressful, but I work with a passionate group of people who like what they do for our patients, and I am proud to be part of the team.

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What do psychiatric medications do?

By Alice Kim, clinical pharmacist at CHOC Children’s

Mental health is an important part of overall health. Therapy is important, but sometimes, medication is necessary to improve or maintain our mental health. These psychiatric medications are safe and effective when taken appropriately under a doctor’s supervision.

Psychiatric medications influence the chemicals in our brains that regulate emotions and thought patterns. They can reduce symptoms such as loss of energy and lack of concentration, so therapy can be more effective.

Psychiatric medications include a variety of drugs prescribed to treat different types of mental health problems, or to reduce symptoms associated with these problems. There are five main types of psychiatric medication: antidepressants, antipsychotics, stimulants, anti-anxiety, and mood stabilizers.

Antidepressants help reduce feelings of sadness or depressed mood and anxiety as well as suicidal thoughts. They do not, however, “make people happy” or change their personalities. Possible side effects of antidepressants include drowsiness or insomnia, constipation, weight gain, tremors and dry mouth.

Antipsychotic medications help reduce or, in some cases, eliminate hearing unwanted voices or having very fearful thoughts. These medications can promote thinking clearly, staying focused on reality, and feeling organized and calm. They also can help you sleep better and communicate more effectively. Possible side effects of these medication include drowsiness, increased appetite and weight gain, blurred vision, constipation, dry mouth, dizziness, restlessness, shakes and twitches, and muscle stiffness. Rare side effects include seizures and problems controlling internal body temperature.

Stimulants and related medicines help improve concentration and attention spans in both children and adults by reducing hyperactivity and impulsiveness. Possible side effects include trouble falling asleep, decreased appetite and weight loss. Less common side effects can include headaches, stomachaches, irritability, rapid pulse or increased blood pressure. These often go away within a few weeks after stopping use or if your health care provider lowers your dose.

 Anti-anxiety medication can reduce anxiety and help you feel more relaxed. These medicines are generally safe when used as prescribed and usually are temporary, since long-term use can cause dependency. Call your doctor right away if you experience headaches, slurred speech, confusion, dizziness, increased nervousness or excitability when taking these medications.

Mood stabilizers help reduce or eliminate extremes of high or low moods and related symptoms. They should not keep you from experiencing the normal ups and downs of life, though. Side effects can include an upset stomach, drowsiness, weight gain, dizziness, shaking, blurred vision, confusion, or lack of coordination.

How to deal with side effects of medication

Side effects often get better with continued medication therapy. For side effects of mental health medication that linger, here are a few tips:

Side Effect What can be done
Dry mouth Try sugarless gum or mints
Constipation Drink plenty of water and eat lots of fruits and vegetables. Ask your doctor or pharmacist about over-the-counter laxatives.
Nausea or upset stomach Take your medication with a meal. Ask your doctor about anti-nausea medication.
Feeling sleepy Ask about changing the time when you take the medication.

Despite the prevalence of mental illness in the U.S. – one in five people have a diagnosable mental health disorder—an unnecessary stigma remains surrounding seeking treatment and utilizing prescribed medication. If you have a mental illness, know that you are not alone. For those without a mental health condition, educate people around you about the reality that mental illness is more common than people realize and speak out against stigma. By improving mental health education, we can challenge our misinformation and negative attitudes.

Stay informed about mental health.

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.

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A pharmacist’s guide to safe and proper medication disposal

By Melody Sun, clinical pharmacist at CHOC Children’s

Medications can have harmful consequences if they are not properly handled. The following steps will help you ensure the medication in your home is properly disposed, with minimal chance for discarded medications to cause illness. Consult your local pharmacy, or local garbage and recycling facility with specific questions.

General guidelines

Medicine take-back days are the preferred way to safely dispose of most types of medications. The U.S. Drug Enforcement Agency holds periodic national drug take-back events, where temporary collection sites are set up in communities for safe disposal of prescription medications. Find out more about upcoming drug take-back days.

If there are no specific instructions in the medication package insert, you can follow these simple steps to dispose of most medicines in the trash:

  • Pour unwanted or expired medications out of their original containers into a zip baggie.
  • Pour hot water (over 110OF – about as hot as a cup of coffee) into the baggie.
  • Insert kitty litter or another inedible product such as dirt or used coffee grounds into the baggie. Seal baggie. Place in trash bin.
  • Remove all personal information on the prescription label or empty pill bottles. Shred them or use a black marker to cross out label information.

Injectables

Devices that penetrate the skin to deliver medication are known as sharps. Any medication that requires delivery with a needle, such as an Epi-pen or insulin pen, comes with a high risk of accidental injuries, so it must be properly disposed in a sharps container. Some drug companies provide a red sharps container for using their medications. Please refer to their website for directions on how to obtain it. You can also purchase a sharps container through various approved mail-back services or make your own.

A sharps container is:

  • Made of heavy-duty plastic
  • Puncture- and leak-resistant with a tight-fitting lid when closed
  • Upright and stable when used
  • Properly labeled to provide caution about hazardous/sharps waste
  • Example containers to use: plastic detergent bottles, liquid fabric softener bottles, empty bleach bottles

Remember:

 Inhalers (aerosols)

Most inhalers can be safely thrown into the regular trash or recycled. Contact your local garbage or recycling facility for specific instructions.

 Patches

 Children may mistake medicated patches as stickers, which can lead to overdoses or even death. When discarding medicated patches, keep in mind the following safety steps to prevent kids from being accidentally exposed to unneeded medicine:

  • Fold the patch together with the medication side inside
  • Mix in an undesirable substance such as cat litter or coffee grounds
  • Place in a sealed container or bag and throw into the regular trash
  • Some patches can be flushed down the toilet. Refer to the Food & Drug Administration flush list.

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Budding pianist gives back to CHOC through piano recital

Lucie, age 13, is no stranger to performing. The budding pianist started playing piano when she was 6 years old, won her first local competition at 7, first international competition at age 9, and currently takes private lessons in addition to attending a performing arts school.

Earlier this year, Lucie’s piano teacher encouraged her to perform in a solo recital for the first time. Lucie’s first thought wasn’t about which songs she would perform or if she would feel nervous on stage — it was about turning the recital into a benefit concert.

Lucie had briefly been a patient in CHOC Children’s emergency department when she was a baby, but her connection to CHOC runs deeper. Her mom Carolyn has been a clinical pharmacist at CHOC for a decade.

“Lucie has grown up hearing about exciting new treatments we’re continuously offering at CHOC, the new technologies we get in the pharmacy, and the important work done for children in our community,” Carolyn says.

Like many people in her community, Lucie has known family members and friends who have received care at CHOC as well.

All of that made Lucie’s decision to choose CHOC as a beneficiary of her concert an easy one.

“I’m grateful to CHOC for treating my friends, relatives, neighbors, and classmates, and I wanted to give back. And this was the perfect opportunity,” Lucie says.

choc-fundraiser-letterboard-thank-you
Lucie’s sign to thank recital attendees who donated to her CHOC fundraiser.

Her decision to give back to CHOC made her mom very proud.

“As much as I wanted Lucie to choose CHOC, I felt it was important for her to choose a non-profit that was close to her heart. So, when she told me she chose CHOC, I was beyond thrilled,” Carolyn says.

Lucie’s concert raised more than $2,000 in support of KidsCARE, a fund that provides unrestricted financial support to meet the greatest needs of the hospital.

Throughout this experience, Lucie has gained a deeper understanding of the importance of giving back, her mom says.

lucie-choc-fundraiser
Lucie speaks to her audience before her recital, which she used as a CHOC fundraiser.

“When children learn the importance of philanthropy, it helps instill altruistic values and helps them develop empathy for others,” Carolyn says. “By giving back, they learn they can make a difference in society, even at a young age. This experience reminded Lucie of everything positive in her life. She gained an important lesson in humanity that will be helpful for the rest of her life.”

Lucie hopes to inspire others to give back.

“To any other young person who wants to give back, I would say don’t be intimidated. It may seem overwhelming to start your own fundraiser, but it’s not. It doesn’t have to be this grand event; it could be something as simple as a neighborhood bake sale or lemonade stand,” she says. “Think of an activity you will enjoy doing. Enlist your family members and friends to help out. Take advantage of social media to spread the word about your fundraiser. Regardless of how much you raise in the end, know that what you did is important and makes an impact for the patients at CHOC.”

Start your own CHOC fundraiser

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Ask a CHOC Doc: How do I properly use a spacer with my handheld inhaler?

Question: I suffer from asthma, and recently got a spacer for my handheld inhaler. How can I make sure I am using it properly? ­-Anonymous

Answer:

A spacer is a small device that can attach onto the mouthpiece of a handheld inhaler device via the inhaler adaptor that allows you to receive the correct dose of medication with each puff. The medication fills the inside of the spacer chamber (body) and allows you to have ease of inhaling the medication through the mouthpiece.

handheld-inhaler
© 2009 – 2019 www.asthma.ca

Once the inhaler dose has been administered, simply replace the cap over the mouthpiece and remove the oral handheld inhaler device from the inhaler adaptor port. Replace the cap over the mouthpiece of the inhaler device and store both at room temperature (68 – 77 degrees F or 20-25 degrees C) in a clean, dry area. To protect from moisture, store the handheld inhaler in a plastic zip-sealed bag.

Proper techniques to rinse mouth after using certain oral inhalers to prevent thrush:

There are certain oral handheld inhalers, referred to as inhaled corticosteroids or steroid inhalers, that can increase the risk of developing oral thrush, a fungal infection in the mouth. Thrush looks like a white, patchy rash inside the mouth and on the tongue, which can be painful and requires an anti-fungal medication to treat it. If you are prescribed a steroid oral inhaler, it’s recommended that you rinse your mouth with water and spit after each dose of the inhaler. After rinsing your mouth with water, it is best to also brush your teeth. By following these easy steps, the risk of developing this is significantly reduced.

oral-thrush
Image: Oropharyngeal / oesophageal candidiasis (oral thrush). www.mymed.com (2019)

If you have specific questions about your inhaler, consult your primary care doctor.

violet-valencia-pharmacy

-Dr. Violet Valencia, clinical pharmacy resident at CHOC Children’s Hospital

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