Chemo, Injections, and Hoods.. Oh My!
I want to start off this blog post by first saying, “Welcome to ACP, Class of 2019!!” I hope everyone is getting settled in nicely and is doing well in classes so far!
Now, the P3s have been on rotation number 2 – yay! I was placed at Tidelands Oncology Center at Georgetown! The rotation is placed in the beautiful Palmetto State of South Carolina! Upon getting the notice that I would be attending an oncology rotation, I felt a little frightened. Oncology is a scary subject and the drugs are hard, not only to learn but on the patients taking them. At the conclusion of the Oncology course at ACP, I was certain that I would not enjoy this rotation and that my knowledge on the subject would not impress my preceptor at all. I was afraid that I wouldn’t be able to handle seeing the patients, knowing how their disease and course of treatment can make them feel. However, after being on this rotation for only 3 weeks, I quickly realized that this is not the case. The patients are all very positive about and involved in their treatments. They all seem so high spirited and ready to fight that scary “C” word. My preceptor and her technician have been nothing but understanding and are very patient with me as I learn the world of oncology pharmacy.
My day to day routine is very exciting. We begin our day at 8 AM by gowning up and cleaning the laminar air flow hoods, horizontal and vertical. After that it is time to prepare the pre-medications. Pre-meds are all medications that are administered prior to administering chemotherapy drugs. These include steroids and antiemetics, among others. Upon notice from the nursing staff that a patient is ready for treatment, we will start to prepare and mix the chemotherapy. The facility at Georgetown uses a brand new, needle-less, closed system for mixing chemo. “What?! How do you mix chemotherapy without needles?!” That was my reaction when I was first told about this system too. Basically, this new system is designed to prevent risk to the pharmacy and nursing staff. I’ll explain.
There are several different adapters: syringe adapters, spike bag adapters, luer lock adapters, and vial adapters. These adapters keep the chemotherapy from leaking out or being accidentally displaced from the syringe. To start mixing, first the IV fluid bag must be connected to its adapters and tubing in order to be primed. Once the bag is primed and ready to go, the chemotherapy vials are prepared by attaching the vial adapters. Lastly, the syringe is attached to the syringe adapter and now we are ready to mix. To pull up drug from the vial, the syringe adapter and the vial adapter must click together. You can pull drug into the syringe or you can push it back out, but when the adapters are no longer attached, you can no longer push drug out until it is safely connected to another adapter. As nerdy as it sounds, it is actually very cool and safe for everyone involved in mixing or administering!
Alongside the closed system, we use a software called DosEdge. This software allows for a system of checks and balances for the pharmacist and technicians. It requires the technician to take pictures of their mixing process. The pharmacist can verify the dosage is correct either inside of the IV Clean Room or from their desk in the office using the pictures. It can become tedious when you’re in the hood mixing medications, however after a while you get used to the work flow. Not to mention, patients can have up to an hour or so of premeds before the chemo can even be used, so therefore there isn’t really a rush for time when mixing these medications. Using this software also helps identify medications based on their lot number in case of a recall. They can track which vial went to which patient on what day, if necessary.
The Cancer Center at Georgetown has given me opportunities to work front line with new therapies in cancer treatments. About a week before my arrival at the center, the staff attended an educaitonal dinner regarding a new treatment for Multiple Myeloma, Darzalex (Daratumumab). This treatment is approved for patients that have failed three previous therapies. It just happened that our site had a patient that fit that profile. On my second week on rotation, I was able to mix Darzalex for our patient, see the nursing staff administer it, and see the patient successfully complete one cycle without any complications. This was the first time this drug had been administered at this location. It was such an amazing experience to see first hand the research involved prior to administration and the preparation of the patient for therapy! The world of chemotherapy is always rapidly changing!
This rotation has proven to be a blessing in disguise. My bit of advice to P2s and P1s is: don’t base your opinion of Oncology solely on the course taught at school. It is so much more than what we are taught and has honestly been one of the most humbling experiences. It’s a lot of information and a lot to know, but it’s also very rewarding knowing that these drugs that you are mixing are literally keeping someone alive. If you’re even the least bit interested in the world of Oncology, I highly recommend the Georgetown Infusion Center as a rotation site!! (Not to mention there is a beach!)
