The pharmacists behind anesthesia drug management
Вставка
- Опубліковано 15 чер 2024
- Behind every anesthesiologist is a pharmacist who plays a vital role in the safe delivery of anesthetic medications. In this video, I get access to a restricted are to see exactly how the operating room pharmacy works at a major academic hospital.
This video was made with the approval of Mount Sinai Hospital's Department of Pharmacy and Department of Anesthesiology.
0:00 Start
0:37 Operating room pharmacy
3:58 Controlled medications
7:39 Medication preparation
9:28 Out-of-date meds
10:07 Compounding
12:20 Pharmacy careers
Music:
Subtle Swagger by Ron Gelinas: / atmospheric-music-portal
The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.
#Anesthesiology #Residency #MedicalSchool - Наука та технологія
Pharmacists are essential and often unappreciated members of medicine. When I had chemo I could not stop vomiting, I tried 8 different medications, smelling alcohol wipes, everything. The doctors said I was out of options. My retail pharmacist fixed it in under ten minutes. She spoke to me about what medicines I was taking together and wrote me a schedule of what to take when. I ever vomited again. She fixed the worst part of chemo when the doctors didn’t know how.
I have a very similar issue you did. I have Lupus meds that make me so violently sick, but my doctor kept saying that since the nausea meds didn’t work, I should just learn to deal with it. Luckily my pharmacist heard me complain about not being able to eat. She taught me what to eat first and how much water to drink and things to avoid. I still have a bit of nausea, but I’m so lucky to be able to eat again. The meds I’m on seriously saved my life and allow me to walk again so I can’t imagine having to live without them.
I'm definitely unappreciative, half those drugs sound crazy, IL take a clean right hook before that needle
Could you write down the schedule? Thanks!
Deeply impressed with the close but highly professional relationship between pharmacy and anesthesia here…it’s not the situation everywhere…
34 years! She is a golden gem
Just to clarify, PharmD requires four years of professional school with as little as two years of undergrad. Most obtain a PharmD after 7-8 years beyond high school. Most speciality pharmacy positions like the ones mentioned (onc, ED, peds) require a general inpatient PGY1 residency and then a second PGY2 residency in that specialized field.
She is the person I want to see in the morning before my surgery. Pharmacists know their stuff!
Walgreens pharm tech here; thanks for this delightful look into hospital pharmacy. The dream location for many suffering in retail pharmacy.. haha!
Your channel sets the standard for medicine on UA-cam. Thanks for all the great content, Dr. Feinstein! If I had it all to do over again, I would have gone into medicine and anesthesiology. The ship has sailed for me but its great to see so many amazing young clinicians to take care of us all in the future!
Much respect for pharmacists, they do the quality control that sometimes your doctor might miss. It’s important to have a good relationship with your local pharmacist. It could be life or death.
This is interesting to see how a different hospital does this. I am an inpatient pharmacy technician at another large hospital in a different city and we have pyxis in all of the ORs. The night shift are the only people that actually go there so we never really interact with anesthesiology unless they run out of something or need something particular to be brought up during the day.
It's so cool watching medical personnel with youtube channels changing their titles as they evolve and grow in the profession with every new video :)
Hi Max! Thank you so much for providing a behind the scenes look into the world of anesthesiology. Although, I'm from another country (Hungary) I can just hope that our hospitals and doctors have the same level of professionalism as you have. I had 7 surgeries so far, 3 knee surgeries (keyhole/laparoscopic) and 4 surgeries related to a ruptured appendix. My CRP level was 396 when I was admitted to the emergency room...I'm lucky to be alive. Huge thanks to the anesthesiologists and surgeons working on my cases. And please keep uploading new videos. :) Your sense of humor is phenomenal.
Great interview ! Spot on. I’m a pharmacist who works in an OR pharmacy. I can attest to the wonderful rapport we have with our anesthesiologists and anesthetists. We also looked at having machines for dispensing in each of our OR suites. You mentioned the inability to interact with someone for issues going on in the OR. Add to that the expense of the machines and medications needed to stock them. Also increase in workload to maintain and stock all those machines. I would definitely miss all the folks who come to the window to pick up their drugs.
I'm a hospital pharmacy tech and we have dispensing machines. I view them as a faster way to get medications to patients, and there is less of a need to jump back and forth to get meds. They are filled with a sufficient amount daily. Also, they make tracking controlled meds easier. You would not have to return them everyday. There isn't much workload if enough staff is in the pharmacy. They are usually stocked once daily.
@@rmccabe916 All you have said is true. When I consider our OR techs and all they do - they would not have time to tend to 27 machines - one in each OR and 4 more in Endo plus all they already do. Management is looking at taking one of our techs away from us. They are trying to get rid of FTE’s.
That sounds awful. Drug quantity in our machines is remotely monitored, which makes our job easier. Our pharmacy handles about 13 ORs and 150 patients, with about 30 Pyxis total (part outside ORs). OR machines are usually smaller, and the filling process is quicker than inpatient models. Pulling meds to fill is primarily the longest process, but you don't have to do it per patient, just each machine. And it makes charting a whole lot easier for doctors.
Max, I absolutely LOVE your mindful approach to economics of medical practice. While that aspect is not as critical as efficacy from a purely medical standpoint, it does have a tremendous impact on patients after discharge. Thanks for caring!!
My Fav Dr. on youtube, no annoying flashy editing with silly sounds, not overly produced and just the right amount of production value to feel authentic.
What a fascinating look into pharmacy. I had no idea how involved pharmacists are in the entire operation of a hospital.
Thank you for spending some time going into the controls preventing abuse. Whenever I see Dr. Feinstein pull a tray... I always wondered what was preventing someone from just sneaking into the OR and pulling a vial from the tray. I'm a little surprised residency isn't required for licensure.
I love that the job of pharmacists is to count pills, and in their free time they provide invaluable patient counseling, prpvider counseling on pharmacokinetics and shit. They keep medication in stock and unexpired, but they also run quality control, aggregating and addressing clinical concerns over safety and efficacy. And just generally keeping a pulse on everyone, checking for bloodshot eyes or something.
They just count pills, but they actually do so much more, the pills are just the obvious function.
Interesting I been a pharmacist for 19 years and haven’t counted a pill yet
What everyone else said. Just adding thanks to Miss Marina for making time for all of us and explaining in such depth the topics you covered.
Wow! That was awesome! The OR pharmacy is very important! I learned a lot! I really wanted to be a anesthesiologist physician, I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy! You rock man
KONICA MINOLTA KONICA MINOLTA KONICA MINOLTA4217
PLASHETWARD LONDON 18th JANUARY 19th FEB
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Hospital pharmacy technician here. I completely understand the benefit to having a pharmacist to speak with in the OR if you have questions during operations. But it just would seem so ineffecient go in and out of the room for more meds at the pharmacy. Our central pharmacy staff is always available to help and is a call away. You have a good working rapport and experience with your coworkers, though. That is what really matters. Thanks for your service in the OR. 🙂
You can’t forget about us pharmacy technicians we are the backbone of the inpatient hospital pharmacy on all levels. Specially speaking I am a hazardous compounding pharmacy technician at a cancer hospital (I make chemotherapy)
Love that a doctor influencer highlights the pharmacists role. Hope I can shadow doctors as good as you guys on rotation soon
Having learned a lot about behind the scenes stuff that goes on between my brother-in-law who’s a clinical engineer in charge of the mapping equipment during heart ablation surgeries and my sister who’s a clinical engineer in charge of equipment installations at hospitals I am always fascinated by learning about other behind the scenes aspects of things that go on in hospitals, so thanks for sharing this great information with us!
Love your content as usual, Dr. Max!! Very educational!
Geez gawd Dr Max makes one looking forward for a great trip under the spell of anesthesia drugs. Seriously he’s doing a wonderful job doing these videos. 👍
Amazing video Dr.! Thank you for sharing your and the pharmacist’s knowledge.
Thanks for highlighting the great work of the pharmacy team at your hospital!
I’m a pharmacy technician, and have enjoyed learning what the drugs do! I load them in the operating rooms all the time, but you’ve taught me how they’re used.
Love you, will be following and keeping up with you and your family. ❤ I'm so sorry, although I know that doesn't make it better. I always look forward to your videos, your voice comforts me and I love keeping up with your family
Thank you Dr. Feinstein.
Its so nice to hear from a practicing Doctor.
For nearly a decade, I provided IT support to a public R1 university's PharmD-based (2 years undergraduate, and then 4 years professional education) college of pharmacy, which included a research drug production facility. I had many great friends and colleagues among the faculty, staff, professional students and graduate (med chem/pharmacoeconomics, etc. ph.d.) students. Pharmacy is a truly fascinating field, I'm glad you were able to do a video with a pharmacist! 🖤💛🦅
This is an excellent interview, providing good insight into quality operations of a pharmacy department at a hospital. Although I am not related to medicine, I work in an industry that is similarly "never-fail" -- or at least, that is the goal. Learning a bit about how an aspect of a quality hospital operation manages this is quite useful. Thank you.
Thanks for showing another OR pharmacist - people don’t understand what pharmacists do in the hospital.
Love your channel! Thanks for al×ays being so fascinating!
Great video. We appreciate pharmacist roles being included in inpatient care
UK hospital theatres pharmacy tech here. Thank you, Max, for showing our work.
Med management and reconciliation sure has come along way.
Now i understand how complicated anaesthesia stuff is. Thank u Dr.
Awesome video regarding surgical pharmacy. Probably laid to rest fears regarding getting the wrong drug...
15:20 Max, your so awesome !!! I've said this before, if I ever needed surgery I would want you to be my anesthesiologist !!!
That was really cool and informative!!! Thank you for this video! My two favourite fields Anesthesia and pharmacology!
Fascinating! Thanks for another great video. It feels like we watched you grow up, "back when I was a resident" haha
This is very interesting....so much happens "behind the scenes" in terms of what happens in a hospital/pharmacy.
What am interesting video. Even though I’m not a doctor myself, it’s quite clear to me everything you’re saying. This is such a good material to everyone from patients to health care professionals.
I am an anesthesia and intensive care nurse in Germany. The dispensing of narcotics in anesthesia and intensive care medicine in Germany is the responsibility of the nursing staff. It's very interesting to see how different countries follow different laws! Thank you for this insight Mr. Feinstein.
Best regards,
Shimon
That was very interesting and educational. Thank you for the video!
At 13:40, please note there was an error regarding qualifying to become a pharmacist in the US. Currently, there is a *four year* PharmD program, AFTER 2-4 years of undergraduate studies. After successfully completing the 4-year Doctor of Pharmacy degree, a comprehensive licensing examination must be completed in order for the graduate to be legally licensed to practice in their state.
Drug abuse in hospital occurs more than you think. I was involved in two cases as a patient where 1 a nurse wasnt delivering the pain meds timely but the records showed another. I had video the clock for a 1/2 hour before and after the dose was due. The nursing director caught her. The second one was. Traveling nurse not providing the right dose. The prescribing notes were on the board in the room so i knew what i was supposed to get. She argued with me and i met with the director of the hospital in the morning. Don’t know what happened with that one. Great video.
It’s frustrating how many people think pharmacists just count and push pills all day. As this interview shows, they do so much more. They’re an integral part of medicine!
You have to do at least one more video with her!!! I'm wondering if she could talk about all the types of staff in the hospital pharmacy and how they work with pharmacists? I love your videos
lmaoooo her reaction at the end re: pharmacist reacts to dr. glaucomflecken. "....we could." i chuckled. amazing video as always; always hoping that whenever i transfer a patient to the OR that i might meet max the youtuber! sinai pride
I am assuming this is just one area that is important to you---where their work allows you to do your job without having to be distracted by doing extra work. Everyday you grab meds you need---without having to do extra work to get them ready. Thanks for giving exposure to pharmacy and any other area you showcase at a later time.
Hi, dr. Max, thanks a lot for this video!!
Loving everything I'm listening to
Max your great!! I’ve had lots of surgeries. This gives me so much peace of mind.
Very interesting topic. Appreciate it Max.
It’s fascinating that pharmacists are so involved in the technical aspects of pharmacy in the US.
RPhTs in Canada do everything, including managing & dispensing (including controlled drugs). Pharmacists are involved in clinical work on the units, they don’t even have to be in the pharmacy for the day-to-day work.
Im a pharmacy technician. This video means a lot
Your videos have been really eye opening to me, thanks for these in depth discussions. I never gave much thought about anaesthesia before, however since they've made me worry about how they work. You mentioned before that the drugs that you use to induce anaesthesia are amnesiacs, however is there a chance that the patient is aware during the surgery but they simply don't remember after? It's a troubling thought I keep having, I wondered if you'd share your thoughts on this. Sorry if you've already mentioned this before on any other videos!
Here in Atlanta sadly we find used up Fentanyl vials and they look to be licked clean inside and not that anyone cares but they must be getting stolen from a pharmacy or hospital by the box because there are lot #s and drug info on the ones we've seen. On a new home we are wiring right near old stadium every day we sweep up used syringes on sidewalk and ones stuck into lumber piles that may injure our workers even with gloves. I just happened to see your utube because I'm getting ready to have a 3 hour neck spine surgery and curious how much anesthesia will be pumped into me during procedure. Great info I was going to go to Med school but decided I'd make more as board licensed electrician and zero school loans. Now I'm regretting that feeling all the injuries I've had over the years. A+ channel.
Fantastic video. If you haven't done so already can you do a video focused on infection control including not bringing personal bags into the operating suite?
training path question, thanks Max
pharmacy gang lets go
👉 Vital info, as always. Thx Max 😊
My mom is a nurse and I have always thought that it would be cool to be a surgeon or and anesthesiologists, but there is no way that I could even come close to passing med school. lol
Cool video Dr Max!
I like that she calls him "Feinstein". She reminds me of Edna Mode in The Incredibles.
She has one of those most desirable pharmacy jobs out there. Creme of the crop literally AND in NYS. That is a tall order in the current climate for the pharmacy field.
At the point you film the pharmacy's handout window, I noticed the presence of a drawer/box with phenylephrine (250ml bag, 80mcg/ml). Is That there for easy access during emergencies?
Nah it’s just for when employees want to take the edge off
@@nathanlopez5332LoL 🤣😆😆 your killing me with your comment 😂😂
Just watching a video from a while ago about waking up during surgery. I had knee replacement surgery in 2009 and I remember stirring and hearing a very loud pinging sound like a hammer hitting metal. I can still hear it. I didn’t feel any pain but it was weird.
Enjoyed it 😊
As a opioid addict i would literally do anything to get to that pharmacy room
LOL!
You'd have to get through the safe first. Plus pharmacists and techs are known to be some of the biggest sticklers in the hospital. You'd have a hard time getting around us. 😠
You would get 5 wanted stars pretty quick 😄
That bag from the pharmacy looked like about a weekend’s worth of fun for me when I was an active addict! 😅😂
I recently learned that the rapper Tyga that was put under general anesthesia for an 8 hour tattoo session. As someone with tattoos, I think that's ridiculous to go under general anesthesia, myself and many others find that the pain and the process of receiving the tattoo is part of the whole experience and to "fast travel" through that seems ridiculous to me. Although to his credit, I will add I don't think I would have the patience for an 8 hour session, I'd have to break that up over at least a couple of days. But anyway, I know this is outside of your normal video type but if you got the chance to make a video just providing your point of view as an anesthesiologist, I would love to hear that. And I wouldn't ask you to attack him or anything, I just want to know, what are the medical risks of going into anaesthesia for a tattoo or is this an appropriate use for anesthesia from a professional perspective?
Not an anesthesiologist, however all anesthesia use comes with potential risks. Is the tattoo artist administering the anesthesia themselves or is there an actual anesthesiologist present? What level is being provided (local, regional, general)? Is the tattoo shop near a hospital in case things go south? How much will it cost? Numbing cream will be different to general anesthesia.
@@danielles3841yes, a tattoo artist is administering general anesthesia. seriously?
Ive sat for 7 .. your endorphins kick in .. I didn’t feel much past the first hour
"think before you ink"
@@gracep2910 eek. yeah no, I'll pass on that. I have a hard enough time with the anxiety of a trained professional putting me under.
Please also interview the lab. They have vital role but are so hidden from the outside world
Hey Max! May I ask where you are doing your fellowship at? 😊
LMFAO, idk if he did that on purpose or what but the signing off on the medications at 4:53 got me
When you get your medication form the pharmacy what is when you need something during an operation which you didn’t encountered before? Like extra medication or something else because the situation changed.
Hi Mr Feinstein, I have a question, lets say 1 of your anestrhesiologist takes pain medication namely dilaudid for back pain , and then he or she does their job and maybe the person has red eyes etc.. and dilaited eyes but its not from what they use during the procedure what would the pharmacist do then? Its not like the doctor is using the meds during the surgery but they are taking their own. Would they have to tell them they have a prescription of their own.? And how would something like that work?
So outside is awash with Fentanyl but the hospital is short. Crazy world. Always interesting videos though.
Well. I wouldn't want the street fentanyl in the hospital lol. That shit is mixed with all sorts of different garbage
Every 2 or 3 month i going under surgery for all my life and i have to said i can sale anesthesia just in my blood like crazy and the weird part is because u used to get anesthesia for so long you can said what is the same or not like i was in surgery last month and i feel so different also is took more time to me to woke up they rush me to icu because i cant open my eyes when my doctor tell me the maybe i get a reaction for that reason in my next surgery in 2 weeks they are gonna used a different one
Part-timed it on a southeastern PA medic chase vehicle for almost 20 years, I had 2 C-II's; Pancuronium; and 3 C-IV's which required verification and recording at each shift change. That was a pain in the arse (nerve wracking responsibility) ; this??? I'd want an armed escort back to the O.R.!
How does it stop them stealing meds if they just chart they gave it?
Why would the cost make a change change of decision ?
Dr. Feinstein, as a future CRNA, can you make a video regarding your professional relationships with CRNAs and the responsibilities they have within your healthcare facility? Thanks!
No wonder operations costs so much.. if each and every operation has its own tray with meds inkl every "shtf" option.
Edit: if possible to figure out, how much does one tray cost :)
Good video. Alittle confused by the 2 years of pharmacy school that was quoted, maybe she misspoke
It’s 6 years all together, 4 undergraduate and 2 graduate. It depends on the state and the school. Some have accelerated programs, some have dual majors etc.
It’s 2 undergraduate and 4 graduate in the U.S. Current PharmD student here. (8 years all together for myself as I completed a BS in biochemistry prior to enrolling in pharmacy school.)
Whats the strongest opioid that is stockpile??
Fentanyl is the strongest common opioid, although medications like sufentanil and remifentanil do exist, they are stronger, but they are less common.
Please do a video with a CRNA!!!
Is this hospital the same as Cedar-Mt Sinai?
No- this is Mount Sinai in NYC.
@@MaxFeinsteinMD Hey, thanks! NYC is spoiled with excellent hospitals.
do people feel the tube when its in your mouth
No you’re under anesthesia
Hey the nordstrom anniversary bell
FENTANYL???
2 year pharmacy school? I thought it was 4 years for a PharmD
It’s 6 years altogether-4 undergraduate and 2 graduate. There are some accelerated programs, as well as dual majors depending on school. There are over 143 pharmacy schools in the US and you need to do your research. If I could do it again, I would chose dual majors over an accelerated program.
Midazolam is controlled in the USA?
en.wikipedia.org/wiki/Midazolam#Legal_status
@@jaromirlatal177 Thank you. I framed my statement bad, It was more of an exclamation of wonder about those news than having doubts. I am used to having Midazolam standing in the medicine cupboard and not in the "drugs save".
@@FrozenFingers What country are you in? Benzodiazepines are very commonly abused drugs, and therefore are considered controlled substances in nearly all western countries, not just the US.
Were you drug tested for asking questions?
Haha no I was not 😂
With the looming collapse of healthcare, what do you see happening to safeguards?
You can tell shed be a nightmare if you were a dr that liked to get high on the supply. lol
Why can't we design a closed-loop security system for medication whereby access to, administration of, and disposal of exact quantities are measured? It could be done using NFC tokens built into syringes or an unremovable sleeve, in conjugation with modifications to the pump or administration device being used to detect and record the data. This would be a system that is very difficult for one individual to circumvent.
I wonder why this hasn't been implemented yet.
Cost, complexity, difficulty to adapt to clinical needs like diluting medication concentrations.
@@MaxFeinsteinMD Ahh good ol’ reality check. Thank you for the video, I really learned a lot and became aware of challenges in medicine I didn’t even know existed. - first year med student here.
Best wishes on your journey!
I was born there!