My name is Haley Kirchner, I am a fourth-year pharmacy student participating in the Romania rotation. I was interested in participating in this experience because: INSERT

For this post, I’ll describe some of the aspects of the portion of the experience that we had in Romania related to our week hospital pharmacy. Each week began with meeting with a student from the pharmacy school in Cluj and then either taking a taxi or a bus over. Our first day was more of an introductory day. We learn a lot and Legia, the Clinical Pharmacist, was really great. She is the only clinical pharmacist in a 400 patient bed hospital and one of only three pharmacists total for the hospital. The other pharmacists include the Director, who is responsible for paperwork and documentation; the Distributor, who prepares doses; and the Clinical Pharmacist, who helps make clinical decisions.

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  • Who we worked with: Legia, Clinical Pharmacist.
    • What does Legia’s role look like? She handles the intensive care (ICU) patients only, which averages at about 80 patients. These patients have the most medications and problems, so they can benefit the most from her care.
  • What are some things we learned?:
    • Clinical and Hospital Pharmacists are less common in Romania.
    • The government pays for the drugs that patients receive in the hospital which helps to ensure that drug prices are very low. However, this also results in shortages all the time. A current example is Right heparin.
    • How the hospital prescription process works.
      • We were shown examples of prescriptions and how they work. A challenge for the Clinical Pharmacist was having recommendations accepted by doctors. She indicated that she had noticed that a factor affecting willingness to change is exposure to other countries and the practice trends in other countries, like the United States.
    • Compounding in a hospital.
      • We were able to make a lipid based ointment that is used on bed sores to prevent further increase in size. The Romanian recipe used lanolin, vasoline, starch, bismuth and zinc oxide. The process took over two hours to sift all the powder! The ointment was packaged into little jars. A supply of 12 lasts about two weeks. We then sat and talked to another resident about her time there and what Legia has helped with.
  • Current drug information needs in Romania:
    • We had the opportunity to read over articles to pull out important information to check against Romanian practice guidelines. I got anticoagulation and Oliva got potassium chloride monitoring. We talked about all the changes and impact on the hospital. We discussed changes protocols and their impact, such as a recent change with albumin.
  • Other issues similar to the US and Romania:
    • Antibiotic resistance and prescribing issues that impact patient care. Pharmacists can be important in writing protocols to address these and other issues.
  • What is an intensive care unit (ICU) in Romania like?:

The ICU unit that I was able to work or shadow in was different from what I expected. There were differences in the amount of walls, dividers, and privacy. The rooms that I saw had patients with different challenges, ranging from necrotic leg infections, to intubation, to neurological disorders that led to cognitive challenges or level in awareness. This experience re-emphasized the importance of antibiotic stewardship as bacterial response to infections was challenging due to what patients understand about how to take medications and the ability to access medications sometimes without a prescription in the community. Being exposed to care differences allowed me to have discussions on differences that I observed. A particular example was being able to discuss preparation of intravenous medications (nurses have full access to these medications and can reconstitute and start bags), and how pharmacists at UIHC include nutritionists that design patient specific TPNs.

This week also provided some cultural exposures like Romanian coffee (I drank way more than I usually do because it was a way to socialize with residents and pharmacists.), discussions about differences between Romania and the US; attendance at a majorat (a big deal in Romania, an 18th birthday celebration). My favorite was attending a futbol game at the last minute. Watching the cheer section was great. It was like a smaller version of the UIowa fans. The never stopped yelling, cheering and chanting. Cluj lost 0-3.

My time spent in Romania and at the hospital taught me many lessons. Learning to navigate the transportation system and schedules can be an adventure. I had to adjust to feeling noticed and trying to figure out how to navigate both work and life. Overall, I really enjoyed this experience.

About the Author of this blog:

Haley is 4th year student pharmacist from Madera Ranchos, California. Following graduation she currently plans to pursue a career as a nuclear pharmacist.

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Have more questions?:

For more questions, you can reach out to Haley at: haley-kirchner@uiowa.edu or contact us at uipharmacy-global@uiowa.edu.

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