Dr. Brian Brown, PharmD is a practicing CVICU/Cardiac Transplant Pharmacist at John Hopkins ALL Children’s Hospital in St. Petersburg, FL. I met Brian in 2012 while he was completing his PGY1 residency at Children’s of Alabama.
In the fall of 2012 we became co-workers. I only had the opportunity to work with Brian for 1 year, but in that year I learned a great deal from him. I gravitated to Brian’s passion for the practice of pharmacy, his thoroughness in completing tasks, and his ability to consistently give 100 percent of his energy to serve others through the practice of pharmacy.
We became good friends in the years that we spent together at Children’s. Professionally, it’s been great to bounce ideas off of a pharmacy savant. Personally, it’s been great to know Brian because he’s a good person. I’m thankful for Brian and count him as a friend. He is a good man, smart, a hard worker, loyal, thoughtful, and compassionate.
I’m thankful Brian has taken the time to be apart of “Profiles in Pharmacy“; he has a wealth of knowledge and expertise to share to our readers today.
1) When did you realize that you wanted to be a Pharmacist?
I decided that I wanted to become a pharmacist at the end of my freshman year of college. I knew I wanted to go into the medical field and was in the pre-med track. Throughout my freshman year I had several different people tell me how they thought I would be a great pharmacist so I decided to apply for a job at a pharmacy and give it a try. After a few months of working in the pharmacy environment I changed from the pre-med to the pre-pharmacy track.
2) When you were in pharmacy school, did you always know you would be a clinical pharmacist working in a Hospital Setting?
No, I did not. My experience on entering pharmacy school only consisted of retail and that was where I was heading in my mind. It wasn’t until my fourth year of pharmacy school when I was on a neurology rotation with my preceptor Jody Rocker, that I really started considering the clinical track. I finally decided to pursue a residency and become a clinical pharmacist a few rotations later when I was completing a Pediatric Intensive Care Unit rotation with the amazing Kelley Norris.
3) How are you able to maintain your composure during Codes (cardiac arrest)? What advice would you give students desiring to work in a critical care environment do to prepare themselves for your rotation? What would you tell new pharmacists about what to do to be better in Code situations?
Maintaining your composure can be difficult but it is essential in code situations. It is important to know that you are there for a job of preparing and getting medications to the patient in a quick and accurate manner, and that you are the best person there for that job. Be sure to stay focused on the why you are there. I also do not like clutter, so keeping a clean work station helps me out a lot, since I am able to locate my medications and supplies easily. Additionally, repetition and practice help with composure in code situations. Continue to practice your skills and keep them tuned up by attending simulation events and going to debriefings after an actual event to discuss with others areas for improvement.
I really don’t expect much at the beginning of my rotations in terms of preparation beforehand. Working in a pediatric cardiac intensive care unit, it is a very special niche of multiple specialties rolled into one. Pediatrics, much less pediatric cardiac, is not common to see taught in schools of pharmacy, so I plan to start everyone at the beginning of the rotation at square one and then grow from there. As future pharmacists though, I do expect the students to be up on their mechanisms of actions and adverse effects of the medications that they are seeing and recommending.
For new pharmacists, I would say to take a deep breath and relax as much as possible. Maintaining your composure and trying to get rid of the nerves will help you out a lot. Practice, practice, practice! Attend simulations and go to debriefings after events occur and listen to all the feedback that is given. Be sure to learn your algorithms so that you can try to predict what medications will be needed next. That way, you can stay a few steps ahead. Furthermore, don’t be afraid to ask for help from others. Call another pharmacist or grab a nurse to help pull medications up. You are not there alone.
4) Who are the Pharmacists that have influenced you the most and why?
There are two pharmacists who immediately come to mind. The first is Kelley Norris, who was my PICU preceptor as a student. Kelley’s rotation is where many of my pharmacy career decisions were solidified. I decided on her rotation to pursue residency, to go into pediatrics, and to also critical care. I learned so much on her rotation from clinical thinking skills, to interacting with providers, to continually pushing myself to learn every single day. I have definitely seen myself modeling my own rotations after Kelley’s model.
The second is Brenda Gorman. I met Brenda during my PGY1 residency year and she became my unofficial mentor. Brenda was always patient with me and pushed me more than I ever thought possible. I also learned a lot about the inner workings and politics of pharmacy and about becoming a mentor myself. I am grateful to still call Brenda a close friend and a highly respected colleague.
5) What would you like the readers to know about you, and your practice?
I have been very fortunate to have had multiple amazing experiences at an early age, and I contribute that to seeing multiple places and getting to know as many people in the profession as I can. If you are able to complete your residency programs in different states, then take that opportunity. See as many ways, as many formularies, and many computer systems as possible as it will widen your knowledge and make you more marketable. As for my practice, I primarily split my time taking care of patients in a pediatric cardiac intensive care unit and a congenital diaphragmatic hernia unit. I also float to the PICU, NICU, and ER. Working in pediatrics is an exciting and challenging experience since there is not much literature to help guide your decisions at times; and every medication/dose that you recommend is calculated specifically for that individual patient.
6) Where do you see pharmacy residencies in the coming years? Personally, I would have never imagined the expansion of residencies that has taken place over the past 10 years. Do you think the federal government will get involved and subsidize residencies, much like what has occurred with Graduate Medical Education?
Pharmacy residencies have definitely taken off over the past several years and it has been difficult to keep up with the supply of residency programs over the growing demand. Another thing, which is excellent for the profession, is the expansion of roles and responsibilities that pharmacists are allowed to complete, which is why it is important to advocate to your state and federal government to continue to advance the profession. I believe that as pharmacist responsibilities continue to grow, residency program will become even more essential to train new pharmacist to perform these tasks successfully. Another item that has been bounced around some, and I do think we are still a little way away from, will be to addition of the PGY3 residency program. PGY1 pharmacy residency programs are able to receive program reimbursement through CMS, however, there have been a lot of issues where CMS has threatened to remove this funding due to arbitrary audit requirements. This is why it is important for pharmacists to stay involved in organizations and reach out to members of congress to continue to support and advocate for the profession. Hopefully we will see an increase of support and funding for residency programs in the future.
7) What’s your pet peeve in the pharmacy?
Hmmm, there are actually several for me. But one of my biggest ones will be procrastination in regards to verifying or getting medications to the floors for the patients. I always try to remind everyone that there is a patient sitting at the other end of what we are doing.
8) Thanks for your time, what words of advice would you like to impart on student pharmacists across the country?
For the students across the country I would definitely start by saying keep an open mind and get as much of a wide range of experiences as possible. Try to book a challenging fourth year to keep you learning and seeing different aspects of the pharmacy world. Unfortunately, some rotations may still fall flat, and if so, pick one medication a day and look up its mechanism of action and common adverse effects. Keep pushing yourself in those situations. I would also strongly recommend finding a preceptor, work colleague, professor, someone to become your mentor. Having a knowledgeable mentor can make a world of difference in your growth as a pharmacist. And finally, don’t get hung up on setbacks. Those situations can lead us in a new and better direction, and we are able to have experiences we never would have thought about otherwise because of those setbacks.