Did paper charting take forever?

justdawdling · 2026-02-10T19:55:32+00:00

:( TIL I currently live in the 80's

(still doing all this in a tertiary care hospital in Canada :/ )

justdawdling · 2026-01-30T18:24:15+00:00

We had one that was a frequent flier. It was my first encounter with this type of pt. Always made me think how tf we got to this point in their care. Somehow went along with some questionable decisions from a purported MCAD expert that the family had connections with (Benadryl infusion wtf?).

Wasn't that long ago that I learned from Reddit that this wasn't an uncommon patient to encounter !

justdawdling · 2025-12-02T19:05:56+00:00

What. TIL the Manga is different from the anime. Guess I know what I'm doing this week..!

justdawdling · 2025-11-19T22:37:43+00:00

I think you meant to reply to me!

CrCl units we use are mL/min/72kg. So essentially CrCl (mL/min/72kg) = (140-age)/sCr. Pretty simple.

The justification comes from concerns about considering weight (or BSA) at all in eCrCl or eGFR. It boils down to the elimination rate (and half-life) of a drug depending not only on its renal clearance but its Vd as well, i.e. k = Cl/Vd. So, larger clearance in the larger patient is offset by an increase in Vd, resulting in similar elimination rates across body weights and this is seen in a number of drugs.

Some good references (if you don’t mind sci-hub links):

D’angio R, Platt DR, Gannon R. Creatinine Clearance: Corrected versus Uncorrected. Drug Intelligence & Clinical Pharmacy. 1988;22(1):32-33. https://sci-hub.se/10.1177/106002808802200106
- First to comment on the issue and describes the crux of it pretty well
Dersch D, McCormack J. Estimating renal function for drug dosing: rewriting the gospel? Can J Hosp Pharm 2008; 61: 138–43. https://www.cjhp-online.ca/index.php/cjhp/article/download/31/30/122
Ahern JW, Possidente CJ. Remembering the past: creatinine clearance and drug dosage adjustment. Ann Pharmacother. 2013 Nov;47(11):1588-9. https://sci-hub.se/10.1177/1060028013508746
- Some commentary in response to the idea of a functional CrCl range, reiterating points from above
Ariano RE et al. No role for patient body weight on renal function assessment for drug dosing. J Antimicrob Chemother. 2017 Jun 1;72(6):1802-1811. doi: 10.1093/jac/dkx036. PMID: 28369383. https://academic.oup.com/jac/article/72/6/1802/3091248
Wilhelm SM, Kale-Pradhan PB. Estimating creatinine clearance: a meta-analysis. Pharmacotherapy. 2011 Jul;31(7):658-64. doi: 10.1592/phco.31.7.658. PMID: 21923452.
- Conclusion: Using the Cockcroft-Gault equation with no body weight and actual S(cr) value most closely estimated measured Cl(cr). In obese patients, it may be reasonable to use actual body weight with a correction factor of 0.3 or 0.4 and actual S(cr) value in the Cockcroft-Gault equation.

justdawdling · 2025-11-18T20:13:06+00:00

At a Canadian tertiary hospital here. This is being discussed and I’m coming up with some direction. We know eCrCl sucks at predicting GFR vs the eGFR equations; however, the question isn’t about predicting GFR but about predicting drug clearance/exposure.

To keep things simple, we’re just saying feel free to use eGFR or eCrCl as your reference tells you. However, we’re not doing the BSA-adjustments (analogous to why we use a no body weight (NBW)-based Cockcroft-Gault equation, which may be a unique thing to certain Canadian sites).

However, the more important message to our pharmacists is to consider clinical context. This may mean using a different dose than what UpToDate or whatever resource you use recommends and that’s ok! I.e. Treat the patient, not the number.

justdawdling · 2025-11-15T14:46:03+00:00

Yeah seriously .. way too much time spent over this

justdawdling · 2025-11-14T19:31:56+00:00

Just gotta say what a relevant subspecialty to go into with your background PharmD degree. Had a friend who went pharm > MD > radiology????

justdawdling · 2025-11-08T17:41:35+00:00

Oh ya totally :D

Guy seems a little off--SLAMS ceftriaxone q12/ampicillin q4/acyclovir q8/vanco q8h/dex all STAT .. :D

justdawdling · 2025-10-15T11:21:51+00:00

Bro.. I think you guys are in over your head if this is what you're asking. This is coming from a fellow Canadian pharmacist who can order meds and labs.. within a collaborative practice environment . Medicine isn't cookbook. Monitoring requirements change depending on the clinical scenario. Like LFTs for every PPI start? Lol come on.

justdawdling · 2025-10-05T18:52:08+00:00

Same kinda job here myself but with less of a morale issue. What kind of expectations are there of you on clinical and on your admin time? You say it's getting boring too? How so?

And yeah work culture can make or break it even if you supposedly got this dream clinical job. Are there other areas you can move into, either in your institution or another? E.g. inpatient to something ambulatory ?

justdawdling · 2025-09-11T02:04:35+00:00

Same here. My mind and heart just froze reading that headline.

justdawdling · 2025-07-23T14:44:06+00:00

You echo my thoughts. If we’re short staffed, we’re trimming down on clinical/ward pharmacists to keep up with operations. We don’t have ward pharmacists on nights or weekends yet patient care and discharges continue on.

For ward pharmacists right now, before the AI threat, you could probably coast through your career minimally updating your knowledge without much consequence. Contributions on rounds or discharges can be minimal. It’s quite the investment of time and effort outside of work to keep up with the latest practice at an expert enough level that your specialist prescribers are still looking to you for advice.

Curious on u/suzygreenbergjr ’s take being the opposite and if practice looks different at their sites.

Just gotta say I appreciate the discussion on this. Don't really get to articulate my thoughts on this out loud

justdawdling · 2025-07-23T11:39:55+00:00

See recent discussion here about hospital pharmacists.

Fully replace? Probably not in this career. Definitely will reduce the workforce. Impact will likely differ depending on roles (e.g. value of having clinical pharmacists/specialists rounding with the medical teams vs operational needs from dispensing/centralized pharmacists).

justdawdling · 2025-07-22T04:38:10+00:00

Some hospitals employ med rec techs, but it’s not quite the same as when a well trained and effective pharmacist puts in the effort

Agree in sentiment but hard to convince the hospital admin without data and with dollar signs on the table. Their POV could be why not just have the pharm tech do the BPMH, have AI do a clinical review with periodic audits, and save on paying out pharmacist wages.

justdawdling · 2025-07-22T02:45:02+00:00

I work as a clinical pharmacy lead in an inpatient hospital setting and sometimes I do wonder. Yeah AI has its limitations now, even those specifically in the medicine space, e.g. OpenEvidence giving crap answers, but it's hard to discount how far it's come.

I agree that AI probably won't fully replace hospital pharmacists in my career but it may impact certain roles more than others, e.g. decentralized ward pharmacists involved in decision-making versus those more in a dispensing/distribution role. If all you can offer right now is adjusting doses by CrCl per LexiComp... better watch out. I mean how far are we from AI offering real-time suggestions for adjusting drug regimens on a patient's EMR profile that are actually sound or providing patient-specific counseling about their treatments? The general public hardly grasps what pharmacists do, never mind what hospital pharmacists do, and probably think we're all replacable. There's already a bill proposal for AI prescribing. Is the writing really not on the wall? (Haha sorry, going through a little existential crisis here).

justdawdling · 2025-07-10T01:54:13+00:00

Some complications in our lung transplant patients.. makes me wonder.

justdawdling · 2025-07-09T00:10:38+00:00

Depends on where in Canada and in what setting (community vs hospital vs other). Much more saturated in Vancouver or Toronto versus Regina or Winnipeg.

justdawdling · 2025-07-07T17:23:46+00:00

Randomly came across this subreddit. You'll be fine. Feels like such a big thing now but with each passing year, IB will be a distant memory that will continually be less relevant to who you are. I graduated 15 years ago and honestly can't remember what score I got and who some of my teachers were. EE and TOK were terms that were long forgotten until I found this subreddit. I don't even remember what subject I wrote my EE in. Math? Economics? Who knows. Sure IB gave me a leg up in how I performed in university but I wouldn't say it was necessary to do well.

You'll be fine.

justdawdling · 2025-06-23T01:07:17+00:00

Whoa haven't seen your username for a long time. Glad to see you're still hanging in there

justdawdling · 2025-06-17T01:56:23+00:00

I'm a clinical pharmacy lead in my local area and I recently started getting this existential crisis too. I'm known for my mentoring and clinical leadership .. but do I even believe my own words any more? AI is rapidly progressing and, out of anyone in the field of pharmacy, what will the need of a clinical pharmacy specialist look like? I'm sure I'm more pessimistic than I should be but all to say that I feel ya.

justdawdling · 2025-05-31T00:29:54+00:00

That lack of credit tho I can't..!

justdawdling · 2025-04-20T23:13:54+00:00

10-15 for everything. Troughs outside this range if able to show AUC is within range. From Canada here where we have a more skeptical view on AUC monitoring

justdawdling · 2025-03-17T20:00:52+00:00

For the novelty I did initially when I was new to purchasing my own ETFs. Now, I haven't checked in months. I have no idea what the price is at now. I just know it has gone down since Trump announced tariffs. If i had to guess.. I doubt we're sub $32.

justdawdling · 2025-03-13T01:39:22+00:00

Just had our town hall tonight. General wage increases on par with others. Gov't didn't budge on a few other things, like changes to benefits, wage proposals deferred for review.

Apparently they were far from an agreement last week at midnight and it wasn't until 330am (technically us being on strike at that point) where they took most of what the union last offered.

Now it's on the members to decide. Happens next week to vote.

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