Part III - the anteroom
Now for the long overdue post describing the third position techs fill in the pharmacy! As the go-between the clean room and main pharmacy, some technicians say the anteroom is the hardest position and I tend to agree. Only one person per shift works in the anteroom. To keep things running smoothly takes multitasking, keeping calm under pressure, and staying on track amid many interruptions. A good anteroom tech can make everything go so much smoother for those working in the chemo and clean rooms.
The day shift anteroom person starts at 7 am. After changing into hospital scrubs, the first thing you do is scrub up and go into the clean room to make the morning doses of any special drugs that are not premade. When that's finished, the next job is deciding what IV medications need to be batched for the day. To figure this out, you look up in the computer system all the IV antibiotics that we make to see how many patients are on each one and how often they are taking it. Going by that, you can figure out how much you'll need for a day's supply. Next, go to the fridge and count how much we already have on hand, also checking expiration dates. Extra syringes of different medications are kept in the freezer so usually you have to pull some of those to fill the fridge. If there aren't many syringes left in the freezer, you'll be batching them today. The goal is to know what you will be batching by the time the clean room tech and pharmacist come in at 8:30. Once you decide what all you'll be making, pull the drugs and supplies and wipe them down before taking them into the anteroom. At this point, the clean room tech is probably there so they can help with dating the syringes that were pulled from the freezer and gathering supplies for stocking the anteroom and clean room. While the clean room tech covers for you, go to break. When you get back, the clean room tech goes on break and you finish setting up the cart with all the supplies needed for batching. Keep in mind that at any time you may be interrupted and have to make a stat drip or some IV medication a nurse calls for.
I don't think I've mentioned much about the chemo making process. The chemo room is a small closet-like room off the clean room. Since it is a negative pressure room, air flow is directed inward instead of outward so that all possible hazardous drug spores are vented to the outside. Being a chemo tech is about as high up the ladder a technician can get. Before you can be trained in mixing chemo, you need several year's experience in making IV drugs. We have one chemo tech and two oncology pharmacists. One of the oncology pharmacists works at the cancer center Monday through Friday. All pharmacists have been trained in mixing chemo, but there are two who rotate working in the chemo room most often. On a normal day, there will be anywhere from 10 to 18 patients scheduled for chemo. Getting the chemo out on time is one of the most important roles of the anteroom tech. When a patient arrives at the cancer center, the oncology pharmacist sends over the chemo order and prints labels in the main pharmacy. The anteroom tech gets the labels and if the drug is stored in the chemo fridge out front, pulls the correct dosage and drug to send back to the chemo room. In the anteroom, gather all other supplies they will need to make that specific chemo, then put it in the pass through window for the chemo tech or pharmacist. It can be frustrating to those making chemo if the wrong supplies or drug are sent back, so try to get it right! You always need to keep an eye on the pass through window in the anteroom so chemo gets quickly passed out to the front, where another tech will walk the chemo to the cancer center.
In between keeping an eye on the printer for chemo labels and watching the pass through, you need to make labels for all the drugs that are being batched in the clean room. You are also responsible for deciding what IV's and supplies need to be ordered and get the order in between 10:00 and 10:30. The morning hours are the most hectic part of the day for the anteroom tech. It feels like you have deadlines to make while being pulled in all different directions. The more organized and calm you stay under pressure makes a big difference in how your day goes! When the labels for batching have been made and order put in, it might be close to lunchtime. Until the clean room tech comes out to relieve you, keep working. Hopefully the anteroom tech gets to lunch before 1:00. At 1:30 labels print for 24 hours worth of antibiotics. This is usually a
lot of labels that you are responsible to pull the drugs for. If the clean room tech has done most of the batching in the morning, they sometimes help label after their lunch break. When the clean room tech and pharmacist are at lunch, the anteroom tech is responsible for making stats, and sometimes that's all you do over their lunch break. Whenever there is someone in the clean room, stats get passed back to them. If the clean room still has a lot of batching to do, they will probably go right back after lunch. Whenever a batch is completed and checked by the pharmacist, it will be passed out for the anteroom tech to put away.
Sometime during the day the anteroom tech checks the monthly schedule or calls the OR to see if there are any hearts scheduled for the next day. If so, you need to gather everything needed for an open heart surgery and send it back so those working in the clean room can make the drips. At 3:00, the next day's OR schedule prints and a pharmacist will look it over to determine if any special OR solutions need to be made.
By this time, the order you put in will probably have arrived. The rest of your time is spent putting the order away and stocking the anteroom, still watching for chemo or any stats that need to go back. The second shift tech comes in at 2:30 or 3:30, depending on who's scheduled. Before you leave at 3:30, give them a brief report on what's going on in the clean room and anything else they need to know.
The evening shift anteroom tech has a totally different role than day shift. After 5:00, there is no one in the clean room so all special IV's are made by the anteroom tech. Some evenings a lot of time is spent making stats. You might get scrubbed up and make one drip, then go back out front. Ten minutes later, there may be another stat to make so you scrub up again. Working second shift anteroom is hard on the hands and skin from all the times you scrub up. During the day, the anteroom tech stays in the pharmacy, but on second shift, they are responsible for delivering certain things because there is only one tech out front. Usually you make three trips out with IV's and antibiotics. In between other duties, work on putting away that day's order and stocking the anteroom because often the day shift tech hasn't been able to do it. After 7:00 you make the radial cocktails for the next day. They are only good for 24 hours so the anteroom tech makes them every evening. When you're finished making radials and have done all your deliveries, it's time to clean the anteroom and clean room. The hoods get cleaned using the 3 step process, trash taken out, floors cleaned using a sticky roller and mopped with a decontaminant solution. By that time, it might be close to 11:00, depending on how busy an evening you've had or how often you're interrupted.
I prefer working day shift anteroom over evening shift. Evenings are usually calmer, but everything is up to you since you're the only IV tech. Also, I like working 7:00 - 3:30 and the day shift anteroom tech is the only one who has those hours. Time usually flies by because you're so busy. Since I like to be busy at work and enjoy working by myself, working in the anteroom has been mostly fun. There are times when it's almost too much, but eventually it will slow down and be more manageable.
This pretty much completes the description of my job. If there's anything else you want to know, comment or send me a message!
