When starting the 2nd rotation of my fourth year in pharmacy school, I had no idea that I would learn or change as much as I did. My rotation was at Green County Hospital, in Eutaw, Alabama. I was very anxious about what the month had in store for me, but at the same time I was excited to find out. Greene County Hospital is a small hospital in rural Alabama. With only ten beds in the hospital, an emergency room, nursing home, and physician’s clinic, I knew I would learn a lot in the month that I was there, but I never thought that I could actually impact patient care after I left.

On my first day of rounds, I was asking my standard questions when I was thrown a curve ball. When I asked for a copy of the hospital antibiogram, I was surprised to find out that they did not have one. Because I was used to working in a large teaching hospital in Birmingham, Alabama, I had never experienced a hospital without this resource. Before I knew it, I was volunteering to create an antibiogram in the month that I would be externing there. I started researching how to create such a tool and found a wealth of knowledge on the subject; then I began working with the laboratory to collect the data. While it was difficult extracting two years of culture and sensitivity data from the small laboratory, I began to see what kind of an impact I could potentially make in this hospital and community.

With the help of my fellow student, Sara Combs, we tabulated all of the microbiology samples and their susceptibilities and created a database, and during our final week of the rotation we presented this data to the hospital staff. Before the antibiogram, the doctors at Greene County Hospital started empiric therapy for infections and often times it was necessary for the medications to be changed when the cultures and sensitivities returned three days later. Throughout the data interpretation process, we discovered that there were various strains of resistant microorganisms. There were also many medications on the hospital formulary that had the exact same coverage capabilities.

When we presented this data, we were told that this information would significantly change the practice of antibiotic prescribing at the hospital. Assistant administrator Susan Fox said that the hospital took the data from the antibiogram and reevaluated their formulary, “Many of the antibiotics we had on our formulary were duplicating coverage, so we have been able already to cut the cost of medication spending at the hospital. This has created a more cost effective system for us. From now on we will want our pharmacy students each month to come up with a special project to help impact patient care at the hospital. In two months, the antibiogram has already helped us significantly.”

Since completing my month in Eutaw, Alabama, my eyes have been opened. I am amazed at the potential impact that pharmacists can have in a small hospital. The opportunity to improve patient care was extremely rewarding; and, I will forever be an advocate of student participation in rural healthcare and/or medically underserved areas. At the same time I strongly recommend that health care professionals take full advantage of their pharmacy students. Yes we are there to learn; however, we are also there to help improve pharmacy practice. The potential learning opportunities and the chance to impact patient care changes us as practitioners, whether or not we realize it at the time. I will be forever grateful to the physicians, nurses, and other staff at Greene County Hospital for giving me this opportunity. I hope that they and other small and rural hospitals will continue to encourage and support the inclusion of pharmacy students in their patient and medication safety initiatives.

The author, Delia M. Charest, is a fourth year pharmacy student at the Samford University McWhorter School of Pharmacy in Birmingham, Alabama and just completed a four week Association Management externship at ASHP. Delia has been an active participant in her School’s Student Society. She currently serves as a student representative on ASHP’s Section of Inpatient Care Practitioners’ Advisory Group on Pharmacy Support Services and on ASHP’s Council on Pharmacy Practice.