Alumni Spotlight: Madeline Acquilano, PharmD

Madeline Acquilano PharmD '19 made the most of her time at MCPHS: the talented student was involved in Phi Lambda Sigma, Phi Kappa Phi and Rho Chi, received the Dean's Award in May 2019 and graduated Summa Cum Laude. After graduation, however, she entered a trial by fire: the talented student is fighting the COVID pandemic on the front lines at St. Vincent's Medical Center in Bridgeport, CT. At the end of June, she will begin her first post-residency position as a multi-specialty clinical pharmacist at Hartford Hospital in Hartford, CT. You can follow her journey on Instagram @theluxepharmacist; we sat down with her to learn more.

What are you seeing on the front lines working as a PGY-1 Pharmacy Resident?

My PGY1 pharmacy residency at St. Vincent's Medical Center in Bridgeport, CT, has become anything but traditional ever since the COVID pandemic started. Unfortunately, a lot of residency experiences I was looking forward to, like the Eastern States Residency Conference and the outpatient heart failure clinic visits, have been canceled. But what I have gained in return is a truly unique, challenging, and humbling learning experience that I will remember for the rest of my life. When the COVID pandemic first started to hit Connecticut, I was on my Critical Care II rotation. While so much was changing around me, I was honored to stand alongside the rest of the ICU teaching team on rounds and throughout the day as if nothing had changed. When I transitioned to my next rotation, Emergency Medicine II, the number of COVID patients at our hospital started to increase.

Even on the most trying of days and saddest of times, the number one thing I have seen on the front lines is absolute compassion, bravery and selflessness from all of my colleagues. I could not be prouder to be a pharmacist during this pandemic.

What does a typical day look like at your hospital?

My typical day depends on which rotation I am on! When I was on critical care, I would do morning sign out with the overnight team, prep for rounds, round with the teaching team, and then in the afternoon continue to be a resource for the team and complete topic discussions or projects with my preceptor.

In the emergency department, we serve as a resource to providers and take care of any patients coming through the department. Typically, we respond to all traumas, cardiac arrests, stroke, seizures, etc., but the bulk of the patients we are seeing lately are respiratory isolation (aka COVID).

My typical day lately involves monitoring all positive or suspected COVID patients (more than 50% of our current census) every day. This is needed because these patients tend to be very complex. We have to make sure COVID medications are being used appropriately per our protocol. A lot of these patients go into renal failure, so on any given day, medications may need to be dose adjusted, they all need appropriate anticoagulation or stress ulcer prophylaxis if they are mechanically ventilated, etc. A lot of these changes I can make automatically through our policies, but if I can't I call the providers to make therapy recommendations!

How has this change affected you and your coworkers--mentally, physically, emotionally?

My coworkers and I, especially my ED and ICU preceptors, are honestly quite drained and exhausted. It takes a lot of work to set up new hospital zones for patients, change protocols and drug therapies daily, see patients fail extubation, or be classified as "comfort measures only" while loved ones cannot be by their sides. At the same time, I know we all feel a great sense of honor in what we are doing to help make a difference for these patients. Being able to lean on each other for support has helped a lot.

(Also, my ED preceptor is actually also an MCPHS alum! Joseph Faulhaber PharmD '15 is the emergency medicine clinical pharmacist at St. Vincent's Medical Center, and is a truly dedicated pharmacist that I look up to, so huge shout out to him!)

Are there shortages--of drugs, PPE, or other resources--you have to contend with? Have you been able to make any substitutions or find any work-arounds?

Between our stock, donations and conservation efforts, our supply of PPE has been okay thus far to the best of my knowledge! I have had the same N95 mask since I got it weeks ago, and I usually use my normal masks until they rip or are too worn out, which has helped save supplies in our department.

Our drug supply, however, has been another issue. A lot of people may think that only the actual COVID therapy supply (drugs like hydroxychloroquine and Actemra, for example) are an issue. However, our biggest problem has been with standard critical care medications like sedatives, opioids, neuromuscular blockers, and pressors, since our volume of critically ill and mechanically ventilated patients has tremendously exceeded normal volume. To combat this issue, we have been calculating our 24-hr use of each of these medications on a daily basis and comparing it to our current stock and what we are able to order.

We have also implemented several emergency protocols surrounding drug utilization. For example, pharmacists have the ability to automatically switch patients from a fentanyl drip to a hydromorphone drip using a pre-approved conversion if our fentanyl supply were to run out. We have also been utilizing several oral medications that are in good supply to help cut down on continuous IV medications.

If you could send any public health message right now, what would you like the community to know to keep themselves safe?

I would urge everyone to continue to listen to the physical distancing practices. I know it is hard not to see our loved ones or friends or go about our lives as we had before, but after seeing the devastation that COVID causes firsthand, it truly is so important in the fight to help stop the spread of this virus. No one should have to die alone without their loved ones, and no family should have to go through the pain of hearing that their loved one has died on the phone while they sit at home helplessly. The role that each of us plays in the fight against COVID is truly important and I ask that we all keep this in mind as we make decisions that could affect others.

As a young alum, what has this public health crisis taught you about being a Pharmacist?

This public health crisis has only strengthened my belief that pharmacists are essential frontline healthcare providers and I will continue to be a voice of advocacy for our profession.

How can the community support healthcare workers right now? Are there meaningful ways that we can contribute?

Every contribution goes so far. On my drive into work every single day I pass by many thank-you signs and big red hearts of support that put a smile on my face each time. I have also received homemade gifts from my family and my coworkers' families that mean so much to me. For example, my new favorite accessories, the hair caps, were given to me by the family of one of our ICU nurse leaders and ICU pharmacist. Our hospital has also received supply donations and food donations from our community. Any thoughtful gesture is sure to go a long way!