Megan Rech, PharmD, MS
@MeganARech
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Research health scientist | EM pharmacist 🚑 | co-founder @EMPHARM_NET | inaugural chair @SAEM_AEMP |wife | boy mama 👦 👦 | Chicagoan
Chicago, IL
Joined April 2017
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Pinned Tweet
So heartened to see 130+ EM pharmacist/advocate volunteers for the
@SAEMonline
#AEMP
interest group! Our community is so diverse, talented and eager, and we can’t wait to get started!
Learn more here 👉
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My boys got me lego orchids for Mother’s Day. I’ll take these over real ones any day🌸
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This may be my most productive week ever:
0 emails answered
0 data analyzed
0 papers written/edited
0 conference calls
One perfect baby boy 💙
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Another one of my colleagues took a nice, cushy MSL job and I just met a new staff pharmacist at my 🏥 who is PGY2 CC-trained and doesn’t WANT to do clinical anymore. At 36, I’m now the “old” one amongst our clinical pharmacist. It’s led me to reflect on why that is. A 🧵: (1/)
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Productivity hack:💡I save emails that I send frequently as a “signature” in Outlook: new student and resident rotations, emails I have to send monthly, topic discussion articles, etc. What do others in
#TwitteRx
recommend to increase efficiency?
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Are clinical pharmacists👩🏼⚕️leaving patient care 🏥 at an alarming rate? In this 📄 we outline contributors to premature attrition and potential solutions 💊
#TwitteRx
@JACCPJournal
@gmjones09
@beaverspharmd
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As an EM pharmacist, I take every opportunity to say I’m… a pharmacist, not a doctor, though sure we have a doctorate.
This line of thinking is not only untrue, it feeds divisive the
@AmerMedicalAssn
scope creep narrative & works against our goals at the bedside
#TwitteRx
How do you tell a medical doctor?
Real doctors: *reluctant to state they are doctors in public/social forums*
Non-MD/DOs: *take every opportunity to say they are a doctor…* (chiropractors, naturopaths, pharmacists, apothecaries, charlatans…)
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Thanks to
@AJHPOfficial
for allowing me to write about the deeply personal decision to leave full time clinical pharmacy & all of the complex emotions that come with it.
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The number of replies in this post asking why pharmacists attend codes/emergencies is astounding.👇
EM/CC pharmacists improve outcomes across many emergencies
Definitely demonstrates a need for our new EM PharmD interest group
@SAEMonline
🚨
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The elitist attitude & lack of multidisciplinary involvement are holding EM professional organizations back.
I completed a PHARMACY residency & now train PHARMACY residents. We’re not trying to be physicians; the level of training intensity can only be explained as a residency.
Words matter.
In the medical setting, *resident*, *residency*, *fellow*, and *fellowship* belong to physicians ONLY. ⬇️📃
Every EM physician, resident, & student should be paying attention to the battle on scope of practice. 🥼
That’s the tweet.
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Today was my last day of work before maternity leave. As I pulled off campus I broke into tears reflexively, before I could even process what I was doing. Then, trying to place the emotions, I looked down at my 39 week pregnant belly and whispered “we made it”. 1/
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🚨🚨Thanks
@ASHPOfficial
@ASHP_EMPharm
for formally responding to the this offensive and exclusionary statement 🙌👏
Hopefully a retraction is soon to follow and we can all work together to put patient care first.
Words matter.
In the medical setting, *resident*, *residency*, *fellow*, and *fellowship* belong to physicians ONLY. ⬇️📃
Every EM physician, resident, & student should be paying attention to the battle on scope of practice. 🥼
That’s the tweet.
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Pharmacists have immense pharmacotherapy knowledge - but the profession has a huge PR problem.👇Why do people think we could be replaced by 🤖? Why do you never see PharmDs on the news or 📺 ? I’ve been seeing a lot of hate lately & it’s time for a change.
#TwitteRx
@political_rx
@jhaskinscabrera
Internet searches and robots can pretty much replace pharmacists. They’re overpaid repackagers.
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Here’s a great idea💡:
Can
@ASHPOfficial
standardize residency application deadlines so I don’t have to turn in any more letters of recommendation while I am spending time with my family over the holiday? Are you really reading my letter on 12/27?
#TwitteRx
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🚨2022 AHA/ASA Guideline for Spontaneous ICH:
🔷 DOACs: Andexanet alfa (COR 2a )> 4FPCC (COR 2b) (Why? ANNEXA-4 is essentially a large case series)
🔷 VKAs: 4FPCC (fixed-dose PCC?)
🔷SBP goal <140 mmHg
🔷Antiplatelet-related ICH: ? desmopressin
#TwitteRx
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A lot of hospitals are pulling clinical PharmDs from rounds. I’m conflicted.
I don't want
#COVID19
any more than the next person; we can't fight for a seat at the table (eg provider status) then pull back when things get dicey.
Can we provide the same level of care? (1/2)
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🔥New
@SCCM
RSI Guidelines led by EM👑
@nacquisto
✅Med-induced preoxygenation
❓Per-intubation pressors
✅Etomidate vs. other induction
❌Etomidate + steroids
✅Roc or succ
Amazing PharmD rep:
@sidpatan
@GrothChristine
@AngelaSlampak
& Kevin Kaucher
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After nearly 7 years at
@LoyolaEM
, I am SO excited to announce that we’re getting a second EM pharmacist 🎉🎊😄😭
Who wants to come be my partner? 🙋♀️ 3 x12h shifts, academic, L1 trauma, burns, peds - you name it! And 10 miles from Chicago 🌃
DM if questions 🤗
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Them: pharmacists are burnt out. How can we help them?
M: ⬆️positions?
T: No
M: time off service?
T: No
Me: wellness activities?
T: No
M: resiliency 🍕?
T: Nope
M: what?
T: change our recruitment strategy to college athletes! They work hard & used to getting sh*t on.
Me: 🤯
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I’ve had an adjunct faculty appointment years at a school of pharmacy. They emailed me to do a mandatory HR training class. Today I requested to terminate my appointment rather than spend 30 minutes on something I don’t care about. Committing to saying “no” this year.
#TwitteRx
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For starters, it’s really hard to be on service constantly. Our physician colleagues often get time off-service, but it’s rare in clinical pharmacist positions. It’s hard to balance (and excel!) at non-stop patient care, admin tasks, teaching, research, etc. long term. (3/)
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Why is responding to peer review so soul-sucking from fellow pharmacists? There’s no need to be rude or insulting. Before you hit “submit”, think of how your words might land on a early-career clinician.
#TwitteRx
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As I embark on ~3 wk furlough, instead of anger I am filled with gratitude. I’m grateful to have made it through months of
#COVID19
in the ED with my and my family’s health, to have a job when so many don’t, and to be living through a time where change upon us.
#furloughroadtrip
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📢 SO excited to share our first RCT
@LoyolaEM
! Congrats
@ShannonLovett
@t_reed_t
🤗
Randomized, Non‐Inferiority, Controlled Trial of Two Doses of IV Sub‐Dissociative Ketamine for Analgesia in the ED
@AcademicEmerMed
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🚑🚨VERY exciting news for EM PharmDs:
We are forming the Academic EM Pharmacist Interest Group within SAEM
See the link for how to join, leadership, networking, resident opportunities, & more!
We need your help to make it a success! 🙌
#TwitteRx
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Wanna save a million bucks? Put pharmacists in charge of anticoagulant reversal. 84% effective hemostasis.👌Would love to see comparative data (e.g. standard care or non-PharmD comparator) next 🙌
#TwitteRx
@accpemedprn
@ASHP_EMPharm
In print today! Impact of a pharmacist driven anticoagulation reversal program!
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Yesterday was by far one of the toughest days of my career: my last shift
@LoyolaEM
. I am so grateful for the wonderful mentors, colleagues and friends made over the years. It is the greatest honor to serve our patients, especially during the pandemic. (1/4)
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Can we talk about the
@ASHPOfficial
Academic and Professional form? Why do I have to copy everything from my CV onto this form? If we can use resident CVs to screen applicants, could ASHP use our CVs to accredit programs? It’s been 5 years since I’ve updated mine 😭
#TwitteRx
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We’re always trying to prove our worth. Being a clinical pharmacist means we’re always trying to expand our scope and services, take on more responsibility, and innovate, all while cutting costs in drug budgets and elsewhere. Over time, this can be exhausting. (4/)
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Public/C-suite perceptions need work. If I can’t get my parents to understand what I do (& my dad is a retail pharmacist), it’s difficult to teach the public. We rarely encounter pharmDs being interviewed in the media - we’re the experts in practice but not always in public. (5/)
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I ordered this (free) calendar with daycare photos as a joke, but I think it perfectly summarizes 2020 so far 🤣😬
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👇 This chart is very concerning for our profession as pharmacists. Time to stop opening and accrediting new schools of pharmacy
#TwitteRx
Last month, I gave a talk that discussed the risks of medical school over-expansion.
“Oh, no, our standards will never decrease!” some deans told me.
*pharmacy has entered the chat*
Why Getting into Pharmacy School is Now Dangerously Easy
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Culture matters. It’s hard to want to take on more responsibility when you don’t feel seen or respected- especially true during COVID. Also, outside of academia, career advancement is limited without giving up patient care. (6/)
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Inspirational doesn’t even scratch the surface! You are all a role model to many! 👏🏻 🎉
Congrats to all of the newly awarded fellows of
@ACCP
- so well deserved and congrats on all of your amazing accomplishments! 🥇
#ACCPGC22
@MeganARech
@notthewongrx
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Admin: we’re pulling this med from your Pyxis due to drug shortage
**Shortage resolves**
Me: Can you put it back in my Pyxis now?
Admin: No, please fill out this 3 page form and wait for this to be reviewed at our committee
🤦🏽♀️
#TwitteRx
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Had to sign paperwork for a mandatory furlough today. I’ve been trying to make the most of this situation but something about clicking “I agree” to this really sets me off. I don’t agree, thanks for asking.
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“So by all means, let’s bring more bright minds into medicine. But let’s not ignore the secret weapon that we already have: pharmacists.”
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Just listened to
@AdamMGrant
Work Life episode with
@MCuban
on
@CostPlusDrugs
& not once did they say the word “pharmacist”. Presumably they are checking meds? How did they (we) become so invisible in this system? Price of drugs is not the only factor in building trust.
#TwitteRx
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Guess pharmacists can handle those 6 pages of drug interactions after all, right
@AmerMedicalAssn
?
#TwitteRx
Revises EUA for Paxlovid; Allows State-Licensed Pharmacists to Prescribe
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How should we reverse factor Xa inhibitors in life-threatening bleeding? 🩸🥊Check out our
@AnnalsofEM
Clinical Controversies:
👉Pro-PCC side by me &
@MGottliebMD
👉Pro-AA side by
@CBthePHARMD
@GilbertPharmD
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Claiming that masks contributed to this man’s death is irresponsible.
Phenytoin 3500 mg should be pushed over 70 (‼️)min. Need ⬇️ verbal orders, education safe admin, tox management. Invest in EM PharmD to prevent the next one
#TwitteRx
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My baby just turned 2 months old & I am all out of paid maternity leave & the year’s worth of PTO I had saved.
I’m fortunate to be able to take my remaining time unpaid but many women cannot. No wonder there’s a wage gap 🤷🏼♀️ This needs to change!
#EqualPay
#paidmaternityleave
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Anndd sigh... relieved to receive my
#COVID19
vaccine today! Excited to return from maternity leave in 2 weeks with a few antibodies 🦠
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I’ve been putting off my oral glucose test because with my first 🤰 the glucose drink made me feel like garbage all day.
This time, I asked if I could use jellybeans as an alternative. Thanks to
@LUMCObGyn
for letting me get away with a jellybean glucose load this morning!
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I was feeling guilty that, because we are not traveling to be with family for the holidays, my 3 year-old will not have as many gifts to open on Christmas this year. So, I did what any great parent would do and re-wrapped a bunch of his toys 🤣
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Tenecteplase vs. alteplase for AIS (NOR-TEST 2, part A):
🔷Favorable functional outcome(mRS 0-1): tenecteplase 32% vs. alteplase 51%, OR 0.45 (95% CI 0.25–0.8)
🔷ICH: tenecteplase 21% vs. alteplase 7%,OR 3.68 (95% CI 1.49–9.11)
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I’m sure that attention to burnout & emphasis on self-care will help, but I encourage new clinical pharmacists to carve out a niche in something you’re passionate about: teaching, research, advocacy, residency development, etc. - find something in addition to patient care! 9/)
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My hubby stayed up late installing the wallpaper I ordered. Who says you can’t put it on the ceiling, right?
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Now I’m certainly not accusing anyone of selling out or giving up, and or criticizing my institution. We need attrition to retain our trainees. My point is that we need to evaluate how all these factors lead to *premature* attrition (without another burnout survey 🙄). (7/)
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Appreciate this candidate editorial about the clinical pharmacists on the pandemic frontlines. We show up every day, are beloved by our colleagues, but get little recognition outside of our units. To the rockstar PharmDs caring for
#COVID19
patients, you are awesome 👏 🙌💪
They show up everyday along with their colleagues. Yet, clinical pharmacists are often not included with the other heroes: doctors, nurses, respiratory therapists, hospital cleaning staff, et al.
@JerryBauman5
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📢 CDC's 2020 Guidelines for Gonococcal Infection:
⬆️ ceftriaxone to single 500 mg IM dose for uncomplicated gonorrhea
🔹Chlamydia co-infxn: + doxycycline 100 mg twice daily x 7 days
📈 resistance rates
@accpemedprn
@ASHP_EMPharm
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From our PHARM-CRIT data: when critical care pharmacists cover 1️⃣ service compared to ≥2️⃣ services or decentralized coverage ➡️ more attempted and accepted interventions
📣Increasing workload beyond one service decreases accepted interventions
@JACCPJournal
@accpcritprn
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To any pharmacy residency programs requiring letter writers to submit additional, reiterative, redundant materials I have two words for you: please stop 🛑
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New
@AnnalsofEM
Clinical Controversy:
🥊Adenosine should be first-line treatment for SVT: by
@PharmD_ED
, Neal Lyons
🥊CCBs should be first-line treatment for hemodynamically stable SVT: with
@MGottliebMD
Team adenosine or CCB?
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13 days, 4000 miles, 4 states, 4 national parks, and SO nice to come home.
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I’ve been consistently impressed by
@ACCP
’s actions over the last month and this is one more way they’re advocating for our profession 👏👏
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Friends, I’ve joined the
@onepeloton
cult. Tell me who I should follow,
#TwitteRx
🤗 My username is MegRechsIt
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🚨EM Pharmacists need more representation at a national level🚨
🔷We characterized pharmacist involvement on EM guidelines, position statements, task forces ("work products") from national EM organizations🧵(1/3):
#TwitteRx
#EMRx
@PharmD_ED
@bfaine1
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PharmDs ⤵️ time to 4F-PCC ( by 2~ hours🤯) which in turn ⬇️ LOS
Work by our group
@LoyolaEM
lead by
@HeartTxpPharmD
@ShannonK_pharmD
@dch1309
Do you have a pharmacist in your ED yet? Maybe you should.
#Teamwork
@aaeminfo
@LoyolaEM
@PharmERToxGuy
Pharmacist Presence Decreases Time to PCC (see graph) in ED Patients with Life-Threatening Bleeding and Urgent Procedures
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Even if Biden wins... the fact that we’re this close is disheartening. All of those people who died from
#COVID19
, kids in cages, climate change. This is the most critical election of our time and we’re blowing it 😬😭
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Thanks to
@ACCP
for listening to members and rectifying the keynote selection 👏
After serving on the program committee (does not plan keynote), I’m wondering who is responsible, if not the board? Glad this whole process will be examined & hopefully member-driven in the future.
The ACCP Board of Regents has provided an update regarding the choice for the 2023 ACCP Annual Meeting Keynote Address. Please read the update here:
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Thanks to
@ACCP
for putting members’ safety first and moving to a virtual option. I appreciate that I don’t have to weigh the opportunity to speak against the safety of my unvaccinated 👦👦. Looking at you next
@ASHPOfficial
👀
#TwitteRx
Proud to see
@ACCP
making the difficult, but completely correct move with the Annual Meeting this year. Hopefully this sets the example for
@ASHPOfficial
.
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🚨Check out our RCT on the optimal dose of ketamine for acute pain 🚨
Bottom line: starting low (0.15mg/kg) was non-inferior to 0.3 mg/kg at 30 minutes.
@ShannonLovett
@t_reed_t
Half of the current standard dose of ketamine provides a comparable level of patient pain relief in a new
@LoyolaHealth
@LoyolaHSD
study led by emergency medicine physician Shannon Lovett, MD.
Learn more about the new study here:
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My baby has been in kindergarten 100 days and I can’t handle how sweet this picture is 😭😇
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Another study demonstrating EM PharmDs ⬇️ door-to-needle times to thrombolysis in stroke 🧠 Time for an
@American_Stroke
recommendation to include a pharmacist on multidisciplinary stroke response teams yet? 🤔
@ASHP_EMPharm
@accpemedprn
Involvement of emergency medicine pharmacists in stroke thrombolysis: A cohort study.
@Biswadev_M
@MonashPharm
@the_shpa
@ASHP_EMPharm
@EmergEdu
@prof_cameron
Truely amazing to be a part of this collaboration!
#PhD
#EMpharmacist
#teamwork
#DTNT
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Me this year: I need to scale back and say no to things
Also me this year: I’m on 7 resident research projects 🫠
#TwitteRx
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Now open access 👇
There are several factors contributing to premature attrition of clinical pharmacists, including burnout, inability to generate revenue for services, current practice models, career advancement and the pandemic
@MeganARech
@gmjones09
@beaverspharmd
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EM PharmDs🚨: Do you do culture follow up for your ED? Do you de-escalate negative results?
Our resident-led pilot study found a substantial 📈 in antibiotic-free days with our de-escalation protocol: 150.5/187 (80.5%) days‼️
@LoyolaEM
@AJHPOfficial
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Check out the top articles of 2021 from Critical Care Explorations! Get
#OpenAccess
articles on
#COVID19
and more:
1.
2.
3.
4.
5.
#SCCMSoMe
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ANEXA-I is stopping early for… “achieving pre-specified stopping criteria of superior haemostatic efficacy, the ability to limit the expansion of a potentially life-threatening bleed in the brain, versus usual care”. 🤔
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My son is in a phase where he has to wear a cape everywhere we go and I just love 4 🤗
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🚨📢First study from
@EMPHARM_NET
hot off the press!
High Prevalence of FQ-Resistant UTI Among US ED Patients
@bfaine1
@ae_gross
@CBthePHARMD
@giles_slocum
@DEZ_EM_Pharm
@gavin_howington
@RxEmergency
@AM_EM_PharmD
@AbbyMBaileyEM
#TwitteRx
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My five year old calls these “scrub jammies” and wants to wear them during the day like mommy 😂
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Do any other parents discretely throw away play-doh the second it comes into the house?
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Want to incorporate viscoelastic testing 🩸 into your practice but not sure where to start? Check out our primer on VET in critically ill populations here 👇
@CBthePHARMD
@GilbertPharmD
@ravigarg415
@nei_scott
#TwitteRx
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Got my son’s daycare photos back and I think he nailed it 🎯
Must be a 2 year old thing? Who else had to pay for photos like this? 😂
#medtwitter
#TwitteRx
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Happening now in Lagoon L at
#ASHP22
! Join
@karenccrx
and I discussing pharmacotherapy for TBI 🧠
#TwitteRx
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So excited to share our first (of many!)
@EMPHARM_NET
publications! Awesome work team!
@DEZ_EM_Pharm
@bfaine1
@CBthePHARMD
@GilbertPharmD
@gavin_howington
@RxEmergency
@giles_slocum
🚨Check our first group publication! 🚨
Staying InformED: Top emergency medicine pharmacotherapy articles of 2020
Highlights:
🔷TXA
🔷Ketamine vs. etomidate
🔷Stroke
🔷All things EM ID!
#TwitteRx
@DEZ_EM_Pharm
@MeganARech
@bfaine1
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Starting out, so many of my residents’ 5-year goals read like this: “I want to work at an academic center where I can teach, precept & do research”. Then after 5 years, they jump ship. What happens? (2/)
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I’ve hit a new low in presentation preparation: recreating a forest plot from scratch so I can effectively present a SR/MA without paying a $1000 fee 😭 Pharmacy conference permissions are getting out of control.
#TwitteRx
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👇 It seems I’ve struck a nerve here amongst clinical pharmacists. If there’s anything I’ve learned its that we have such an amazing, supportive
#TwitteRx
community! I’m proud to be a part of it 🤗👏
Another one of my colleagues took a nice, cushy MSL job and I just met a new staff pharmacist at my 🏥 who is PGY2 CC-trained and doesn’t WANT to do clinical anymore. At 36, I’m now the “old” one amongst our clinical pharmacist. It’s led me to reflect on why that is. A 🧵: (1/)
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I'm wholly convinced that being an
#EmergencyMedicine
doctor is the best job in the world.
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Congrats to my friend
@CBthePHARMD
for the well-deserved
@accpemedprn
New Clinical Practitioner Award 🎉🍾
#TwitteRx
@ACCP
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My first editorial for
@PharmacoJournal
! Should oseltamivir make the move to OCT for influenza? 😷 What do you think
#TwitteRx
,
#MedTwitter
?
@ASHP_EMPharm
@accpemedprn
@SIDPharm
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Why should YOU switch to IVP ABx in your ED?
🔷Faster time to ABx administration
🔷Safe & effective
🔷RN satisfaction ⬆️
🔷Saves 💰: PharmD/RN time, IVPB supplies
Read more👉:
@MGottliebMD
@accpemedprn
@ASHP_EMPharm
#TwitteRx
#PharmICU
Why you should use IV push antibiotics in the ED led by the incredible
@MeganARech
FREE for the next 50 days!
Open Access Link:
#FOAMed
@RushEmergency
@LoyolaEM
@AnnalsofEM
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This amazing group of rock🌟s saw a problem and took action.💪 In <1 year, there’s been a petition, changes and support from
@ACCP
and
@ASHPOfficial
, and now this paper/call to action. So proud of this group lead by
@BissellBrittany
@HeavnerPharmD
@rebeccaraesmith
#TwitteRx
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