The situation that pharmacy doctoral students Zachary Lanoue and Lauren Hom found themselves in sounds like a fictional scenario presented in a classroom, an instructional tale about professionalism, where the professor might ask, “What would you do?”
Make no mistake: it was real. And the students performed so expertly that they were honored with a military challenge coin for quick thinking in an emergency, which prevented an error and ensured a patient’s safety.
At a coining ceremony at the Aviano Air Force Base in Italy in November, Lt. Col. Emily Dietrich (pictured above, at left) praised the duo for “immersing yourselves and being up for any experience that we’re able to give you. And then not only witnessing that and learning from it but doing a patient safety catch.
“We take patient safety extremely seriously.”
Quick thinking protects a patient
Lanoue and Hom were on an ACPHS rotation at the Air Force base, when a patient arrived after being bit and scratched by a feral cat. She was at risk of rabies and other infections. Medical protocol called for immediate injections of rabies vaccine and rabies immunoglobulin, which both help to prevent the onset of infection even after exposure, at the bite site. But in this case, the bite site was tiny, near the knuckle of the patient’s ring finger. There was no way the entire, required 8.2 milliliter dosage could be injected there and absorbed.
So medical staff came up with a plan to distribute the required dosage in four separate muscular sites – one in each thigh, and two in the gluteus muscles – for proper absorption.
But that plan didn’t sit right with Lanoue. He had done a rotation several months before in an emergency room, where he’d seen more than a few rabies cases. Something seemed wrong about administering the vaccine into the glutes. When he and Hom stepped away from the patient’s side into the hallway, he opened his phone.
“At this point we're all standing in a circle in the hallway,” Hom said, “and Zach nudges me, and he says, ‘I don't know if we can give it in her glutes.’”
Lanoue had found on an app for medical providers that the rabies vaccine should not be administered in the gluteus muscles due to potential poor absorption and the chance of sciatic pain. Lanoue said he was nervous to speak up.
“I was like, I don't want to overstep,” Lanoue said.
“And so then I was like, ‘Zach, show her your phone,’” Hom said.
Lanoue shared what he had seen. Air Force base medical staff were grateful. They discovered they could give as much as four milliliters in each thigh and did that.
The action appeared effective, as the patient did indeed avoid rabies. Nonetheless, she developed another infection, and the antibiotics she was receiving in pill form were not working. Military medical staff asked to send her to a local hospital. In Italy, the availability of antibiotics is limited, and the hospital said the patient could only be transferred if the military base started her on a different antibiotic treatment first. Lanoue and Hom were tasked with researching what to give her, and recommended vancomycin and ertapenem.
“What we chose completely resolved her infection, and her finger was completely fine, and she didn't need any surgery intervention, and we found out about a week later that the patient was totally fine after receiving the antibiotics,” Hom said. “We were so relieved we couldn't believe it.
Lanoue and Hom’s supervisors were impressed with their actions. In the days just before the students’ departure from Italy, they surprised them with the presentation of a challenge coin, a military tradition that rewards excellence.
Once-in-a-Lifetime Experience
The coining capped off what had already been a once-in-a-lifetime experience for Lanoue and Hom.
The rotation in Italy is currently one of a few international options for required Advanced Pharmacy Practice Experiences (APPE) for pharmacy students. Program options were more robust before the COVID-19 pandemic; with restrictions eased, international rotation options are slated to increase soon, said Courtney Tackes, assistant dean for experiential education.
The option of a rotation abroad was a reason Hom decided to enroll at ACPHS, she said, and she has been looking forward to an international rotation since she entered school. Lanoue was interested in the rotation both because of the chance to experience working in another country and the opportunity to work on a military base.
The town of Aviano sits at the foot of the picturesque Dolomite Mountains in northeastern Italy, approximately a 90-minute train trip from Venice. Lanoue and Hom lived in an Airbnb apartment owned by a man named Fabio, situated right in the piazza (town square), where open-air produce and antiques markets were held. They interacted with townspeople, adapting such daily traditions as eating pastry and espresso for breakfast. (On days when they wanted familiar food, there was a Subway sandwich shop on the base.) They walked everywhere, including to work. Townspeople were familiar with Americans from the base, and English was spoken everywhere.
From a professional perspective, the military base gave Lanoue and Hom the chance to take on more responsibility than they might have had elsewhere, they said. Pharmacy personnel also had military duties; when the military duties became the priority, Lanoue and Hom had a chance to temporarily fill positions of more authority.
“You get a lot more responsibility as a student,” Lanoue said.
Hom said her time at the Aviano Air Force Base has affected how she will pursue future professional experiences.
“I was a part of a team that made a real difference for patients,” she said. “I felt like the work that we were doing there was thoroughly appreciated, and I felt like we were making differences for people."
Learn more about experiential education at ACPHS.