Pharmacy Residency - Rotation Description, Cardiology - Bronson Healthcare

Pharmacy Residency - Rotation Description, Cardiology

Cardiology Rotation

Preceptor: Andrew Johnson, PharmD
Office: E466
Hours: 8:00am-4:30 pm
Phone: 269-341-7999
Email: johnsand@bronsonhg.org

1.  General Description and Expectations of Residents:

Cardiology is an required 1-month learning experience at Bronson Methodist Hospital. The resident will be assigned to the cardiology floor for the month. The team is composed of attending physicians, various medical residents, interns, physician assistants/nurse practitioners, pharmacists and/or students. Other disciplines may consult with or round with the team, including, but not limited to respiratory therapy, dietary, and nursing.

The resident is responsible for identifying and resolving medication therapy issues for patients admitted to the cardiology unit at Bronson Methodist Hospital. The resident will become proficient in identifying pharmacotherapeutic problems, implementing cost-effective medication regimens, identifying and counseling high risk patients, and providing patients with effective discharge counseling. The resident will also be responsible for providing therapeutic drug monitoring for cardiology patients on target medications including but not limited to warfarin, heparin and argatroban. Patient and topic discussions will be done throughout the month with the resident responsible for leading these discussions. By the end of the rotation, the resident is expected to complete drug information questions along with either completing a drug monograph in adding a medication to formulary, patient case presentation or a journal club.

During the rotation, the resident will also be expected to participate in the Advanced Cardiology Heart Failure Clinic with the cardiology pharmacist. The resident will be expected to review patients prior to clinic, participate, and write notes based on the current template that is provided. Expectation is to work closely in a multidisciplinary approach with a dietician, nurse practitioner, nurse, cardiologist, and medical assistant. Time of the clinic will vary based on the days the pharmacist/preceptor is in the clinic.

2.  Disease States:

Common disease states in which the resident will be expected to gain proficiency may include, but are not limited to:

  • Coronary artery disease
  • Acute myocardial infarction

○    NSTEMI

○    STEMI

○    Angina

  • Atrial fibrillation
  • Congestive heart failure
  • Arrhythmias
  • DVT/PE
  • Pneumonia
  • Diabetes

Topic discussions and reading key articles will be used to help develop the resident's patient care skills for common disease states or acquiring knowledge about diseases seen infrequently on the service.

During the learning experience the resident will focus on the designated goals and objectives by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all of the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame.

Preceptor Interaction:

Daily: 0800 Meet with preceptor for morning information 0805 Attend morning Huddles

0815 Work-up patients

1100 Attend Rounds

1300 Meet with preceptor for topic discussions, patient reviews, journal club, etc. Various times: Discharge counseling/counseling on high risk medications

Day 1:  Preceptor to review rotation learning activities, schedules, and expectations.

Week 1: Resident to work up assigned patients and present to preceptor and students. Preceptor will participate in rounds and resident will observe modeling of the pharmacist's role in the healthcare team.

Week 2: Resident to work up assigned patients and present to preceptor and students. Preceptor may attend/participate in team rounds and will coach the resident to take on more responsibility as a pharmacist on the team.

Week 3-4 Resident to work up assigned patients and present to preceptor and students. Preceptor may attend and observe the resident's participation in team rounds and/or may expect a summary report from the resident regarding rounding activities and use of recommendations made by the resident. Preceptor will be available for questions, will follow patients independently to monitor resident skill development in all aspects of the learning experience, and will facilitate the resident as the pharmacist on the team.

[The length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident's progressions in the current rotation and where the rotation occurs in the residency program]

Evaluation Strategy

The resident will receive on-going, regular formative verbal feedback throughout the rotation. In addition, the preceptor and resident will have a midpoint discussion to assess the overall learning experience for the resident. The goal for this meeting will be to identify areas on which to focus, future activities, etc., based on resident feedback as well as preceptor identification of areas for improvement. This feedback will be documented as a formative assessment in PharmAcademic. At the completion of the rotation the resident and preceptor will independently complete the Summative Evaluation, then will meet and compare the evaluations prior to cosigning. The resident will also complete the Learning Experience Evaluation and a Preceptor Evaluation for each preceptor.

Expectation of Residents:

See General Description

Taught and Evaluated Objectives

Activities

Goal R1.1

In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regimens, and multiple medications following a consistent patient care process

 

OBJ R1.1.1

(Applying) Interact effectively with health care teams to manage patients' medication therapy

1. Arrange for introduction to all team members on first day of rotation 2. PLan to assist team with pharmacy-specific patient care needs through frequent follow-ups with team members

3. Organize day to allow for patient care activities with team as priority

OBJ R1.1.2

(Applying) Interact effectively with patients, family members, and caregivers

Effectively counsel patient in the hospital; follow-up with the patient in the clinic and give appropriate recommendations

OBJ R1.1.3

(Analyzing) Collect information on which to base safe and effective medication therapy

1. Distinguish appropriate source to gather pertinent patient data ie electronic medical chart, physical chart and patient (family members, if needed). 2. Analyze the validty of information presented from different sources to develop a sound plan

OBJ R1.1.4

(Analyzing) Analyze and assess information on which to base safe and effective medication therapy

1. Analyze patient specific profiles prior to rounds to identify any pharmacy related issues 2. Actively participate in multi- disciniplinary rounds and ensure issues are discussed during rounds are followed up 3. Analyze orders for verification to identify any pharmacy related issues and follow up with the prescriber for resolution

OBJ R1.1.5

(Creating) Design or redesign safe and effective patient- centered therapeutic regimens and monitoring plans (care plans)

Evaluate patient's improvement through use of objective clinical information found in the medical record alongside with subjective information gathered from patient and care providers

OBJ R1.1.6

(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions

1.Review patient's progress on current regimen 2. Formulate appropriate therapeutic plan changes based on patient's individual response

OBJ R1.1.7

(Applying) Document direct patient care activities appropriately in the medical record or where appropriate

1.Categorize interventions appropriately 2. Summarize sequence of events for submission into a patient net report if medication error occurred

OBJ R1.1.8

(Applying) Demonstrate responsibility to patients

Demonstrate appropriate use of handouts to convey message to audience

Goal R1.2

Ensure continuity of care during patient transitions between care settings

 

OBJ R1.2.1

(Applying) Manage transitions of care effectively

1. Appropriately discuss with the team regarding transition of care 2. Effectively make recommendations for outpatient visit to the heart failure clinic


Evaluations:

Evaluation

Evaluator

Evaluated

Timing

Summative Evaluation

All Preceptors

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed

ASHP Learning Experience Evaluation

Residents

Learning Experience

Ending and Quarterly if Needed

ASHP Preceptor Evaluation

Residents

All Preceptors of this Learning Experience

Ending and Quarterly if Needed

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed

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