Pharmacy Residency - Rotation Description, Cardiology - Bronson Healthcare

Pharmacy Residency - Rotation Description, Cardiology

Cardiology

PGY1 - Pharmacy (43400)

Faculty: Andrew Johnson, Julie Schmidt

Site: Bronson Methodist Hospital

Status: Active

Required

Description:

Preceptor: Andrew Johnson, PharmD
Office: E461
Hours: 8:00am-4:30 pm
Phone: (269) 341-7999
Email: johnsand@bronsonhg.org

1. General Description and Expectations of Residents:

Cardiology is a 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 will be expected to give a formal presentation the cardiology staff. The resident will also be expected to complete an edition of the cardiology newsletter and send out to the pharmacy staff.

During the rotation, a resident may be shown a heart cath and/or a cardioversion pending progress throughout the rotation or preceptors discretion. If a resident has an interest in heart failure and is unsure of future rotations, they may be given the opportunity to shadow in the Bronson Heart Failure Clinic. This is an elective rotation that can be pursued once the cardiology rotation is completed.

The role of the pharmacist on the cardiology floor is to review patient's charts, provide medication interventions that will be of benefit of the patient, dosing medications and providing a thorough review of the patient's medications prior to discharge. The expectation is to also counsel patient on high risk medications, heart failure and AMI medications. The pharmacist will attend rounds and answer questions from physicians, APPs, nurses and other staff.

2. Disease States:

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

  • NSTEMI
  • STEMI
  • Angina
  • Atrial fibrillation
  • Congestive heart failure
  • Arrhythmias

Topic discussions, referring to the guidelines 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 goals and objectives outlined below 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.

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/Expected Progression:

Daily expectations:

0805 Attend morning Huddles with preceptor

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, dosing medications, verifying orders, consults and other required duties of the cardiology pharmacist

Day 1: An update about expectations and topic discussions will be sent to the resident prior to starting the rotation. Expectations will be discussed and goal is to orient to the floor.

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. Goal is to completely work-up 5-10 patients during the first week.

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. Goal is for the resident to be independent on counseling and start participating in rounds pending comfort leve. Resident expected to be working up 10-15 patients at this point. A mid-point evaluation will be completed by the end of this week to look into progress.

Week 3: Resident will continue to increase patient load. The expectation is that the resident will be working up 20-25 patients at this time. Resident is expected to be more independent which includes having the phone on the floor (pending comfort level), answering questions independently, running rounds under the preceptor supervision and starting to complete all activities that the cardiology pharmacist complets with guidance.

Week 4: Resident is expected to be independently running the cardiology floor during this week (preceptor will determine the comfort level of the resident). Goal is for the resident to work-up every patient on the cardiology floor. This would include verifying orders in PRU and cath lab. Preceptor will be available as needed. Resident to go to rounds independently (preceptor to determine readiness/comfort). At the end of this week, a formal evaluation will be done and documented in pharmacademic.

[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 Learners:

See General Description

Non-Patient Care Related Activities

Topic discussions: Each week a topic discussion will be assigned (subject to change per preceptor discretion)

Newsletter: Resident will write a 1-2 page article regarding new/hot topics in cardiology that will be sent out to the staff. Preceptor to review and give feedback before sending out to the pharmacy staff.

Nursing presentation: Resident will give a short presentation on topics that the nursing staff would like to learn more about. The presentation is around 20 minutes in length.

Journal club (as directed by preceptor): If a new study comes out or there is a hot topic in cardiology during the month, the resident will be directed to do a journal club to discuss with the preceptor.

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 comorbidities, high-risk medication regimens, and multiple medications following a consistent patient care process

OBJ R1.1.1

(Cognitive - Applying) Interact effectively with health care teams to manage patients’ medication therapy

1. While on rounds, be prepared to identify medication-related problems and make evidencebased recommendations to the team

2. Participate in daily rounds on cardiology and provide recommendations on assigned patients.

3. Work with physicians and nurses to resolve issues found when reconciling patients’ medications prescribed on admission with medications taken as outpatient. Contact prescribing physician to resolve issues found when verifying medication orders.

4. Work with nurses and other health care providers to resolve medication related questions throughout the entire rotation

OBJ R1.1.2

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

1. Assess patients’ and/or caregivers’ understanding of medication therapy and address educational needs through counseling.

2. Provide medication education to patients, their families, and/or care-givers for all patients on assigned floor to be discharged on anticoagulants.

3. Perform any needed discharge counseling for patients, their families, and/or caregivers as part of medication reconciliation duties for patients on assigned floors.

OBJ R1.1.3

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

1. Collect pertinent information on each assigned patient from medical record, patient’s nurse, and patient (as applicable) every morning prior to rounds

2. Review INRs, medical record, and interview patients (if warfarin dose unknown) before altering warfarin therapy

3. Perform a medication history, review medical record, and contact patient’s pharmacy or prescribing physician as needed when performing medication reconciliation. Record discrepancies found and recommendations in EHR

4. Conduct a medication profile review daily on assigned patients, including a review of medical record and patient interview as needed

5. Gather all pertinent patientspecific information in an organized manner and be prepared to discuss recommendations with preceptor and interdisciplinary team during rounds and daily preceptor meetings

6. When verifying orders, review patient’s profile, medical record (as needed), and interview patient, if necessary, to help assess potentially medication orders

OBJ R1.1.4

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

1. Identify any issues with medication therapy and be prepared to discuss issues identified with preceptor by assigned time daily

2. Based on information collected while performing medication reconciliation, assess whether any issues need to be addressed

3. Analyze assigned patient-specific profiles, medication administration records, and pertinent clinical data /documentation records on a daily basis

4. Actively question orders in real time to determine the appropriateness of drug orders (e. g., indication, dose, route, frequency, rate of administration, drug interactions, compliance, cost, etc.)

OBJ R1.1.5

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

1. Start patient on a dosing regimen designed to achieve target levels. Determine when levels or other appropriate labs need to be ordered and collect other information from medical record, as applicable, to assess response to therapy and monitor for adverse reactions. Revise regimen as necessary.

2. Be prepared to discuss recommendations for addressing medication therapy issues with preceptor prior to rounds with the interdisciplinary team.

3. Contact prescribing/primary physician with recommended changes to medications or monitoring plans if determine changes are needed based on clinical informatics alerts.

OBJ R1.1.6

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

1. Document recommended changes to the regimen and monitoring plan in the electronic medical record via I-vents and discuss with appropriate clinic staff when a situation may require more immediate means of communication.

2. Discuss recommendations for addressing medication therapy issues with interdisciplinary team on rounds. After rounds, ensure agreed upon medication changes have been ordered and verified.

OBJ R1.1.7

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

1. For pharmacy consults, write an initial consult note and then a follow-up note whenever drug level results are reported by the lab or the regimen is changed. Enter all orders into the informatics system as “per protocol”.

2. Document any identified adverse drug events into the system’s incident reporting system.

OBJ R1.1.8

(Cognitive - Applying) Demonstrate responsibility to patients

1. Prioritize patient problems. Work to resolve all existing or potential medication therapy issues before leaving for the day.

2. Communicate any medication therapy issues not resolved by the end of the day to the appropriate evening shift pharmacist.

3. Ensure patients have information and/or access to resources to obtain prescribed medication therapy.

Goal R1.2

Ensure continuity of care during patient transitions between care settings

OBJ R1.2.1

(Cognitive - Applying) Manage transitions of care effectively

1. Complete discharge medication reconciliation daily and medication education for all targeted medications.

2. When patients are transferred from cardiology to a medical/surgical unit, communicate any necessary information to the pharmacist assigned to the medical/surgical unit.

3. When patients on anticoagulation, ensure that this will be affordable to the patient and find alternative medications if cost is a barrier


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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