Pharmacy Residency - Rotation Description, Pediatric & Pediatric Intensive Care - Bronson Healthcare

Pharmacy Residency - Rotation Description, Pediatric & Pediatric Intensive Care

Pediatrics and Pediatric Intensive Care

PGY1 - Pharmacy (43400)

Preceptors: Evans, Brandon; Riddle, Bonnie

Description:

Preceptor: Brandon Evans, Pharm.D., and Bonnie Riddle, Pharm.D. Office: E-371

Hours: 8:00am-4:30pm Phone: (269)341-7977

Email: riddleb@bronsonhg.org and evansbr@bronsonhg.org

General Description:

Pediatric (PEDS) and Pediatric Intensive Care Unit (PICU) is a 4 week experience in the Pharmacy Residency PGY-1 program. This experience allows the resident to practice basic skills needed for patient-oriented pharmacy services in the general pediatric and pediatric intensive care areas. The resident will be responsible for  monitoring patients admitted to PEDS and PICU at the Children's Hospital at Bronson Methodist Hospital. The resident will become proficient in pediatric patient monitoring, while utilizing diagnostic and laboratory tests in pediatric patient therapy evaluations and the clinical use of serum drug concentrations. Emphasis will be placed on the resident demonstrating an understanding of common pediatric disease states in hospitalized patients and     the treatment of those diseases. The resident will work closely with the medical residents, nurses, and attending physicians to identify, resolve, and prevent medication issues for pediatric inpatients admitted to the pediatric hospitalist service. Good communication skills and interpersonal relationships will be essential in this practice setting. In addition, the resident will assist with oversight of Doctor of Pharmacy students from Ferris State University who may also be assigned to PEDS and/or PICU in that given month. The resident will participate in several academic activities during the rotation. These activities include, but are not limited to, drug-drug interactions and dose modifications; disease state topic discussions; journal clubs; and case presentations. A patient case presentation to pharmacy or medical staff will be required sometime during or immediately following completion of the rotation.

Disease States:

Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience including, but not limited to: 

  • Trauma - Traumatic brain injury, burns
  • Respiratory disorders - Status asthmaticus, asthma exacerbations, acute respiratory distress syndrome (ARDS), cystic fibrosis, bronchiolitis
  • Neurological disorders - Status epilepticus, drug overdose, sedation/analgesia
  • Endocrine disorders - Diabetes mellitus including diabetic ketoacidosis
  • Infections diseases - Pediatric pharmacokinetic considerations, healthcare-associated and community- acquired pneumonia, septic shock, cellulitis, osteomyelitis
  • Cardiovascular disorders - Hypertension, cardiogenic shock
  • Gastrointestinal disorders - Gastroesophageal reflux disease
  • Renal disorders - Renal failure
  • Hematologic disorders - Sickle cell disease Preceptor Interaction

Daily: 8:30 Pre-rounds with resident

9:00 Team rounds with resident and team

12:00 - 4:30 Preceptor office hours available for topic discussions, reviewing progress notes, patient updates, etc. Evaluation Strategy

The resident will receive on-going, regular formative verbal feedback throughout the rotation. The resident and preceptor will meet for an informal midpoint discussion at the end of week two in order to assess the overall  learning experience for the resident. This meeting will be documented as formative feedback in PharmAcademic and will serve to identify areas on which to focus, future activities, etc., based on resident feedback as well as preceptor identification of areas for improvement. At the completion of the rotation the resident will independently complete the Summative Evaluation, then will meet with the preceptor to discuss, after which the preceptor will complete his/her own Summative Evaluation. The resident will also complete the Learning Experience Evaluation and a Preceptor Evaluation for each preceptor.

Expectation of Residents:

Communication:

  1. Daily scheduled meeting times: Residents to prioritize questions and problems to discuss during scheduled meeting times as listed above.
  2. E-mail: Residents are expected to read e-mails at the beginning, middle and end of each day at a minimum for ongoing communication. This is appropriate for routine, non-urgent questions and problems.
  3. Work mobile phone: Appropriate for urgent questions pertaining to patient care.
  4. Personal phone number: Provided to resident at time of learning experience for emergency issues.

Expected progression of resident responsibility on this learning experience:

(Length of time preceptor spends in each of the phases will be customized based upon resident's abilities and timing of the learning experience during the residency training year)

Day 1 Preceptor to review Peds/PICU learning activities, schedules, and expectations. Discuss potential participation in attending a pediatric sedation, shadowing a medical resident or attending, participation in the medication reconciliation process at admission, attending various medical procedures, taste testing of oral liquid medications with the medical residents, 5-min topic presentation to the pediatric team, medication reconciliation at admission activities, etc. Please bring a copy of your Outlook calendar on Day 1 of your rotation. The following items need to be scheduled during day 1 of your rotation: midpoint evaluation (done together), resident self evaluation (independent), preceptor and resident review self evaluation (together), preceptor to complete final evaluation (together). Schedule 5 minutes at the end of every week to review goals for the following week of the rotation: preceptor's goals and resident's goals (include desired experiences or focused areas of improvement).

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

Week 2 Resident to work up assigned patients. Preceptor will attend/participate in team rounds (coaching the resident to take on more responsibility as a pharmacist on the team). Preceptor will be available for questions and will follow patients independently to monitor resident skill development in all aspects of the learning experience (facilitating the resident as the lead pharmacist on the team).

Week 3-4 Resident to work up assigned patients. Preceptor may attend team rounds and observe the resident's participation, 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 and will follow patients independently to monitor resident skill development in all aspects of the learning experience (facilitating the resident as the lead pharmacist on the team).

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

Actively participate in multi-disciplinary rounds and ensure issues discussed during rounds are followed up.

Analyze orders for verification and pending admission orders to identify any pharmacy related issues and follow up with the prescriber for resolution.

Analyze patient specific profiles prior to rounds to identify any pharmacy related issues.

Discuss with provider, nurse, and/or patient any potential problems to obtain more information or potential solutions. Work with the provider(s) to resolve the issues and/or optimize therapy.

OBJ R1.1.2

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

Discuss with provider, nurse, and/or patient any potential problems to obtain more information or potential solutions. Ensure recommendations made are both evidence based and best for each patient based on cost, adherence, and patient preference considerations.

OBJ R1.1.3

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

Accurately gather and organize patient specific information on assigned patients prior to pre-rounds with preceptor.

Prioritize problems for concise discussion with preceptor and/or the team.

OBJ R1.1.4

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

Analyze the data collected from various sources and develop an appropriate plan based on the data obtained.

Identify appropriate areas within Epic to gather pertinent patient data (ex: Media tab, Notes, etc).

Identify appropriate source to gather pertinent patient data (ex: Epic, patient/family, PCP, pharmacy, etc).

OBJ R1.1.5

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

Develop strategies to monitor patient progress using both objective and subjective measures to ensure the best treatment outcome while limiting adverse reactions/side effects.

Formulate appropriate therapeutic plan changes based on patient's individual response.

Review patient's progress on current regimen.

Utilize guidelines and primary literature to develop evidence based, patient specific plan and explain the literature behind recommendation if asked.

OBJ R1.1.6

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

Discuss with provider, nurse, and/or patient any potential problems to obtain more information or potential solutions. 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.

Work with the provider(s) to resolve the issues and/or optimize therapy.

OBJ R1.1.7

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

Use EMR to document interventions and progress notes per hospital policy.

OBJ R1.1.8

(Applying) Demonstrate responsibility to patients

Identify and report medication events (ADE or medication errors).

Goal R1.2

Ensure continuity of care during patient transitions between care settings

 

OBJ R1.2.1

(Applying) Manage transitions of care effectively

Participate in the medication reconciliation process at admission and discharge as needed to optimize patient outcomes.

Utilize EMR documentation (i-vents, progress notes, sticky notes and pharmacist specific flowsheets) to adequately handoff concise information between colleagues.

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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