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Pharmacy Residency - Rotation Description, Clinical Pharmacist

Clinical Pharmacist

PGY1 - Pharmacy (43400)

Faculty: Katie Adrian

Site: Bronson Methodist Hospital

Status: Active

Required

Description:

Bronson Methodist Hospital - Clinical Pharmacist Rotation

Learning Experience Description

Preceptor: Varies, depending on practice area

General Description:

The Clinical Pharmacist Rotation is a required two week learning experience at Bronson Methodist Hospital. This experience gives residents the opportunity to demonstrate proficiency and the skills necessary to practice as an independent pharmacist on an inpatient unit.

Disease States:

Common disease states in which the resident will be expected to encounter during this rotation include, but are not limited to:

Cardiovascular disorders
- Hypertension, heart failure, stroke, hyperlipidemia
Renal disorders
- Acute renal failure, end-stage renal disease, glomerulonephrosis
Gastrointestinal disorders
- GERD, PUD, pancreatitis, hepatitis
Endocrinologic disorders
- Diabetes, thyroid disorders, osteoporosis
Infectious diseases
- UTI, pneumonia, endocarditis, sepsis, skin and soft tissue infections, bone and joint infections
Neurological disorders
- Epilepsy, drug overdose, sedation
Pulmonary disorders
- Asthma, COPD, pulmonary embolism
Psychiatric disorders
- Depression, bipolar disorder, schizophrenia
Trauma
- Traumatic brain injury

Other activities: In addition to the objectives and activities that will be formally taught and evaluated, the resident will be expected to function as the floor pharmacist. Therefore, he/she will be expected to perform all the duties expected of the floor pharmacist, including but not limited to:

a. Actively participate in multidisciplinary rounds (times variable depending on floor)

b. Be prepared to provide education to patients on a variety of medications including but not limited to:

Warfarin
Lovenox/Arixtra
Xarelto/Pradaxa
Discharge counseling

c. Respond to drug information questions

Expected progression of the resident*:

Week 1: The preceptor will be available for any questions or concerns the resident may have throughout the week. The preceptor may attend rounds with the resident depending on the resident's comfort level, but the resident is expected to lead rounds and work up all patients on the floor. The preceptor will be available to the resident during the hours of the floor shift (whether on the floor or in the pharmacy). The preceptor MAY be available on the floor.

Week 2: The preceptor may be available for questions in the hospital, but will not be on the floor with the resident. The resident is expected to attend rounds independently and manage the needs of their assigned floor during the week. If questions arise, the resident is expected to utilize the other pharmacists as recourses as a typical decentralized pharmacist would.

*This is subject to depending on the comfort level of the resident/preceptor

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 may be documented as a formative assessment in PharmAcademic. At the completion of the rotation the resident and preceptor will independently complete the Summative Evaluation feedback then will meet and compare the evaluations prior to cosigning. The preceptor will solicit and incorporate feedback from non-pharmacy staff on the assigned patient care unit. The resident will also complete the Learning Experience Evaluation and a Preceptor Evaluation for each preceptor.

Expectation of Learners:

Expectations of Residents:

The resident will be responsible for monitoring all patients admitted to the designated floor. During the two week learning experience, the resident will develop and monitor pharmaceutical care plans, participate in multidisciplinary rounds, provide antibiotic and anticoagulation dosing services, initiate and monitor TPNs, provide renal dosing, and make recommendations to providers. The first week, the preceptor will be available for questions and concerns from the resident, and the second week the resident will be expected to be completely independent on their designated floor, reaching out to the centralized and decentralized pharmacist resources if help is needed as a typical decentralized pharmacist would.

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	Assist other members of the healthcare team with medication-related questions Demonstrate ability to make appropriate medication therapy recommendations during interdisciplinary rounds Employ effective direct communication skills
OBJ R1.1.2	(Cognitive - Applying) Interact effectively with patients, family members, and caregivers	Provide education to patients and family members during medication teachings for anticoagulation therapy, medication reconciliation, etc.
OBJ R1.1.3	(Cognitive - Analyzing) Collect information on which to base safe and effective medication therapy	Accurately gather and organize patient-specific information Demonstrate ability to understand which references to use, and how to access them
OBJ R1.1.4	(Cognitive - Analyzing) Analyze and assess information on which to base safe and effective medication therapy	Assess antibiotics and other qualifying medications for renal dose adjustment Demonstrate ability to assess medical literature and form an appropriate response to a drug information request Utilize the electronic medication record to obtain objective patient specific information about patient’s progress
OBJ R1.1.5	(Cognitive - Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)	Develop responses to drug information questions that contribute to the care of the patients Develop strategies to monitor patient progress using both objective and subjective measures to ensure the best treatment outcomes while limiting adverse reactions/side effects Utilize guidelines and primary literature to develop evidence-based, patient specific plans
OBJ R1.1.6	(Cognitive - Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions	Actively participate in rounds and make interventions as necessary based on the resident's evaluation of patient medication regimens Monitor to ensure recommendations are acted upon, and follow up with providers on interventions as necessary/appropriate Problem solve with other appropriate members of the healthcare team
OBJ R1.1.7	(Cognitive - Applying) Document direct patient care activities appropriately in the medical record or where appropriate	Appropriately determine if documentation should be left as an i-vent, a sticky note, or a progress note. Utilize the electronic medical record to correctly document interventions
OBJ R1.1.8	(Cognitive - Applying) Demonstrate responsibility to patients	Document and report adverse drug events and patient safety reports if indicated
Goal R1.3	Prepare, dispense, and manage medications to support safe and effective drug therapy for patients
OBJ R1.3.2	(Cognitive - Applying) Manage aspects of the medication-use process related to formulary management	Demonstrate ability to assess IV administration guidelines for appropriateness of IV medications ordered Ensure approved drug use criteria are followed for appropriate antibiotic use. Follow approved criteria for use of patient supplied medications Follow approved policies and procedures for borrowing medications from or sending medications to other organizations and demonstrate correct procedure for logging transaction Institute therapeutic interchanges for medications not carried by Bronson pharmacy and approved by PNT committee for automatic substitution

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