Pharmacy Residency - Rotation Description, Clinical Pharmacist
Clinical Pharmacist
PGY1 - Pharmacy (43400)
Preceptors: Adrian, Katie
Description:
Bronson Methodist Hospital - Clinical Pharmacist Rotation
Learning Experience Description Preceptor: Katie Adrian, Pharm.D., BCPS Phone: (269) 341-7072
E-mail: adriank@bronsonhg.org
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 at the skills necessary to practice pharmacy on various medical units.
Disease States:
Common disease states in which the resident will be expected to encounter during this rotation include, but are not limited to:
o Hypertension, heart failure, stroke, hyperlipidemia
o Acute renal failure, end-stage renal disease, glomerulonephrosis
- Gastrointestinal disorders
o GERD, PUD, pancreatitis, hepatitis
o Diabetes, thyroid disorders, osteoporosis
o UTI, pneumonia, endocarditis, sepsis, skin and soft tissue infections, bone and joint infections
o Epilepsy, drug overdose, sedation
o Asthma, COPD, pulmonary embolism
o Depression, bipolar disorder, schizophrenia
o 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:
- Actively participate in multidisciplinary rounds (times variable depending on floor)
- Be prepared to provide education to patients on a variety of medications including but not limited to:
-Warfarin
-Lovenox/Arixtra
-Xarelto/Pradaxa
-Discharge counseling
- Respond to drug information questions
Preceptor Interaction*:
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. 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.
*This is subject to change 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 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:
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.
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Taught and Evaluated Objectives
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Activities
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Goal R1.1
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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
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OBJ R1.1.1
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(Applying) Interact effectively with health care teams to manage patients' medication therapy
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Assist other members of the healthcare team with medication-related questions
Employ effective direct communication skills
Make appropriate medication therapy recommendations during interdisciplinary rounds
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OBJ R1.1.2
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(Applying) Interact effectively with patients, family members, and caregivers
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Provide education to patients and family members during medication teachings for anticoagulation therapy, medication reconciliation, etc.
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OBJ R1.1.3
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(Analyzing) Collect information on which to base safe and effective medication therapy
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Accurately gather and organize patient-specific information Understand which references to use, and how to access them
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OBJ R1.1.4
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(Analyzing) Analyze and assess information on which to base safe and effective medication therapy
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Answer drug information questions for pharmacists, or other members of the healthcare team
Understand how to assess medical literature and form an appropriate response to a drug information request.
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OBJ R1.1.5
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(Creating) Design or redesign safe and effective patient- centered therapeutic regimens and monitoring plans (care plans)
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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.
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OBJ R1.1.6
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(Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions
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Discuss potential problems and solutions with other appropriate members of the healthcare team
Utilize the electronic medication record to obtain objective patient specific information about patient's progress
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OBJ R1.1.7
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(Applying) Document direct patient care activities appropriately in the medical record or where appropriate
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Utilize the electronic medical record to correctly document interventions
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OBJ R1.1.8
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(Applying) Demonstrate responsibility to patients
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Understand how to document and report adverse drug events or medication errors
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Goal R1.3
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Prepare, dispense, and manage medications to support safe and effective drug therapy for patients
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OBJ R1.3.2
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(Applying) Manage aspects of the medication-use process related to formulary management
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Assess antibiotics and other qualifying medications for renal dose adjustment
Evaluate approved drug use criteria for appropriate antibiotic use
Evaluate enoxaparin dosing based on pharmacy guidelines Institute therapeutic interchanges for medications not carried by Bronson pharmacy and approved by PNT committee for automatic substitution
Review IV administration guidelines for appropriateness of IV medications ordered
Understand instances of when use of patient's home medications are appropriate/inappropriate
Understand policies regarding borrowing medications from or sending medications to other organizations and demonstrate procedure for logging transaction
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OBJ R1.3.3
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(Applying) Manage aspects of the medication-use process related to oversight of dispensing
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Check accuracy of medications dispensed
Effectively prioritize work load and organize work flow
Utilize Epic Dispense Prep and Check system in IV room and unit dose (for oral liquids) to verify accurate technician preparation
Verify packaging by pharmacy technician for accuracy prior to adding to inventory
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Evaluations:
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Evaluation
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Evaluator
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Evaluated
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Timing
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Summative Evaluation
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All Preceptors
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Each Resident Taking this Learning Experience
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Ending and Quarterly if Needed
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ASHP Learning Experience Evaluation
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Residents
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Learning Experience
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Ending and Quarterly if Needed
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ASHP Preceptor Evaluation
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Residents
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All Preceptors of this Learning Experience
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Ending and Quarterly if Needed
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