Pharmacy Residency - Rotation Description, Internal Medicine - Bronson Healthcare

Internal Medicine-Practical

Internal Medicine-Practical

PGY1 - Pharmacy (43400)

Faculty: Amanda Hult, Pharm.D., hultam@bronsonhg.org

Site: Bronson Methodist Hospital

Status: Active

Required

General Description:

Internal Medicine - Practical (IMP) is a four week learning experience at Bronson Methodist Hospital that fulfills the required internal medicine experience. IMP uses a floor based practice model to give the resident the opportunity to participate in direct patient care activities and gain experience practicing as a clinical pharmacist. They will also experience working with a multidisciplinary team that includes attending physicians, medical residents, nurses, case managers, social workers, dietitians, and respiratory therapists. The resident will work towards assuming responsibility for all patients admitted to the Adult Medical Unit (AMU, maximum number of beds assigned is 33)and Extended Medical Care Unit (EMCU, maximum number of beds assigned is 25). During the 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, offer medication counseling to patients, and engage in topic discussions with the preceptor.

The pharmacist's role is to interact effectively with the healthcare team to provide excellent care to the patients. This role also includes daily chart reviews of patients, identifying issues with medication regimens and making appropriate recommendations to providers, answering phone calls from staff, documenting interventions within EPIC, order verification, completion of consults requested by providers, admission and discharge medication reconciliation, IV to PO medication conversion per policy, renal dosing of medications per policy, and patient counseling.

Disease States:

Common disease states in which the resident will gain experience during this rotation include, but are not limited to:

Cardiovascular disorders: Hypertension, heart failure, stroke, hyperlipidemia, atrial fibrillation

Alcohol withdrawal and substance abuse

Renal disorders: Acute renal failure, end-stage renal disease

Gastrointestinal disorders: GERD, PUD, pancreatitis, hepatitis, diverticulitis, GI bleed

Endocrinologic disorders: Diabetes, thyroid disorders, osteoporosis

Infectious diseases: UTI, pneumonia, endocarditis, sepsis, skin and soft tissue infections, bone and joint infections, bacteremia

Neurological disorders: Drug overdose, encephalopathy

Pulmonary disorders: Asthma, COPD

Psychiatric disorders: Depression, anxiety, bipolar disorder, schizophrenia, dementia, delirium

Thromboembolic disorders: DVT and PE

Schedule and Preceptor Interaction*:

Daily Schedule:

0800: Meet with preceptor for morning information and attend huddles

0815-0945: Patient chart reviews in preparation for multidisciplinary rounds

0945-1000: Present patient care plans to preceptor prior to rounds

1000-1100: Attend EMCU rounds 1100-1200: Attend AMU rounds

1200-1530: Complete daily responsibilities (ie. Antibiotic/anticoagulation/TPN dosing services, medication counseling, documenting interventions, review discharge medication reconciliations) and make further recommendations to providers as necessary.

1530: Sign out with second shift staff and provide information for evening follow-up if needed

Four Week Timeline:

Day 1: Preceptor to review learning experience description, associated activities, schedules, evaluation strategy, and general expectations with the resident. Preceptor to provide tour of the floors and introduce resident to staff.

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

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

Week 3-4: Resident to work up assigned patients and present to preceptor. Preceptor may attend and observe resident's participation in 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 progression in the current rotation and where the rotation occurs in the residency program.

Evaluation Strategy

The resident will receive on-going, regular informative 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. 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.

Expectation of Learners:

The expectation of the resident is that they become an effective member of the healthcare team. They will work towards assuming responsibility for all patients admitted to the Adult Medical Unit and Extended Medical Care Unit. During the 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, offer medication counseling to patients, and engage in topic discussions with the preceptor as time allows.

The resident will also be responsible for creating and giving an inservice presentation to the AMU and EMCU nursing staff on a topic to be determined by the nurses or of the resident's own choosing. Inservice materials will be presented to the preceptor prior to the presentation for review and approval. The presentation itself should be no longer than 15 minutes with a short handout or pocket card created to provide to the staff.

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

Demonstrate ability to participate effectively in multidisciplinary rounds.

Demonstrate professionalism when interacting with the healthcare team.

Use appropriate communication methods with the healthcare team (ie. in person, telephone, paging, sticky notes to provider)

 

OBJ R1.1.2

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

Demonstrate appropriate patient counseling on selected medications (ie. anticoagulants).

Demonstrate the ability to clarify accurate allergy and medication information with patients when necessary.

OBJ R1.1.3

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

Distinguish appropriate areas in EPIC to collect patient data efficiently.

Examine data via chart review, nurses, case managers, and patient interaction in order to make the most appropriate medication recommendations

OBJ R1.1.4

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

Examine evidence-based guidelines/literature when assessing medication therapies

Examine orders in verification for accuracy and appropriateness.

Examine patient specific data in order to make recommendations to providers to optimize patient care.

OBJ R1.1.5

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

Develop individual care plans on all patients that can be presented to the preceptor prior to rounds.

Investigate patients' progress on current medication regimens and redesign new regimens if necessary.

OBJ R1.1.6

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

Demonstrate the ability to provide detailed instructions to other pharmacists for follow-up between shifts

Implement effective strategies for patient monitoring and follow-ups that can be used to ensure all activities are completed before leaving for the day.

Use the appropriate documentation in EPIC regarding patient care plans that can be used for daily monitoring (ie. Ivents, sticky notes, flowsheets)

OBJ R1.1.7

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

Demonstrate the ability to document and categorize interventions appropriately using Ivents within the EPIC system.

Use EPIC to document completion of patient education appropriately.

Use the appropriate flow sheets within EPIC for daily monitoring of warfarin, heparin, TPNs, vancomycin, and aminoglycosides.

OBJ R1.1.8

(Cognitive - Applying) Demonstrate responsibility to patients

Demonstrate the ability to follow patients' care plans throughout the day.

Schedule time in the day to follow up on patients' questions and educational needs when necessary.

Use the discharge medication reconciliation workflow to review discharge medication lists for accuracy and resolve issues prior to discharge

Goal R1.2

Ensure continuity of care during patient transitions between care settings

 

OBJ R1.2.1

(Cognitive - Applying) Manage transitions of care effectively

Demonstrate ability to work with case managers when necessary for discharge needs related to medications (ie. Checking medication insurance coverage)

Demonstrate the ability to communicate important information to ambulatory care pharmacists within the Bronson system if necessary on mutual patients.

Use the admission medication reconciliation workflow to work with the pharmacy technician on obtaining and documenting accurate home medication lists for all patients.

Goal R4.1

Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups)

 

OBJ R4.1.1

(Cognitive - Applying) Design effective educational activities

Demonstrate the ability to create a 15 minute nursing inservice presentation with handout/pocket card.

 

OBJ R4.1.2

(Cognitive - Applying) Use effective presentation and teaching skills to deliver education

Execute an effective nursing inservice.

Evaluations:

Evaluation

Evaluator

Evaluated

Timing

Summative Evaluation

All Preceptors

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed

ASHP Preceptor Evaluation

Residents

All Preceptors of this Learning Experience

Ending and Quarterly if Needed

ASHP Learning Experience Evaluation

Residents

Learning Experience

Ending and Quarterly if Needed

Summative Evaluation

Residents

Each Resident Taking this Learning Experience

Ending and Quarterly if Needed