PGY1: Pediatric Infectious Diseases Riley Hospital for Children Indiana University Health

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1 PGY1: Pediatric Infectious Diseases Riley Hospital for Children Indiana University Health Preceptors Kristen Nichols, PharmD, BCPS (AQ-ID) Office: /Pager: /Cell: General Description This month-long pediatric infectious diseases (ID) rotation satisfies the pediatric rotation requirement for PGY1 Pharmacy Residents. The Pediatric ID service provides care for patients admitted to the service (approximately 1-6 daily) as well as consultations on other primary services. The Pediatric ID team consists of an attending physician, pediatric or adult ID fellows, pediatric medical residents, and 3 rd and 4 th year medical students; rounds are typically held at 8:30 AM in SFT7WB M-F. Residents will have the opportunity to apply knowledge & skills to a new population and to learn how to provide care for children. Patients cared for range from premature neonates to young adults. The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team. This includes maintaining a high degree of intellectual curiosity and ensuring knowledge of rationale for all drug therapy choices. Routine responsibilities include: reconciling medications for all patients admitted to the team, therapeutic drug monitoring, anticoagulation management, medication allergy clarification, and patient discharge counseling. The pharmacist will also provide drug information and education to healthcare professionals as well and patients and caregivers. For patients that are Pediatric ID consults (vs primary Pediatric ID team patients), the clinical pharmacy specialist is responsible for evaluating medication therapy as it pertains to the ID problems (including impact on other disease states or medications where applicable) and ensuring safe and effective medication use for these problems. This includes open and detailed communication with the patient s primary clinical pharmacist. Pediatric Antimicrobial Stewardship activities may include: review of positive blood cultures, review of patients receiving anti-infectives, evaluation and optimization of anti-infective dosing, development of standard dosing or therapy recommendations, or medication use evaluations. Residents are expected to attend Peds ID conference each Thursday. Disease States The resident will be expected to gain proficiency through direct patient care experience for common diseases including, but not limited to: Common pediatric disease states Asthma Diaper rash Thrombosis ADHD Seasonal allergies Constipation Pain 1

2 Fluid & electrolyte management Pediatric infectious diseases Kawasaki disease Bone & joint infections Skin & soft tissue infections Neonatal herpes infections Bacterial meningitis Viral infections Acute otitis media UTI Pneumonia Endocarditis Intra-abdominal infections Nosocomial pediatric infectious diseases Neutropenic fever Pneumonia Catheter-associated infections Clostridium difficile infections Topic discussions and reading of text book chapters and key articles will be used to help develop the resident s patient care skills for common disease states and for acquiring knowledge about diseases seen infrequently on the service. Goals and Objectives Competency Area GOAL R1.1 Objective R1.1.1 Objective In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients following a consistent patient care process. (Applying) Interact effectively with health care teams to manage patients medication therapy. Activities Round with the Pediatric ID team daily. Provide recommendations in an acceptable, non-threatening way and assess response. Determine desired timing and mode for communication with team members, including RNs and MDs. Respond to requests for patient or drug information in a timely manner and in a format acceptable to requestor. 2

3 Objective R1.1.2 (Applying) Interact effectively with patients, family members, and caregivers. Objective R1.1.3 (Applying) Collect information on which to base safe and effective medication therapy. Objective R1.1.4 (Analyzing) Analyze and assess information on which to base safe and effective medication therapy. Objective R1.1.5 (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans). Obtain necessary medication history from patient and/or caregiver. Counsel patient and/or caregiver, using a careful determination based on age and cognitive level, on home medications and evaluate concerns. List all medication doses, frequencies, routes, and dosage forms for each inpatient and all anti-infectives for each consult patient (weight-based and total dose). Determine indication for each medication. Determine and collect necessary monitoring parameters (baseline and follow-up) for each medication. Evaluate appropriateness of medication doses based on available resources. Evaluate response to medications, including determination of benefit or harm. Assess choice of medication based on indication and currently available best evidence, including activity of chosen antimicrobials against known or suspected pathogens. Weigh risks and benefits in a chosen treatment approach. Determine optimal treatment regimen for each patient problem based on currently available best evidence and patient factors. Determine need for monitoring parameters including: clinical parameters, who will monitor and how often; laboratory parameters and how often. Compare needed monitoring to current level of monitoring. 3

4 Objective R1.1.8 (Applying) Demonstrate responsibility to patients. GOAL R4.2 Effectively employs appropriate preceptors roles when engaged in teaching. Objective R4.2.1 (Analyzing) When engaged in teaching, select a preceptors role that meets learners educational needs. Objective R4.2.2 (Applying) Effectively employ preceptor roles, as appropriate. Ensure thorough and timely followup to patient questions or requests for pharmacy or that that need to be referred to another healthcare provider. Prioritize patient care effectively, addressing urgent issues first and ensuring that needed tasks are completed prior to leaving for the day (or from home as necessary). Acknowledge and admit when unsure about patient s therapy or monitoring, and ask for assistance if unable to find an answer alone. Determine APPE student s current level of performance and utilize information to determine whether direct instruction, modeling, coaching, or facilitating is most appropriate for each situation. Provide direct instruction as needed to APPE students. Ask thought-provoking open-ended questions to engage students in the learning process. Demonstrate thought & care processes as the need arises and ask the student to demonstrate use of similar process. Demonstrate positive, effective interactions with team. Where possible, encourage student to answer questions, make recommendations and take on responsibility. Provide assistance & feedback to students where necessary. Preceptor Interaction The preceptor s schedule is highly variable, making a norm difficult for this rotation. However, the preceptor is almost always available for questions and assistance even when physically located at another campus. Some discussions may need to occur via phone. A tentative schedule for the month will be provided to the resident by day 1 of the rotation, and needed changes will be made based on resident feedback. 8:00 8:30 Pre-rounds with resident ± students; it may be possible to phase this out as the rotation progresses 12:00 12:30 Preceptor available in office (or by phone) to touch base regarding 4

5 patient needs, resident responsibilities, and plan for the remainder of the day 2:40 2:50 Resident, preceptor, and students (where available/possible) to attend huddle in inpatient pharmacy Communication: A. Daily check-ins: Residents will need to prioritize questions and problems to discuss during scheduled or unscheduled meeting times as listed above. Urgent requests should be handled as such. Necessary information will be shared with preceptor when resident is transitioning between learning experiences (example, leaving site to attend clinic responsibilities.) B. Daily scheduled meeting times: Residents will need to prioritize questions and problems to discuss during scheduled or unscheduled meeting times as listed above. C. Residents are expected to read s at the beginning, middle and end of each day at a minimum for ongoing communication. This is appropriate for routine, nonurgent questions and problems. D. Office extension: Appropriate for relatively urgent questions pertaining to patient care. E. Pager: Residents to text message or page preceptor for urgent/emergency situations pertaining to patient care Expected progression of resident responsibility on this learning experience: (Length of time preceptor spends in each of the phases will be personalized based upon resident s abilities and timing of the learning experience during the residency training year) Day 1: Preceptor to review learning activities and expectations with resident. Resident to work up all of the team s inpatients and attend rounds with preceptor. Week 1: Resident to work up all of the team s inpatients and approximately 1/2 of the team s consults and present to preceptor daily. Preceptor to attend and participate in team rounds with resident for first 2-3 days, modeling pharmacist s role on the health care team and beginning to coach resident in team involvement. Preceptor will model interactions with APPE students and begin to shift small responsibilities to resident. Weeks 2-3: Resident to work up all of the team s inpatients and consults, present to preceptor once/weekly, and discuss problems with preceptor daily. Preceptor available to attend rounds with resident if desired by resident, but likely that resident will round alone for the majority of days. Resident to discuss patients with students if applicable. Preceptor will coach resident on patient care and begin the transition to facilitation of resident. Preceptor will continue to coach resident in student precepting. Weeks 4 through the end of rotation: Resident should continue to work up the team inpatients & consults, taking on more of a primary role in communicating with clinical pharmacists from other teams and precepting APPE students. 5

6 Evaluation PharmAcademic will be used for documentation of scheduled evaluations (see chart below). The resident and the preceptor will independently complete the assigned evaluation and save as draft. The resident and the preceptor will then compare and discuss the evaluations. This discussion will provide feedback both on performance of the activities and the accuracy of the resident s self-assessment skills. Evaluations will be signed in PharmAcademic following this discussion. Summative evaluations: This evaluation summarizes the resident s performance throughout the learning experience. Specific comments should be included to provide the resident with information they can use to improve their performance in subsequent learning experiences. Preceptor and Learning Experience evaluations must be completed by the last day of the learning experience. What Who When Summative Preceptor End of month Preceptor/Learning Experience Evaluation Resident End of month An informal mid-point evaluation will occur at approximately midway through the rotation. This will involve a discussion of resident s performance (things to continue and things to improve) as well as ways for preceptor to maximize the learning opportunity. This evaluation will be documented in PharmAcademic or in another manner as desired by preceptor/resident. 6