1. General description

Transcription

1 Oncology Clinic Learning Activities: Preceptor: Jeni Ludescher, PharmD; Tim Samuelson, RPh Work area: Luther Building North, Cancer Center Hours: 8:00-16:30 Phone: (715) General description Oncology Clinic is a required, four week, rotational learning experience at Mayo Clinic Health System- Eau Claire Clinic. The oncology department has a range of encounters for each day depending on nursing staff and physician coverage. There are four oncology/hematology physicians, eleven registered nurses, 1.5 FTE pharmacists and 1.5 FTE pharmacy technicians in the department. Other disciplines involved in the department include massage therapist, healing touch, dietician, cancer guide, and investigational research department. 2. Expectations of residents The pharmacy resident is responsible for reviewing lab values, determining appropriate treatment protocols, answering medication therapy questions, supervising preparation of sterile products, hazardous waste management, inventory management, in-servicing nurses on new medications for treatment, attending morning huddle, and working toward assuming daily management of the oncology pharmacy department throughout the learning experience. The resident will be responsible for the timely documentation of pharmacy progress notes using both the pharmacy computer software and the clinic s electronic medical record. Good communication, leadership, strong clinical and interpersonal skills are vital to success in this experience. The resident must devise efficient strategies for accomplishing the required activities in a fast paced work environment within a limited time frame. 3. Disease states/topics for weekly discussion Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience includes, but are not limited to: Neoplastic diseases: Breast cancer Colorectal Cancer Leukemia-acute and chronic Lung cancer Lymphomas Ovarian cancer Prostate cancer Cancer-related disorders and cancer treatment disorders: Constipation and diarrhea Fatigue Hypercalcemia Infections in immunocompromised patients Mucositis Myelosuppression Nausea and vomiting Oncology Clinic Learning Experience Rev 12/16/16 1 P a g e

2 Nutritional deficiencies Pain Skeletal-related events Spinal cord compression Thrombosis Tumor lysis syndrome In addition, residents will acquire knowledge of the following cancer-related disorders and cancer treatment-related disorders to conduct discussion of their characteristics and treatment. Alopecia Anaphylaxis Anorexia Disseminated intravascular coagulation Drug extravasations Graft-versus-host disease Infertility Malignant effusions Medical emergencies Organ-specific toxicities (e.g. cardiotoxicity, dermatologic, hepatotoxicity, neprhotoxicity, neurotoxicity) Radiation therapy complications Secondary malignancies Superior Vena Cava Syndrome Surgical complications Syndrome of inappropriate antidiuretic hormone secretion Treatment procedures residents will have experience with patients undergoing the following, or will acquire sufficient knowledge of the following procedures to conduct discussion of their characteristics: Autologous hematopoietic stem cell therapy Intrathecal/intraventricular therapy Residents will acquire sufficient knowledge of the following treatment procedures to conduct discussion of their characteristics: Allogeneic hematopoietic stem cell therapy Radiation therapy Surgery 4. Preceptor Interaction Prior to Rotation: Required Reading: Hematology/Oncology I and II PSAP-V, Book 10. ACCP; April 2006, ISBN: X. (May obtain from Mayo Clinic Health System Library & AV Services) The Oncology Survival Guide: Part 1 and Part 2. Pharmacist s Letter. Volume 2010, Course No. s 214 and 219. (Copies available in the oncology pharmacy) Daily: 8:00am Access Epic computer program for work-day use 8:15am Review chemotherapy nurse infusion schedule for current day 8:30am Review applicable lab values/results for appropriateness of chemotherapy administration for each patient and attend morning huddle Oncology Clinic Learning Experience Rev 12/16/16 2 P a g e

3 1:00pm Review chemotherapy nurse infusion schedule for next day to evaluate for new patients and adequate medication inventory 2:45pm Generate daily medication inventory order through cardinal 3:30pm-4:30pm Preceptor office hour available for topic discussions, reviewing progress notes, patient updates, etc. Expected progression of resident responsibility on this learning experience: Week 1: Begin processing and verifying oncology orders on selected patients and reviewing patient charts for lab values and plan of care. Pharmacist will continue to discuss common disease states and treatment options for selected patients. Week 2: Begin processing and verifying larger percentage of oncology orders and treatments. Serve as source of medication information for oncology staff. Begin reviewing oncology treatments that have not yet been covered by specific patient care situations. Week 3-4: Assume daily management of the oncology pharmacy and serve as a resource to staff members. Continue to review oncology conditions and palliative care options for treatments not experienced in the learning activity. (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.) 5. Activities Competency Area R1 Goal R1.1 Objective R1.1.1 Objective R1.1.2 Objective R1.1.3 Objective R1.1.4 Objective R1.1.5 Patient Care 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. (Applying) Interact effectively with health care teams to manage patients medication therapy. (Applying) Interact effectively with patients, family members, and caregivers. (Analyzing) Collect information on which to base safe and effective medication therapy. (Analyzing) Analyze and assess information on which to base safe and effective medication therapy. (Creating) Design or redesign safe and effective patient-centered therapeutic regimens Activities Oncology Clinic Learning Experience Rev 12/16/16 3 P a g e Organize a progression of patient s drug therapy delivery with the nurse to facilitate workload prioritization. Organize the initiation of REMS specialty oncology treatments through the enrollment process and consultation with the patient. Analyze oncology patients from schedule. Examine the patient s chart to collect clinical information Analyze all necessary lab orders Plan patient care with nursing staff and review current copies of orders for completeness, and appropriate

4 and monitoring plans (care plans). medication therapy management. Objective R1.1.6 (Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions. Plan therapy adjustments with providers as needed. Objective R1.1.7 (Applying) Document direct patient care activities appropriately in the medical record or where appropriate. Develop a pharmacy communication note to document interventions and patient progress notes. Objective R1.1.8 (Applying) Demonstrate responsibility to patients. Select appropriate treatments and doses for certain oncology medications. Choose appropriate doses per protocol and current guidelines through calculations. Goal R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients. Objective R1.3.1 (Applying) Prepare and dispense medications following best practices and the organization s policies and procedures. Organize infusion orders for technician compounding. Utilize sterile product verification steps to approve products prepared by infusion technician Objective R1.3.2 (Applying) Manage aspects of the medicationuse process related to formulary management. Identify all next day patients to determine current inventory needs. Objective R1.3.3 (Applying) Manage aspects of the medicationuse process related to oversight of dispensing. Develop workload for current day and next day. Plan workload for technician based on nursing recommendations. Competency Area R2 Advancing Practice and Improving Patient Care Goal R2.1 Demonstrate ability to manage formulary and medication-use processes, as applicable to the organization Objective R2.1.1 (Creating) Prepare a drug class review, monograph, treatment guideline, or protocol. Develop in-services for nursing staff on new treatments. Objective R2.1.2 (Applying) Participate in a medication-use evaluation. Make use of tumor board discussion to evaluate medication-use in oncology Objective R2.1.3 (Analyzing) Identify opportunities for improvement of the medication-use system. Take part in evaluation of clinical inquiries, adjuvant treatment, palliative care, and compatibility questions. Objective R2.1.4 (Applying) Participate in medication event reporting and monitoring. Make use of Midas to report errors as appropriate. Competency Area E2 Added Leadership and Practice Management Skills Goal E2.1 Apply leadership and practice management skills to contribute to management of pharmacy services. Objective E2.1.1 (Applying) Demonstrate personal leadership qualities essential to operate effectively within the organization and advance the profession and practice of pharmacy. Identify and organize tasks to complete daily workload. Objective E2.1.2 (Applying) Contribute to the development of a new pharmacy service or to the enhancement of an existing service. Construct an SBAR for pharmacy staff on new drug therapies. Oncology Clinic Learning Experience Rev 12/16/16 4 P a g e

5 Objective E2.1.3 (Applying) Contribute to the pharmacy procurement process. Make use of inventory management and ordering, including specialty medications, controlled substances, short supply, and multiple suppliers. Objective E2.1.4 (Applying) Contribute to the financial management of the department. Utilize current inventory management process to ensure adequate amounts of medications and supplies are ordered and returned as appropriate. Objective E2.1.5 (Applying) Manage the use of investigational drug products (medications, devices, and biologicals). Select the investigational drug preparation, administration, documentation and inventory management. Goal E5.1 Participate in the management of medical emergencies. Objective E5.1.1 (Applying) Exercise skill as a team member in the management of medical emergencies according to the organization s policies and procedures. Utilize drug knowledge to assist with management of medical emergencies in the department. 6. Evaluation Strategy Formative Evaluation PharmAcademic will be used for documentation of formative evaluations (mid-rotation evaluations). Residents will perform a selected activity with the preceptor. Resident and preceptor will review the activity or document, and then complete the necessary steps to document the evaluation in PharmAcademic. The formative evaluation activity or document for review will be selected on the basis of the learning experience s objectives and the resident s skill development needs. Summative Evaluation The summative evaluation will incorporate the residents self-evaluation and the preceptors evaluation of the learning experience. The preceptor will utilize the summative evaluation chosen for the learning experience. The document will be completed no later than the last day of the learning experience, unless another timeline is established by the preceptor or resident and agreed to by the program director. The preceptor will discuss the summative evaluation with the resident at the time of the evaluation. If more than one preceptor is assigned to the rotation, only one evaluation needs to be completed, incorporating input from other preceptor(s). If preceptors choose to complete an additional summative evaluation, this is also allowed if the preceptor discusses the results with the resident. Standard definitions of progress related to evaluations help provide consistent feedback and documentation for the Mayo Clinic Health System Eau Claire residency program. The following definitions for Needs Improvement, Satisfactory Progress, and Achieved Expectations will be used by residents, preceptors and the program director(s). Needs Improvement (NI) Definition: The resident performance is at or below the level expected of a PharmD candidate (for a current PGY-1 resident) or at or below the level expected of a PGY-1 resident (for a current PGY-2 resident). NI may be appropriate for an experience new to the resident. Potential criteria for evaluation: o Promising start to a new experience for the resident where notable room for improvement is still needed Oncology Clinic Learning Experience Rev 12/16/16 5 P a g e

6 o Failure to complete assigned tasks to the satisfaction of preceptor(s) o Display of little to no improvement in performance despite repeated communication and modeling by preceptor(s) o Failure to demonstrate progressive independence with clinical activities by the end of the rotation Action: The preceptor is required to provide specific comments within PharmAcademic which outlines specific examples when NI was chosen for an individual goal/objective. Preceptors are encouraged to contact the RPD early in the rotation if any resident performance concerns are noted. Satisfactory Progress (SP) Definition: The resident performance is consistent with expectations for that particular time and point of residency training. Potential criteria for evaluation: o Displays improvement in the goal/objective from the start to the end of the rotation o Performance is satisfactory to what a preceptor would expect of a PGY-1 or PGY-2 resident, respectively Action: The preceptor is required to provide both positive and constructive feedback within PharmAcademic related to individual goals/objectives to foster and promote the clinical and professional development of the resident. Achieved (ACH) Definition: The resident performance is at the graduate level of the respective program. Potential criteria for evaluation: o Under the auspices of preceptor facilitation, the resident is capable and/or displays the necessary skills for independent work o Display of consistent mastery of the goal/objective from the start to the end of the rotation Action: The preceptor must provide specific comment(s) and example(s) within PharmAcademic to document ACH. Achieved for Residency (ACHR) Documentation of a resident s achievement of a goal/objective for the residency program will be the responsibility of the RPD at quarterly evaluations, or may be marked by preceptor(s) if noted in the customized training plan. Oncology Clinic Learning Experience Rev 12/16/16 6 P a g e

7 7. Resident Evaluation of the Preceptor and Learning Experience Resident will complete the preceptor evaluation document for this purpose no later than the last day of the learning experience, unless another timeline is agreed to with the preceptor and approved by the program director. Discussion of this form will be part of the summative evaluation debriefing session. Residents are responsible for forwarding the document to the preceptor on the day it is discussed. What Snapshot Who When Formative Infusion Schedule, Daily Medication Inventory Sheet Preceptor and Resident End of week 2 Summative Preceptor End of Learning Experience Preceptor/Learning Experience Evaluation Resident End of Learning Experience I understand this and will comply with the above expectations: _. (Resident Signature) Date:. Oncology Clinic Learning Experience Rev 12/16/16 7 P a g e