Infectious EUH Learning Activities:

Transcription

1 June 2010 Infectious EUH Learning Activities: Preceptor: Jan Pack Office: EUH Pharmaceutical Services Hours: ~ 8:00 5:00 Desk: Pager: General Description Infectious Diseases (ID) is a four week learning experience at Emory University Hospital. There are two teaching ID teams; ID consult service and ID transplant service and an antimicrobial stewardship program. Each resident will rotate through both the consult and transplant service during the four week rotation. Each resident will help manage the stewardship program. Each resident will be expected to attend microbiology rounds minimum of two times a week. The pharmacy resident is responsible for identifying and resolving medication therapy issues for consult patients and stewardship patients. In addition, the resident will provide and document therapeutic drug monitoring services for assigned Zone patients receiving vancomycin or aminoglycosides. Documentation must be completed within the electronic medical record on the day service was provided. Good communication and interpersonal skills are vital to success in this experience. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame. In addition to patient care, the resident must provide education to the team or pharmacists as the need arises. At least, one educational presentation is required to be presented to the team during the learning experience. Infectious Diseases Topics Hospital related infections in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience include, but are not limited to: Catheter related infections

2 Staphylococcus aureus bloodstream infections Nosocomial Pneumonia Community Acquired Pneumonia Endocarditis Meningitis Management of new fever in critically ill patients Clostridium difficile associated disease Consensus review of therapeutic monitoring of vancomycin Synergy use of low dose aminoglycosides Management of candidiasis and application of healthcare guidelines Antimicrobial stewardship Multidrug resistant organisms Evaluation of newer antimicrobials Goals Selected Goals selected to be taught and evaluated during this learning experience include: Goal R1.5: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients and health care providers. Goal R2.1: As appropriate, establish collaborative professional relationships with members of the health care team. Goal R2.2: Place practice priority on the delivery of patient centered care to patients. Goal : Collect and analyze patient information. Goal : Design evidence based therapeutic regimens. Goal : Design evidence based monitoring plans. Goal R2.8: Recommend or communicate regimens and monitoring plans. Goal R2.9: Implement regimens and monitoring plans. Goal : Evaluate patients progress and redesign regimens and monitoring plans. Goal R2.11: Communicate ongoing patient information. Goal R2.12: Document direct patient care activities appropriately. Goal R5.1: Provide effective medication and practice related education, training, or counseling to patients, caregivers, and healthcare professionals.

3 Activities Activity Goal Accurately gather, organize, and analyze patient specific information on team s patients prior to pre rounds with preceptor R2.2 Meet with preceptor for pre rounds R2.2 Actively participate in ID team rounds R2.8 R2.9 Compose accurate, concise progress notes documenting direct patient care activities ( ADR, drug drug interaction, kinetics, monitoring of therapy) within time frame to be useful R2.12 R2.8 R2.12 Provide 3 mini in service regarding drug information on rounds topics requested by team (or preceptor). At least one should be case based format. R1.5 R5.1 Provide a full in service reviewing primary literature review topic requested by team Five to ten minutes in length. Topic should be decided by the middle of the second week and approved by preceptor. The handout should be 1 page front and back, prepared in Microsoft Word, and include references. Presentation to antibiotic subcommittee that involves the areas of pharmacodynamic R1.5 R5.1

4 dosing, cost benefit analysis or other antibiotic related issues. Complete a minimum of 4 topic discussions as related to patients encountered on the rotation. Resident should lead some of the discussions. If students or other residents are on the rotation concurrently then an outline must be prepared for the discussion Provide pharmacokinetic monitoring/renal dosing services for patients receiving drugs requiring monitoring including, but not limited to, aminoglycosides and vancomycin R5.1 R2.8 Initiate monitoring plans or medication therapy changes as per protocol or verbal orders R2.9 Weekend and day off sign out for PK +/ team patients R2.11 Document ADRs and interventions in Pharmacy One Source R 1.5 Document medication variances in STARS Event Reporting System R2.12 R2.12 Present patients to preceptor in the afternoons employing evidence based medicine knowledge gained via independent reading and learning R1.5 Provide educational in services to nurses or pharmacists as requested by preceptor R5.1 Serve as co preceptor for pharmacy students when applicable R5.1 Balance patient care and other residency responsibilities R2.2 Discuss time management strategy with preceptor R2.2 Preceptor Interaction Daily: Preceptor available for patient presentations, reviewing progress notes, and/or topic discussions midmorning 09:30 to 11:30.

5 Microbiology Rounds 13:00 14:00 minimum two times a week. Team rounds usually start at 14:00 daily, but can vary depending upon the attending on service. Expected progression of resident responsibility on this learning experience: Day 0800: Preceptor to review ID learning activities and expectations with resident. Week 1: Resident to work up consult or transplant team patients and present to preceptor prior to team rounds. Preceptor may attend and participate in team rounds (modeling pharmacist s role on the health care team). Week 2: Resident to work up consult or transplant team patients and present select patients to preceptor prior to team rounds. Preceptor may attend and participate in team rounds (coaching the resident to take on more responsibilities as the pharmacist on the health care team). Week 3 4: Resident will rotate to other ID team for the remaining two weeks of rotation. Resident will work up team patients and present select patients to preceptor prior to team rounds. Preceptor may attend and observe the resident s participation on, and/or may expect a summary report from the resident regarding rounding activities and use of recommendations made by the resident. Preceptor will always be available for questions and will follow patients independently to monitor resident skill development in all aspects of the learning experience (facilitating the resident as the pharmacist on the health care team). Note: 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 when the rotation occurs in the residency program Evaluation Strategy ResiTrak will be used for documentation of formal evaluations. For formative evaluations, residents will perform the activity appropriate to the snapshot with the preceptor. Resident and preceptor will then independently complete the snapshot. After both have signed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self assessment. Formative evaluation will also occur as verbal or written feedback on a daily basis. What Snapshot Who When Formative Self Evaluation R Resident week 2 Formative R Preceptor week 2

6 Midpoint Summative Self Evaluation Midpoint Summative Evaluation Resident End of week 2 Preceptor End of week 2 Formative Self Evaluation R2.9.2 Resident week 3 Formative R2.9.2 Preceptor week 3 Summative Self Evaluation Resident End of learning experience deadline to be signed and submitted by 1300 the day following rotation completion. Summative Evaluation Preceptor End of learning experience deadline 7 days post final day of rotation to meet with resident to discuss. Preceptor & Learning Experience Evaluation Resident End of learning experience deadline 7 days post final day of rotation.