PGY1: Pediatric Cardiovascular Intensive Care Unit Riley Hospital for Children at Indiana University Health Preceptor Christopher Thomas, PharmD Office: 317-948-3140/Pager: 317-367-3417/Cell: 317-716-3079 General Description The Pediatric Cardiovascular Intensive Care Unit (CVICU) rotation at Riley Hospital for Children is a required, four week learning experience. There are 12 beds in the pediatric CVICU, housed on one continuous unit. There is one patient care rounding team consisting of an attending pediatric cardiac intensivist, a pediatric cardiologist, pediatric acute care nurse practitioners, a pediatric dietician, primary care nurses, respiratory therapists, and a pediatric cardiac critical care clinical pharmacy specialist. Pharmacy residents and other health professionals in training also participate when assigned to the pediatric CVICU team. Typically the team will be responsible for the care of up to 12 patients. The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team. Routine responsibilities include: reconciling medications for all patients admitted to the team, addressing formal consults for non-formulary drug requests, therapeutic drug monitoring, and anticoagulation. Emphasis is specifically placed on the provision of evidence-based medicine to optimize patient outcomes with an optimal pharmacoeconomic approach when clinically appropriate. The pharmacist will also provide drug information and education to healthcare professionals as well and patients and caregivers. Disease States The resident will be expected to gain proficiency through direct patient care experience for common diseases including, but not limited to: -Congenital heart diseases (anatomy, surgical interventions, pre/post-operative care) -Congestive heart failure -Arrhythmias -Cardiomyopathy -Endocarditis -Myocarditis -Anticoagulation -Hypertension -Pulmonary hypertension -Hyperlipidemia -Pain/sedation/neuromuscular blockade -Fluids, electrolytes, and nutrition -Stress ulcer/vte prophylaxis -Cardiopulmonary resuscitation -Extracorporeal membranous oxygenation -Cardiogenic shock -Developmental pharmacology 1
Topic discussions and reading key articles will be used to help develop the resident s patient care skills for common disease states or acquiring knowledge about diseases seen infrequently on the service Goals and Objectives During the learning experience the resident will focus on the goals and objectives outlined below by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all of the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame. Achievement of the goals of the residency is determined through assessment of ability to perform the associated objectives. The table below demonstrates the relationship between the activities and the goals/objectives assigned to the learning experience. Goals and Objectives Activities Competency Area GOAL R1.1 Objective R1.1.1 Objective R1.1.2 Objective R1.1.3 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. (Applying) Interact effectively with patients, family members, and caregivers. (Applying) Collect information on which to base safe and effective medication therapy. Actively participate in patient care rounds and make interventions regarding pharmacologic therapy with the primary team and/or consulting services. Provide effective patient care counseling for patients regarding medications they may be receiving in the hospital and/or being discharged home with. Provide thorough medication histories and document them in the medical record. Incorporate the use of a patient care monitoring sheet to record patient-specific data to utilize on patient care rounds. 2
Objective R1.1.4 Objective R1.1.5 Objective R1.1.8 GOAL R4.2 Objective R4.2.1 Objective R4.2.2 (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 and monitoring plans (care plans). (Applying) Demonstrate responsibility to patients. Effectively employs appropriate preceptors roles when engaged in teaching. (Analyzing) When engaged in teaching, select a preceptors role that meets learners educational needs. (Applying) Effectively employ preceptor roles, as appropriate. Evaluate patient-specific subjective and objective data to guide medication therapy interventions and monitoring parameters while aiming to achieve therapeutic goals. Utilize evidence-based medicine, when appropriate, by seeking out primary literature and using it in conjunction with changing subjective and objective information about the patient s status in order to design or redesign a patient specific pharmacologic plan. Proactively search for strategies to maximize patient safety and patient care outcomes for each patient. Proactively search for primary literature that can be applied to patients to ensure an evidencebased approach to patient care. Adapt to student s specific learning styles/strengths by modifying the teaching approach. Utilize modeling and coaching strategies to optimize learning. Preceptor Interaction Residents will be required to attend patient care rounds and will be responsible for monitoring the diagnostic, medical, and preventative care for assigned patients. There will be a primary focus placed on practicing evidence-based medicine. There will be a daily discussion time (1-2 hours) when residents will present their patient(s) to the preceptor and participate in topic discussions. Topic discussions will typically be assigned the day before they are due. They are designed to cover topics as they occur during the rotation month. Topic discussions will typically be led by the resident unless previously specified by the preceptor. Patient care rounding times are listed below. Mon, Tues, Fri: 8:30 11:00 (approximate ending time) 3
Wed, Thurs: 9:00 11:30 (approximate ending time) *Rounding times are subject to change without notice by the rounding team. Communication: A. Daily scheduled meeting times: Residents to prioritize questions and problems to discuss during scheduled meeting times. Meeting times will typically be scheduled by the preceptor shortly after rounds (but may be up to a day or two in advance) and will typically start in the afternoon (about 2-3pm), but are subject to change. B. E-mail: Residents are expected to read e-mails at the beginning, middle and end of each day at a minimum for ongoing communication. This is appropriate for routine, non-urgent questions and problems. C. Office extension: Appropriate for routine questions pertaining to patient care. D. Pager: Residents to page preceptor for urgent/emergency situations pertaining to patient care E. Personal phone number: Residents to call/text preceptor for urgent/emergency situations pertaining to patient care or emergent personal issues. 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. Patient care workload will be assigned at the beginning of the rotation based upon experience level and is intended to steadily advance throughout the rotation. Day 1: Preceptor to review learning activities and expectations with resident. Week 1: Resident to work up approximately 1/3 of the team s patients and present to preceptor daily. Preceptor to attend and participate in team rounds with resident, modeling pharmacist s role on the health care team. Week 2: Resident to work up approximately half of the team s patients and discuss problems with preceptor daily. Preceptor to attend team rounds with resident, coaching the resident to take on more responsibilities as the pharmacist on the team. Weeks 3-4: Each week the resident is expected to take over the responsibility of working up more of the team s patients, continuing to discuss identified problems with preceptor daily. Once the resident is able to take responsibility for all patients assigned to the team, the preceptor will no longer attend team rounds, but will continue to facilitate the resident as the pharmacist on the team. By completion of week 4 of the rotation: Resident will have presented a journal club and/or patient case presentation to a group of pharmacists or other healthcare practitioners. In addition, a healthcare professional in-service and/or quality improvement project may be assigned by the preceptor to be completed prior to the end of the rotation. 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. 4
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 selfassessment 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 week 4 Preceptor/Learning Experience Evaluation Resident End of week 4 An emphasis on the provision of daily verbal feedback will be an expectation of both the preceptor and the resident. A verbal midpoint evaluation will also be given by the preceptor regarding the progress of the resident as well as the resident regarding his/her self-evaluation and preceptor evaluation. 5