ROTATION DESCRIPTION ROTATION TITLE: PGY1 - Outpatient Transplant Ambulatory Care PURPOSE The Medical Center performed over 200 abdominal organ transplants annually. This clinical practice site will provide the PGY1 pharmacy resident with the opportunity to develop the patient-care management skills necessary to care for the complex medical issues associated with adult and pediatric transplant recipients. Outpatient transplant pharmacists provide medication education, disease-state management recommendations, and intervene to optimize the monitoring and medication adjustments necessary to provide long-term care in this patient population. LEARNING EXPERIENCE DESCRIPTION Upon successful completion of this rotation, the PGY1 resident should be able to: begin to understand the role of the transplant pharmacist on a multidisciplinary team; develop skills necessary to communicate effectively with patients and other members of the multidisciplinary transplant team; manage and monitor the care of outpatient transplant recipients through programmatic specific protocols; design patient care plans that provide optimal pharmacotherapy while accounting for disease-specific factors; ensure continuity of care from the outpatient ambulatory clinic to inpatient admission; evaluate transplant and ambulatory care literature and begin to provide evidenced-based pharmacotherapy recommendations; document pharmaceutical care activities using pharmacotherapy notes; describe the etiology and pathophysiology of common diseases that lead to end-stage kidney and liver disease necessitating transplantation; explain pharmacotherapy requirements for solid organ transplant recipients and provide an outline of common drug-drug and disease-drug interactions; describe the pathophysiology and management for common comorbid conditions found in transplant patients; lead transplant specific pharmacotherapy discussions; provide patient and caregiver education. LEARNING EXPERIENCE ACTIVITIES The following activities are required during transplant clinic rotation for a PGY1 resident. Activities directly related to RLS objectives evaluated on this rotation are noted. 1. Collect and interpret all relevant data needed to optimize medications and identify medication related issues in a transplant patient a. Collect and analyze patient information (R2.4) b. Determine the presence of medication therapy problem's in the patients current medication regimen (R2.4.2) c. Using an organized collection of patient specific information, summarize patient's health care needs (R2.4.3) 2. Based on patient specific factors, set short and long-term pharmacotherapeutic goals for each patient encountered a. Design evidence-based therapeutic regimens - Specify therapeutic goals for a patient incorperating the principles of evidenced based medicine that integrate patient specific data disease and medication specific information, ethics, and quality of life considerations (R2.6.1, R2.7.1)
b. Design a patient centered regimen that meets the evidence based therapeutic goals established for a patient; integrates patient specific information, ethical issues and quality of life issues, and considers pharmacoeconomic prinicples (R2.6.2) c. Exercise skills in systematic resolution of problems arising in the operation of the service (R3.2.10) d. Specify therapeutic goals for an internal medicine patient incorperating the principles of evidenced based medicine specific informaiton, ethics, and quality of life considerations (R2.6.1) e. Display initiative in preventing, identifying, resolving pharmacy related patient care problems (R4.3.2) f. Display initiative in preventing, identifying and resolving pharmacyrelated patient care problems (R1.4) 3. Develop and implement a pharmacotherapy plan designed to achieve desired goals for optimize short and long-term patient outcomes a. Demonstrate a commitment to advocacy for the optimal care of patients through the assertive and persuasive presentation of patient care issues to members of the health care team, the patient or the patient's caregivers (R3.1.3) b. Create an efficient and effective advanced search strategy to prepare a drug information response (R1.5.1) c. When presented with limited evidence-based biomedical literature, synthesize a reasonable response for a specific drug information need (R1.5.9) d. When presented with an internal medicine patient with health care needs that cannot be met by the internal medicine pharmacy specialist, make a referral or consult with the appropriate health care provider based on the paiten's acuity and the presenting problem (R2.5.1) e. Design a regimen that meets the evidence based therapeutic goals established for the internal medicine patient - integrates patient specific information, ethical issues and quality of life issues, and considers pharmacoeconomic principles (R2.6.2, R2.7.1, R2.6, R2.6) f. Implement regimens and monitoring plans (R2.9) g. Recommend or communicate a patient-centered, evidenced based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and patients in a way that is sytematic, logical, accurate, timely and secures consensus from the team and patient (R2.8.1) h. When appropriate, initiate patient centered, evidence based therapeutic regimen and monitoring plan for a patient according to the organization's policies and procedures (R2.9.1) i. Evaluate patient's progress and redesign regimens and monitoring plans (R2.10, R2.10.1, R2.11.1) 4. Document all appropriate activities in the patient medical record a. Appropriately select direct patient care activities for documentation (R2.12.1) 5. Provide education to patients, caregivers, and providers to ensure optimal medication utilization. Use effective communication skills with all these activities
a. Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handing and medication administration (R2.9.2) b. Use effective negotiation skills to resolve conflicts (R3.1.4) c. Explain the nature of mentoring in pharmacy. Its potential connection with achievement, and the importance and willingness to serve as a mentor to appropriate individuals (R3.1.5) d. Use effective communication skills to report orally the study results and recommendations (R3.3.8) e. Establish a collaborative patient centered pharmacist patient and pharmacist caregiver relationship (R2.3.1, R2.3) f. When necessary, contribute to the work of the team that secures access to drugs used in the patient's regimen (R2.9.3) g. Use effective educational techniques to provide counseling to internal medicine patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, storage, and medication administration (R2.9.4) h. Implement a strategy that effectively establishes cooperative, collaborative, and communicative working relationships with members of interdisciplinary health care team (R2.1, R2.1.1) i. Use effective communication practices when documenting a direct patient care activity (R2.12.2) 6. Lead and actively participate in transplant-related topic discussions, which incorporate primary literature and allow the resident to build a repository of journal articles and contribute to the goal of providing evidence based pharmacotherapy recommendations a. Employ advanced literature analysis skills in preparing drug information (R1.5) 7. Act ethically and display professional behavior and attitude. a. Practice self-managed continuing professional development with the goal of improving the quality of one's own performance through selfassessment and personal change (R3.1.1, R4.3) b. Assure that the service operates in accord with legal and regulatory requirements (R3.2.2) REQUIREMENTS OF LEARNING EXPERIENCE Required Hours Generally the resident will need to be present from 8 am to 5 pm. These hours may vary based on the resident s efficiency, activities occurring that day, and non-rotation activities. The resident shall alert the preceptor if they anticipate they will exceed the resident work hours set forth in the ACGME policy on resident work hours. Required Meetings Daily clinic Ambulatory Care Pharmacotherapy Discussion Series, times and days vary month to month, usually involve 5 to 6 topics per month, usually twice weekly discussions in the afternoons
Bar and Grill Patient Case-Based Discussions varies, usually each Friday afternoon, for 3 or 4 sessions per month Transplant Journal Club: varies, usually 3 rd Wednesday of Month 4 to 5 PM Pharmacy Critical Care Journal Club: varies, usually 2 nd Tuesday of Month 1 to 2 PM Pharmacy Resident Seminar: Mondays, 1:00-2:00pm Pharmacy Resident RITE presentations: Fridays, 12:00-1:00pm Any other learning opportunity designated by the RPD or preceptor Optional activities: Depending on the clinic flow, activities and the other obligations of the resident, they may present an inservice at the end of the month to the clinic providers. The topic will be chosen based on clinic providers interest, and the length is generally 10 to 15 minutes; handouts are encouraged. The resident may present at transplant or critical care journal club (at the request of the preceptor). The resident may have the opportunity to observe a kidney, liver, or pancreas transplant surgery if interested. ROTATION PRECEPTORS: Nicole Pilch, Pharm.D., MSCR, BCPS 150 Ashley Ave; PO Box 250584 (843) 792-3702 office weimert@musc.edu James Fleming, PharmD, BCPS 150 Ashley Avenue; PO Box 250584 (843) 792-0312 office fleminj@musc.edu Holly Meadows, Pharm.D., BCPS 150 Ashley Ave; PO Box 250584 (843) 792-5861 office barrier@musc.edu
METHOD OF EVALUATION Evaluation of resident will be based on the RLS goals assigned by the Residency Program Director (RPD) in Resitrak. The preceptor and resident will review the resident s customized plan and the learning experience introduction document on the first day of rotation. Feedback will include, but not be limited to, verbal and written midpoint and end of rotation evaluations. The resident will receive formal written and verbal evaluation approximately two weeks after starting the rotation and within 3 days of completing the rotation, usually on the final day of the rotation. The final evaluation will reflect the goals and objectives identified for the rotation in Resitrak. Evaluations will incorporate feedback from the interdisciplinary team when available. In addition, the preceptor will make every attempt to provide informal feedback to the resident throughout the month. The resident is encouraged to seek feedback at any time. The resident is expected to provide verbal feedback to the preceptor regarding any areas of the rotation that could be improved to enhance the rotation, both for the month and in the future, at the midpoint and final evaluations. Interim feedback is welcome.