Liver Transplant Clinic @ EUH Learning Activities: Preceptor: Sarah Saxer, PharmD Office: EUH E923 Hours: ~ 7:00-4:00 Desk: 404-712-5325 Pager: 14385 Personal cell phone: 678-427-5627 General Description The Liver Transplant rotation is a 6 month to 11 month learning experience at the Emory Clinic, Building B, 6 th floor. The goal of the rotation with the transplant team is to provide an opportunity for the resident to develop the knowledge, skills and appreciation required to provide pharmaceutical care in an ambulatory setting to solid organ transplant patients, with a focus on liver transplant recipients. In clinic, patients may be scheduled to see the transplant surgeon, transplant hepatologist, transplant dermatologist, or mid-level practitioner. The patient is also seen by a clinic nurse, transplant coordinator and clinical pharmacist. Please refer to the liver transplant pathway for more information regarding clinic visits. Transplant clinic is located in clinic Building B 6 th floor. Transplant clinic occurs every day of the week. You will participate in clinic no less than 4 hours per week. Clinic schedule may vary, but typically will occur either on Wednesday or Friday morning from 0800-1200. The pharmacy resident is responsible for identifying and resolving medication therapy issues for all patients seen in clinic on the given clinic day. Documentation of care must be completed within the electronic medical record on the day service was provided. Clinic documentation should occur in the electronic medical record. 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 while balancing the demands of other rotations and commitments. In addition to patient care, the resident must provide education to the team, nurses or pharmacists as needed. Topic discussions should occur with the preceptor no less than two times per month. See the liver transplant resident calendar for more detailed information. Disease States
Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience may include, but are not limited to: Liver disease: Hepatitis C, Hepatitis B, Hepatitis A, Autoimmune Hepatitis, Laennec s cirrhosis, Hepatocellular Carcinoma, Primary Sclerosing Cholangitis, Primary Biliary Cirrhosis, Drug Induced- Hepatitis, Wilson s disease, Budd-Chiari Complications of liver disease: hepatorenal, hepatopulmonary, ascites, encephalopathy, portal hypertension, variceal bleeding, splenomegaly, malnutrition Cardiovascular disorders: Hypertension, hypercholesterolemia, hypertriglyceridemia Endocrine disorders: New onset diabetes after transplantation, hyperglycemia, osteoporosis Hematologic: Anemia, thrombocytopenia, post transplant lymophoproliferative disorder Infections: Prophylactic strategies for bacterial, viral and fungal infections, opportunistic infections in the immunosuppressed host Immunology: Pharmacotherapy, hyperacute rejection, acute cellular rejection, chronic rejection, immunizations Adherence Goals Selected Goals selected to be taught and evaluated during this learning experience include: Goal R1.4: Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system. 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 : Place practice priority on the delivery of patient-centered care to patients. Goal R2.4: Collect and analyze patient information. Goal R2.5: When necessary, make and follow up on patient referrals. Goal R2.6: Design evidence-based therapeutic regimens. Goal R2.7: Design evidence-based monitoring plans. Goal : Recommend or communicate regimens and monitoring plans. Goal : Implement regimens and monitoring plans. Goal R2.10: Evaluate patients progress and redesign regimens and monitoring plans. Goal Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
Activities Activity Goal Accurately gather, organize, and analyze patient specific information on patient s prior to pre-rounds alone or with preceptor Review pertinent patient information (including data in OTTr and Powerchart such as, but not limited to: progress notes, reason for transplant, date of transplant, medications, immunosuppressive levels, CMV status) R 1.4 R2.4 R2.6 R2.10 Review patient finding with care provider (MD, PA, NP) and implement plan. Provide a minimum of 4 interventions per clinic. Communicate patient concerns with the care provider. Appropriately refer clinic patients or problems to the care provider or a consult service based on needs of the patient. Suggest and contact resources for patients as appropriate (social work, dietician, etc). R.1.4 R.2.1 R2.5 Provide concise, accurate drug information to providers in clinic. Provide inservice to nurses or transplant team as needed. Answer questions from patients accurately. R.1.5 Meet with preceptor for pre-rounds and literature discussion Actively participate in clinic R 1.4 R2.4 R2.7 R2.10 R 1.5 R2.4 R2.5 R2.6
R2.10 R3.1 Compose accurate, concise progress notes documenting direct patient care activities. Document notes in PowerChart as appropriate by the end of the day of clinic. Provide and document education to patients and caregivers discharged from the hospital. On the patient s first clinic visit since discharge, medication education needs should be assessed and medication education reinforced. R2.7 Assist with ongoing research in the transplant clinic as appropriate. Document research activities per protocol of the project. R1.4 R2.3 Ensure patients in clinic have their medications reconciled in EeMR. Obtain and verify medication list. Verify and reconcile allergies. R 1.4 Clinic nurse is primarily responsible for updating medication list, but it is the resident s responsibility to make sure this is accurate.. Verify vaccination status (pneumovax, influenza) with the patient. Document vaccination history. Complete a minimum of 2 topic discussions or literature discussions per month. Resident should lead some of the discussions. Initiate monitoring plans or medication therapy changes as per protocol or verbal orders R 1.4 Document at least 1 ADR per month and 8 interventions per month in Pharmacy One Source R 1.5 Serve as co-preceptor for pharmacy students when applicable R3.1 Balance patient care, primary rotation, and other residency responsibilities R2.12 R3.1
Preceptor Interaction Weekly: -Preceptor available from 1200-1400 1-2 days prior to clinic for pre-rounds and patient questions with resident as needed -Attend transplant clinic located on the 6 th floor, clinic B for 4 hours per week. A transplant clinic is held every day of the week -Tuesday 1300-1700, Friday 0800-1200 (preceptor available as needed for questions); may select to attend this clinic based on needs after 3 months with preceptor in Wednesday clinic -Wednesday 0800-1200 (preceptor attends); clinic for first 3 months of experience -Preceptor available for patient presentations, reviewing patient notes, and/or topic discussions from 1100-1200 or as needed Non-Daily Activities/Expectations: -Preparation for topic and literature discussion at least 2 times per month Expected progression of resident responsibility on this longitudinal learning experience: Day 1 @ 0800: Preceptor to review liver transplant clinic learning activities and expectations with resident. Month 1: Resident to work up patients and present to preceptor prior to clinic. Preceptor will attend and participate in clinic (modeling pharmacist s role on the health care team). Month 2: Resident to work up clinic patients and present select patients to preceptor prior to clinic. Preceptor will attend and participate in clinic (coaching the resident to take on more responsibilities as the pharmacist on the health care team). Month 3: Resident to work up clinic patients and present select patients to preceptor prior to clinic. Preceptor will attend and participate in clinic. Month 4+: Preceptor may attend and observe the resident s participation in, and/or may expect a summary report from the resident regarding clinic 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. Evaluations should be completed prior to meeting to discuss. All evaluations will be discussed in person between the resident and preceptor. This
discussion will provide feedback both on their performance 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 Quarterly Summative Self-Evaluation Quarterly Summative Evaluation Resident End of month 3, 6, 9 Preceptor End of month 3, 6, 9 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.