Acute Care Cardiology Learning Description at Emory University Hospital Midtown (EUHM) Preceptor: Candace R. Stearns, PharmD, BCPS Office: EUHM, Peachtree Building, 2 nd floor, room 2182 Hours: ~ 7:30 5:30 Desk: 404 686 8911 Pager: PIC # 18475 Email: candace.stearns@emoryhealthcare.org General Description: The Acute Care Cardiology learning rotation is a calendar month clinical experience at EUHM. The Coronary Care Unit (CCU) is a 12 bed intensive care unit. The goal of the Acute Care Cardiology learning experience is to provide experience in the management of patients with ischemic cardiac disease, heart failure, dysrhythmias, and other cardiovascular related disease states. The resident will work as an integral participant on the CCU team. The CCU team consists of an attending physician, cardiology fellow, affiliate provider, clinical pharmacy specialist, nutritionist, the patient s nurse, as well as a respiratory therapist when applicable. The resident will develop knowledge and skills for the provision of pharmaceutical care to patients admitted to the CCU. The resident is expected to provide clinical pharmacy services daily through review of the medical history, evaluation of medication regimens, monitoring of laboratory data, identification of adverse drug events and medication errors, resolve medicaton related problems, provide drug information, as well as documentation of interventions and adverse drug events in the CCU. The resident will respond to pharmacotherapy consults, perform pharmacokinetic monitoring, and provide Dr. 99 code response. The resident should assume responsibility for patient care and promote positive drug therapy outcomes. Effective communication skills are necessary for this experience. The Acute Care Cardiology rotation functions to provide a patient population that will allow for the understanding and application of pathophysiology, pharmacology, and management of cardiovascular disease states within the CCU.
Pharmacy resident responsibilities include: Daily CCU interdisciplinary rounds at 10:30am Monday through Friday Attendance at Cardiology Conference from 07:30 08:30am on Mondays and Fridays in the CV Learning Center on the 4 th floor of the MOT Daily patient profile review with identification and resolution of medication related issues Provide assistance with medication order entry, order review, and other clarification as needed Resource for the coordination of distribution problems not resolved by in patient pharmacy Communication with inpatient pharmacy staff to discuss patients therapies and provide answers to questions related to patients that may help expedite their pharmacotherapy orders Provide and document therapeutic drug monitoring (pharmacokinetics) services for patients in the CCU; documentation must be completed within the electronic medical record on the day service was provided Participation in Dr. 99 codes that occur within the inpatient areas at EUHM 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 CCU team, Clinical Pharmacists, and/or nursing staff during the learning experience. Disease States/Topics
Although many comorbidities will be encountered during this learning experience, topic discussions will focus on disease states directly related to cardiovascular disorders. The resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience to gain knowledge and skills that will assist in the the management of the following disease states/topics, which may include, but not limited to: Anatomy and electrophysiology of the heart Normal EKG findings Abnormal EKG findings Atrial arrthymias Ventricular arrythmias Hypothermic protocol Cardiac devices Acute coronary syndromes Post PCI management Acute decompensated and chronic heart failure Monitoring cardiovascular parameters when using inotropic/vasoactive agents Intra aotic balloon pumps Ultrafiltration Hypertensive urgency/emergency Hyperlipidemia Nosocomial infections and antimicrobial use in CCU patients Pharmacokinetics in CCU patients Pharmacology Drugs that prolong QT interval Upon completion of the learning experience, the resident is expected to have a better understanding and increased competence in the management of patients in the CCU. Goals Selected
Goals selected to be taught and evaluated during this learning experience include: R2.1: As appropriate, establish collaborative professional relationships with members of the healthcare team. R2.4: Collect and analyze patient information. R2.6: Design evidence based therapeutic regimens. R2.7: Design evidence based monitoring plans. R2.9: Implement regimens and monitoring plans. R2.10: Evaluate patients progress and redesign regimens and monitoring plans. Activities Activity Accurately gather, organize, and analyze patient specific information for appropriateness of therapy, dose, dosage regimen, route/method of administration, therapeutic duplications, therapeutic outcomes, cost, and avoidance of ADRs prior to multidisciplinary rounds Actively participate in multidisciplinary rounds by making recommendations to prescribers in a way that is systematic, logical, and secures consensus from the medical team Initiate medication therapy changes or monitoring plans as per protocol or verbal orders Provide pharmacokinetic services for patients receiving drugs requiring monitoring including, but not limited to, aminoglycosides, vancomycin, warfarin, digoxin, and phenytoin Ensure continuity of pharmaceutical care as patients are admitted to CCU and are transferred to different levels of care throughout the hospital Goal R2.4, R2.6 R2.1, R2.6, R2.7, R2.9 R2.9 R2.4, R2.6, R2.7, R2.9, R2.10 R2.7, R2.9 Resident is required to communicate pertinent information to clinical pharmacist on the transferring service and weekend and day off sign out for pharmacokinetics patients to appropriate covering pharmacist Compose accurate, concise progress notes documenting direct patient care activities on the day the service is provided Present patients to preceptor. Relevant primary literature and/or R2.7 R2.4, R2.6, R2.7,
guidelines should be incorporated into discussion and pharmaceutical care plans for CCU patients R2.9 Preceptor Interaction Daily: Multidisciplinary rounds at 10:30am Preceptor available for patient presentations, reviewing progress notes, and/or topic discussions in the afternoons (hours depending on schedule) Expected progression of resident responsibility on this learning experience: Day 1 : Weeks 1: Weeks 2 4: Preceptor to review CCU learning activities and expectations with resident. Resident to work up CCU patients before rounds. Preceptor will attend and participate in rounds (modeling pharmacist s role and coaching resident to take on more responsibilities on the health care team). Resident to present assigned patients to preceptor in the afternoons. Resident to work up CCU patients before rounds. The resident will be expected to round independently after the first week of the rotation. Resident to present patients and plan to preceptor in the afternoons. 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). Evaluation Strategy
ResiTrak will be used for documentation of formal evaluations. Formative evaluation will occur as verbal or written feedback on a daily basis. What Who When Midpoint Summative Self Evaluation Midpoint Summative Evaluation Resident End of week 2 Preceptor End of week 2 Summative Self Evaluation Resident End of learning experience deadline to be signed and submitted the last day of the rotation. 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 to be signed and submitted the last day of the rotation.