PGY 2 Residency Training Program Medical Intensive Care Unit Rotation EUHM Preceptor: Derek M. Polly, PharmD Office: EUHM, 2 nd Floor, Room 2182 Hours: ~ 7:30 4:00 Desk: 404 686 5674 Pager: 404 686 5500 ID# 12665 Personal cell phone: 931 239 8254 Email: derek.polly@emoryhealthcare.org Useful Contacts 71 ICU Phone Number: 404 686 2253 Zone 3 Pharmacist: 404 831 6022 Main Pharmacy: 404 686 2683 IV Room: 404 686 2636 General Description: The Medical Intensive Care Unit (MICU) rotation is a four week learning experience at Emory University Hospital Midtown (EUHM). The overall purpose of the MICU rotation at EUHM is to allow the resident to develop expertise in all aspects of critical care medicine. The resident will achieve the advanced knowledge and skills needed by assuming complete responsibility for and providing pharmaceutical care to the critically ill patient population in the MICU. This will allow the resident to assert their role as the pharmacist on the multidisciplinary team during the course of the experience. The rotation functions to provide pathophysiology, pharmacology, and management of various disease states within the medical intensive care unit through direct patient based learning, literature review, peer instruction, and topic discussion.
The rotation utilizes a 20 bed closed unit for critically ill medicine patients. The multidisciplinary team consists of an attending physician, medical fellow, residents, and students, nurse practitioners, a clinical pharmacy specialist, pharmacy resident, pharmacy student, respiratory/physical/speech therapists, nutrition support, and palliative care services. Multidisciplinary morning rounds begin at 9:00am and completion of rounds is contingent upon the patient population and the attending physician. Weekend rounding times vary according to attending physician preference. Rounds are suspended at 12 noon on weekdays for medical noon conference and typically resume at 1:30 2:00 pm. The patient load is divided between mid level practitioner patients (~6 8) and medical resident patients (~12 14). Pharmacy resident responsibilities include: Daily MICU interdisciplinary rounds and medical team topic discussions 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 MICU receiving aminoglycosides, vancomycin, phenytoin, fosphenytoin, warfarin, enoxaparin, heparin, fondaparinux, and argatroban; documentation must be completed within the electronic medical record on the day service was provided Participation in Dr. 99 codes that occur in the MICU 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 and/or nursing staff during the learning experience. 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 include, but are not limited to: Asthma and COPD exacerbations Acid base disorders
CHF exacerbations Diabetic ketoacidosis Hematologic disorders Treatment and management of pulmonary embolism Nosocomial infections and antimicrobial use in critically ill patients Venous thromboembolism prophylaxis Gastrointestinal stress ulcer prophylaxis ICU analgesia, sedation, and neuromuscular blockade Monitoring cardiovascular parameters when using inotropic/vasoactive agents Systemic inflammatory response syndrome (SIRS)/severe sepsis/septic shock Pharmacokinetics in critically ill patients Hypertensive urgency/emergency Acute gastrointestinal bleeding Acute drug overdoses Management of stress induced hyperglycemic in the ICU Alcohol withdrawal and other drug withdrawal states ICU Delirium Acute lung injury/acute respiratory distress syndrome Acute kidney injury/dialysis (peritoneal/intermittent/continuous) Goals Selected Goals selected to be taught and evaluated during this learning experience include: R1.1: Exhibit essential personal skills of a practice leader R2.1: Establish collaborative professional relationships with other members of the interdisciplinary critical care team R2.2: Prioritize the delivery of care to critically ill patients R2.4: Collect and analyze pertinent patient information R2.5: Design evidence based therapeutic regimens for critically patients R2.6: Design evidence based monitoring plans for critically patients R2.7: Recommend regimens and monitoring plans for critically ill patients R2.8: When appropriate, implement selected aspects of critical regimens and/or monitoring plans R2.9: Evaluate critically ill patients progress and redesign regimens and monitoring plans R2.11: Document direct patient care activities appropriately R3.1 Provide effective education or training to healthcare professionals and healthcare professionals in training
Activity Accurately gather, organize, and analyze patient specific information for appropriateness of therapy, dose, dosage regimen, route/method of administration, compliance, 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, and fosphenytoin/phenytoin Ensure continuity of pharmaceutical care as patients are admitted to MICU and are transferred to different levels of care throughout the hospital Goal R2.2, R2.4, R2.5, R2.6, R2.9 R2.1, R2.2, R2.4, R2.5, R2.6, R2.7, R2.8, R2.9, R3.1 R 2.2, R2.8 R2.2, R2.4, R2.5, R2.6, R2.7, R2.8, R2.9, R2.11 R2.2, R2.7 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 (medication history, anticoagulation, pharmacokinetics, monitoring of therapy, adverse drug reactions) within time frame to be useful Ensure patients have their medications reconciled. Present patients to preceptor daily. Relevant primary literature identified by the resident should be included in the discussion and plans. R2.2, R2.7, R2.11 R 2.1, R2.2, R2.4, R2.11 R2.4, R2.5, R2.6, R2.7, R2.9
Complete a minimum of 4 topic discussions with preceptor. At least one is to be resident led. Primary literature identified by resident is to be provided to preceptor at least 3 days prior to discussion. R3.1 Document ADRs and interventions R2.11 Document medication variances in STARS Event Reporting System R2.11 Provide requests for drug information from medical team and nursing staff in a timely manner Provide one inservice (including primary literature review) topic requested by team and/or nursing staff Resident will present one inservice to medical team and/or nursing staff on an ICU pharmacotherapeutic topic during the 3 rd week of the rotation. The presentation should be approximately 10 15 minutes in length and resident should provide one page information handout including references. Provide educational inservices to nurses or pharmacists as requested by preceptor R2.1, R3.1 R2.1, R3.1 R3.1 Serve as co preceptor for pharmacy students when applicable R3.1 Balance patient care and other residency responsibilities Discuss time management strategy with preceptor R1.1,R2.2 R1.1,R2.2 Preceptor Interaction Daily: Multidisciplinary rounds at 9:00am Preceptor available for patient presentations, reviewing progress notes, and/or topic discussions as schedule allows (Schedule will be discussed daily) Expected progression of resident responsibility on this learning experience: Day 1 : Weeks 1: Orientation to service and expectations. Resident will begin to follow medical resident patients. Preceptor will attend and participate in rounds. Preceptor will follow mid level patients. Resident to present assigned patients to preceptor daily.
Weeks 2 4: Resident will follow all MICU patients. Resident will be expected to round independently beginning with the second week. Resident to present patients and plans to preceptor daily. Preceptor will remain available for questions and will independently follow all of the MICU patients in order to evaluate the resident s development during the learning experience. 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 during the residency year. 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.