Pharmacy Services

Pharmacy Services Residency

BMT (Bone Marrow Transplant)

 (PGY1 Rotation - Acute Care)

Preceptors:

Kristen Vinik, PharmD
Mary Lampas, PharmD, BCOP
Kali Ditolla, PharmD, BCOP
Hanna Bailey, PharmD

 
Site Description:

The inpatient BMT unit at the Huntsman Cancer Institute is a 15-bed inpatient hospital unit serving patients receiving stem cell transplants and acutely ill stem cell transplant recipients not currently receiving stem cell transplant. While the inpatient BMT unit has 15 beds, the pharmacists are responsible for managing pharmacotherapy for all patients admitted to the inpatient BMT service, regardless of physical location, including patients admitted to other areas of the hospital such as intensive care units.

 
Rotation Description:

The clinical pharmacists working with the inpatient BMT service are responsible for ensuring the clinical appropriateness and safety of all medications prescribed for admitted patients, verifying the accuracy and appropriate dispensing of chemotherapy orders, performing medication reconciliation at admission and discharge, and educating patients on their medications every time they are discharged from the inpatient BMT service. The pharmacists function in a decentralized capacity and work directly with BMT attending physicians, hospitalists, oncology fellows, physician assistants, nurse practitioners, nurses, medical assistants, as well as centralized pharmacists and pharmacy technicians to optimize pharmaceutical care of inpatient BMT patients. The pharmacist also works with the entire BMT program on updating standards of practice for all aspects of the BMT service, ensuring that standing orders for chemotherapy regimens are appropriate, and attending numerous multidisciplinary meetings including a weekly intake meeting where patients who will be admitted to the inpatient BMT service are discussed and planned for. The pharmacists also participate in pharmacy department educational activities and meetings as much as time allows based on the needs of the inpatient BMT service.

 
(FIRST acute care rotation):

  • GOAL R1.1 In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regimens, and multiple medications following a consistent patient care process
    • OBJ R1.1.1 Interact effectively with health care teams to manage patients’ medication therapy
    • OBJ R1.1.2 Interact effectively with patients, family members, and caregivers
    • OBJ R1.1.4 Analyze and assess information on which to base safe and effective medication therapy
    • OBJ R1.1.5 Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)
    • OBJ R1.1.7 Document direct patient care activities appropriately in the medical record or where appropriate
    • OBJ R1.1.8 Demonstrate responsibility to patients
  • GOAL R1.2 Ensure continuity of care during patient transitions between care settings
    • OBJ R1.2.1 Manage transitions of care effectively
  • GOAL R3.1 Demonstrate leadership skills
    • OBJ R3.1.1 Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership

(SECOND acute care rotation):

  • GOAL R1.1 In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regimens, and multiple medications following a consistent patient care process
    • OBJ R1.1.1 Interact effectively with health care teams to manage patients’ medication therapy
    • OBJ R1.1.3 Collect information on which to base safe and effective medication therapy
    • OBJ R1.1.6 Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions
    • OBJ R1.1.8 Demonstrate responsibility to patients
  • GOAL R1.3: Manage aspects of the medication-use process related to formulary management
    • OBJ R1.3.2 Manage aspects of the medication-use process related to formulary management
  • GOAL R3.1 Demonstrate leadership skills
    • OBJ R3.1.2 Apply a process of on-going self-evaluation and personal performance improvement
  • GOAL R3.2 Demonstrate management skills
    • OBJ R3.2.4 Manages one’s own practice effectively
  • GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public
    • OBJ R4.1.1 When engaged in teaching, select a preceptor role that meets learners’ educational needs

Activities Evaluated:

Rotation Activity

RLS Objective

Teaching Methods

Work up and/or follow a minimum of 5 of the admitted patients each day, depending on patient load and the resident's comfort level with BMT practices.

R1.1.3-6

IMCF

Attend and participate in daily inpatient rounds.

R1.1.1 R1.1.6
R1.1.8

IMCF

Interact daily with physicians, nurse practitioners, nurses, medical assistants, other pharmacy personnel, and patients to resolve medication-related problems for these patients.

R1.1.1
R1.1.2
R.3.1.1

IMCF

Lead presentations on medication-related topics of the inpatient BMT team's choosing (if applicable).

R3.1.1
R3.2.4

CF

Lead 5 discussions with preceptors on a variety of BMT topics.

R1.1.4
R4.1.1

CF

Give 5 formal and/or informal patient presentations to the preceptors.

R1.1.3-6

CF

As appropriate inform the clinic pharmacist of follow up items from inpatient discharge

R1.1.1
R1.1.6
R1.2.1

MCF

Respond to drug information requests from the providers and nurses

R1.1.3-4

MCF

Verify and enter orders for 2 chemotherapy regimens (if patient load allows), which will be double-checked by the pharmacist preceptor and an additional pharmacist.

R1.1.3-4
R1.1.8

IMCF

Assist in 5 patient's medication reconciliation at admission and discharge (if patient load allows), patient education at discharge, and maintaining accurate patient medication lists for the patients and BMT service providers.

R1.1.2
R1.1.7
R1.1.8
R1.3.2

IMCF

The resident may complete one project while on rotation with the inpatient BMT service. The choice of project will depend on the interests of the resident and the needs of the BMT program. If the preceptor is working on a project of interest to the resident, they would be able to assist in that endeavor.

R1.1.3

CF

Use and incorporate feedback from preceptors to continuously improve performance on the rotation

R3.2.4

CF

Teaching Methods include: I=direct instruction, C=coaching, M=modeling, and F=facilitation

 
Readings and Preparatory Work:

Topic discussion and reading suggestions will be provided to the resident upon starting the rotation. Topic discussions will occur 1-2 times per week. When more than one learner is on rotation at a given time, they will alternate leading the discussions but all involved should be capable of leading or taking over a discussion as much as possible.

Possible topics:

  • HSCT Basics
    • Allo vs, Auto
    • Stem cell sources
    • Conditioning Regimens
    • Myeloablative vs. Nonmyeloablative
    • Chemotherapy dosing in obese patients
  • Infection Prophylaxis/Neutropenic Fever
  • Graft versus host disease
    • Prophylaxis
    • Acute Treatment
    • Chronic treatment
  • Oncologic Emergencies
  • Drug Interactions
  • Pulmonary Complications/Critical Care Considerations
  • Chemotherapy Induced Nausea & Vomiting
  • Oral Complications/mucositis
  • GI Complications
  • VOD/SOS
  • Infections
    • Fungal
    • Viral (CMV)
    • Infections prior to engraftment

Typical Daily/Weekly/Monthly Activities:

Residents should arrive around 0700 to work up patients before rounds at 0930. Rounds typically last 2 to 4 hours, depending on the patient census and attending physician. Time after rounds is occupied by patient discharge and counseling, following up on planned interventions discussed in rounds, attending educational activities and meetings, entering chemotherapy orders, and topic discussions.

 
Evaluations:

Residents will receive daily feedback from the inpatient pharmacist regarding their knowledge, skills and abilities. A short summative evaluation will be recorded in PharmAcademic at the midpoint of the rotation. At the end of each rotation, the resident will self-evaluate, the preceptor will evaluate the resident, and the resident will evaluate both the preceptor and the learning experience.

Updated March 2016