Pharmacy Services

Pharmacy Services Residency

Cardiovascular (CV) Medicine

 (PGY1 Rotation - Acute Care)

 
Preceptors:

Teshia Sorensen, PharmD, BCPS
Tyler Sledge, PharmD
Joshua Sessions, PharmD

 
Site Description:

At University of Utah Health, the cardiovascular medicine pharmacists provide comprehensive pharmaceutical care to patients on multiple services (i.e., teams): General Cardiology, Interventional Cardiology, Heart Failure and Transplant, Cardiothoracic Surgery, and Electrophysiology. Patients are typically bedded on the Cardiovascular Medicine Unit (CVMU) or the Cardiovascular Intensive Care Unit (CVICU).

The pharmacist works collaboratively with members of the multidisciplinary teams, including providers (attending cardiologists and subspecialists, fellows, residents, interns, nurse practitioners, and physician’s assistants), nurses and medical assistants, case managers, social workers, and more. The pharmacist contributes to improved patient care by providing an array of clinical pharmacy services including individual and group patient education, medication review and optimization, drug information, and provider education.

Common medical conditions encountered include acute coronary syndromes (unstable angina, myocardial infarction), heart failure, arrhythmias, infections (endocarditis, LVAD infections, etc.), valvular heart disease, congenital heart disease, and pulmonary artery hypertension.

 
Rotation Description:

The Cardiovascular Medicine Acute Care I / II rotation provides learning experiences for the resident in multiple settings (clinic, acute care, ICU). The resident’s specific rotation structure (see options below) will be determined prior to the first day of the rotation based on resident interest and preceptor availability.

The resident is expected to provide comprehensive pharmaceutical care to all patients on their service. Daily activities will include completing medication histories, analyzing all appropriate patient-specific data, developing complete therapeutic and monitoring plans, rounding with the multidisciplinary team, resolving all medication-related issues, and providing patient education and counseling. The resident will also complete topic and patient presentations, landmark clinical trial discussions, a journal club presentation, an in-service presentation, and observational learning experiences.

The resident will strive to develop excellent written and verbal communication skills. The resident is expected to supplement knowledge gaps by researching those topics via primary literature and/or clinical guidelines.

Rotation Structure Options:

Option

Week 1

Week 2

Week 3

Week 4

A

Cardiology

Cardiology

Cardiology

Cardiology

B

Heart Failure

Heart Failure

Heart Failure

Heart Failure

C

Cardiology

Cardiology

Heart Failure

Heart Failure

D

Cardiology or Heart Failure

Cardiology or Heart Failure

Cardiology or Heart Failure

Clinic

 
Residency Goals and Objectives:

  • Acute-1 Rotation:
    • 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.
    • R1.2 Ensure continuity of care during patient transitions between care settings.
      • OBJ R1.2.1 Manage transitions of care effectively.
    • R3.1 Demonstrate leadership skills.
      • OBJ R3.1.1 Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership.
  • Acute-2 Rotation:
    • 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.
    • R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients.
      • OBJ R1.3.2 Manage aspects of the medication-use process related to formulary management.
    • R3.1 Demonstrate leadership skills.
      • OBJ R3.1.2 Apply a process of on-going self-evaluation and personal performance improvement.
    • R3.2 Demonstrate management skills.
      • OBJ R3.2.4 Manages one’s own practice effectively.
    • R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups).
      • OBJ R4.1.1 Design effective educational activities.

Activities Evaluated and Taught:

Objective Number (Level of Learning Required) & Description

Rotation Evaluated

Teaching Method(s)

Related Rotation Activities

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.

Acute-1
Acute-2

Direct instruction
Modeling
Coaching
Facilitation

  • Round daily with multi-disciplinary team
  • Recommend evidence-based, patient-specific modifications to medication therapy
  • Identify and address patient needs, nurse needs, and physician needs where pharmacists can contribute
  • Contact home infusion, case management, discharge pharmacy, etc. when needed to ensure patient access to medications

OBJ R1.1.2 Interact effectively with patients, family members, and caregivers.

Acute-1

Direct instruction
Modeling
Coaching
Facilitation

  • Interview patients and/or family members to complete medication histories
  • Provide education on medications to patients and/or caregivers

OBJ R1.1.3 Collect information on which to base safe and effective medication therapy.

Acute-2

Direct instruction
Coaching
Facilitation

  • Review pertinent patient-specific data in preparation for rounds daily

OBJ R1.1.4 Analyze and assess information on which to base safe and effective medication therapy.

Acute-1

Direct instruction
Coaching
Facilitation

  • Assess patient-specific data and incorporate into medication therapy decisions

OBJ R1.1.5 Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).

Acute-1

Direct instruction
Coaching
Facilitation

  • Determine appropriate monitoring parameters to assess safety and effectiveness of each medication
  • Reevaluate frequently and redesign medication therapy as appropriate

OBJ R1.1.6 Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions.

Acute-2

Direct instruction
Facilitation

  • Review each patient to ensure medication therapy changes were implemented in a timely manner

OBJ R1.1.7 Document direct patient care activities appropriately in the medical record or where appropriate.

Acute-1

Direct instruction
Modeling
Coaching
Facilitating

  • Interview patients and/or family members to complete medication histories
  • Provide education on medications to patients and/or caregivers

OBJ R1.1.8 Demonstrate responsibility to patients.

Acute-1
Acute-2

Modeling
Coaching
Facilitation

  • Exhibit ownership in all patient care activities

R1.2 Ensure continuity of care during patient transitions between care settings.

OBJ R1.2.1 Manage transitions of care effectively.

Acute-1

Direct instruction
Modeling
Coaching
Facilitation

  • Ensure patient specific medication access and affordability
  • Review all discharge orders and reconcile issues
  • Provide adequate pass-off to ICU / floor pharmacists at transfer

R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients.

OBJ R1.3.2 Manage aspects of the medication-use process related to formulary management.

Acute-2

Direct instruction
Modeling
Coaching
Facilitation

  • Understand the formulary approval process and understand how to address requests for non-formulary medications
  • Review and follow all pertinent medication management policies  

R3.1 Demonstrate leadership skills.

OBJ R3.1.1 Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership.

Acute-1

Direct instruction
Modeling
Coaching
Facilitation

  • Work closely with all members of the multi-disciplinary team to identify and resolve medication related issues (physicians, nurses, discharge pharmacy, case management, social work, home infusion, etc.)

OBJ R3.1.2 Apply a process of on-going self-evaluation and personal performance improvement.

Acute-2

Direct instruction
Modeling
Coaching
Facilitation

  • Assess areas for self-improvement in knowledge and skills frequently
  • Discuss areas for growth with preceptors at the beginning of the rotation and at midpoint (at a minimum) so learning opportunities can be arranged

R3.2 Demonstrate management skills.

OBJ R3.2.4 Manages one’s own practice effectively.

Acute-2

Direct instruction
Modeling
Coaching
Facilitation

  • Prioritize medication related issues and resolve urgent / higher risk issues as soon as identified
  • Resolve all medication related issues prior to leaving for the day
  • Complete all rotation and residency responsibilities on time

R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups).

OBJ R4.1.1 Design effective educational activities.

Acute-2

Direct instruction
Modeling
Coaching
Facilitation

  • Complete an inservice presentation for physicians or nurses
  • Provide education on medications to patients and/or caregivers

 
Readings and Preparatory Work:

Residents are required to be ACLS and BLS certified or actively pursuing certification. Readings will include landmark clinical trials, as well as more recent trials that may impact patient care, clinical guidelines for core cardiovascular conditions, and relevant Pharmacotherapy Self Assessment Program (PSAP) modules. Current lists of required and recommended readings are available at H:\Rx Residents\Rx Residents\Cardiovascular Medicine Rotations.

 
Project Description:

  1. Landmark Clinical Trials Discussion (4)
    1. Read each trial in preparation for an informal discussion with preceptors.
    2. Verbally describe each trial and discuss the trial’s impact on current practice.
    3. Handout not required.
  2. Journal Club (1)
    1. Topic must be related to cardiology.
    2. Article published within the last 6 months.
    3. Study should be likely to have impact on patient care.
    4. Formal presentation and handout required.
  3. In-service Presentation (1)
    1. Present medication related topic to cardiology team, heart failure team, clinical pharmacists, or nurses.
    2. Formal presentation and handout required.
    3. Approximately 15 minutes.
  4. Patient Presentation and/or Topic Discussion (2)
    1. Present patient in SOAP format.
    2. Topic discussion should focus on disease state(s) relevant to the patient presented.
    3. Formal presentation and handout required.
  5. MUE/System Improvement Project (1)
    1. Optional. May complete in place of (1) formal patient presentation/topic discussion.
    2. Project must be completed by the end of the rotation.
    3. List of potential projects will be provided during orientation.
  6. Observational Experiences (3)
    1. May include observing cardiac stress tests, cardiac catheterizations, and cardioversions.
    2. Preparation for each observational experience is required.

Typical Daily/Weekly/Monthly Activities:

The resident is expected to be punctual and to prioritize daily activities. A typical day will be from 0630 to 1600. Residents must arrive earlier than suggested below if needed to fully prepare for rounds or clinic appointments. Additional time is usually necessary to complete daily responsibilities and ensure best outcomes for the patient.

•0630 - 0730 Daily - Patient monitoring and rounds preparation (Heart Failure)
•0730 - 0800 Daily - Patient presentations (brief) with preceptor (Heart Failure)
•0800 - 1200 Daily - Heart failure team rounds (active participation is required)

•0700 - 0830 Daily - Patient monitoring and rounds preparation (Cardiology)
•0830 - 0900 Daily - Patient presentations (brief) with preceptor (Cardiology)
•0900 - 1200 Daily - Cardiology team rounds (active participation is required)

•1200 - 1230 Daily - Patient presentations (in-depth) with preceptor, resolve remaining issues
•1300 - 1400 Daily - Core topic discussions and presentations with preceptor
•1400 - 1600 Daily - Patient education on high risk medications, medication histories
•1600 + Daily - The resident is expected to complete all pertinent patient care activities prior to leaving each day. Additional time outside of regular rotation hours will be required for reading, project research, and presentation preparation.

 
Evaluation:

The resident will receive verbal feedback (formative evaluation) on a daily basis from the preceptor. A short summative evaluation will occur at the midpoint and a full summative evaluation of all goals will occur at the end of the rotation. The final evaluation will be recorded in PharmAcademic. The resident self-evaluation is due by the last Wednesday of the rotation. All evaluations must be co-signed within 2 weeks of completion of rotation.

Updated March 2016