Pharmacy Services

Pharmacy Services Residency

Neonatology

 (PGY1 Rotation - Acute Care)

 
Preceptors:

Tom Peterson, PharmD, BCPS
Ruth Ruble, RPh
Kellie Holtmeier, PharmD

 
Site Description:

The Neonatology rotation is in a 48 bed level IIIb newborn intensive care unit caring for VLBW and ELBW infants drawn from a diverse urban/rural population of approximately 2 million covering 5 states. Pharmacy services include pharmacokinetic dosing, parenteral nutrition, medication utilization review, medication decision making, patient counseling and education of pharmacy students, pharmacy residents and pediatrics residents.

 
Rotation Description:

This rotation provides an initial post-doctoral experience in the newborn intensive care unit. Upon completion the resident will be qualified as a beginning practitioner in the NBICU. During the rotation, the resident will provide pharmaceutical care to approximately 25 preterm neonates at various stages of development from very low birth weight infants to term infants with complications requiring intensive care. Disease states include newborn respiratory distress, sepsis and other infectious diseases, cardiovascular diseases, seizures and drug withdrawal. The experience consists of daily interdisciplinary patient rounds, daily drug utilization review and monitoring, providing drug information and consultation to the NBICU team, weekly patient presentation or journal club, a written drug information article for the unit newsletter, and participation in administrative and quality improvement activities. Specific skills emphasized during the rotation include pharmacokinetic drug dosing, infectious disease management, newborn resuscitation, sedation and analgesia, and management of parenteral nutrition.

 
RLS Goals:

  • 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.
    • Objective R1.1.1: (Applying) Interact effectively with health care teams to manage patients’ medication therapy.
    • Objective R1.1.2 (Applying) Interact effectively with patients, family members, and caregivers.
    • Objective R1.1.3: (Analyzing) Collect information on which to base safe and effective medication therapy.
    • Objective R1.1.4: (Analyzing) Analyze and assess information on which to base safe and effective medication therapy.
    • Objective R1.1.5: (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).
    • Objective R1.1.6: (Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions.
    • Objective R1.1.7: (Applying) Document direct patient care activities appropriately in the medical record or where appropriate.
    • Objective R1.1.8: (Applying) Demonstrate responsibility to patients.
  • Goal R1.2: Ensure continuity of care during patient transitions between care settings.
    • Objective R1.2.1: (Applying) Manage transitions of care effectively.

Activities Evaluated:

Outcome, Goal, Objective Number  (Level of Learning Required) & Description

Teaching Method(s)

Related Rotation Activities

Competency Area R1:  Patient Care.

Goal R1.1:  Interact effectively with health care teams to manage patients’ medication therapy.

OBJ R1.1.1 Interact effectively with health care teams to manage patients’ medication therapy.

Direct instruction
Modeling
Coaching
Facilitation

  • Round with medical team daily and respond to all drug information questions that arise.
  • Make recommendations to the physician team daily to insure best medications, doses, schedules, or routes are used. 
  • Communicate potential medication therapy problems with recommended solutions to the appropriate member of the multidisciplinary team. 
  • Resolve all medication-related problems in a timely manner.

Objective R1.1.2 (Applying) Interact effectively with patients, family members, and caregivers.

Direct instruction
Modeling
Coaching
Facilitation

  • Provide discharge counseling for at least one patient’s family during the rotation, instructing on medication use and administration.

Objective R1.1.3: (Analyzing) Collect information on which to base safe and effective medication therapy.

Direct instruction
Modeling
Coaching
Facilitation

  • Document pertinent information on a patient monitoring form in an easily retrievable format using iVents.
  • Present patient and treatment plans to preceptor daily in an organized and efficient manner.

Objective R1.1.4: (Analyzing) Analyze and assess information on which to base safe and effective medication therapy.

Direct instruction
Modeling
Coaching
Facilitation

  • Present patient and treatment plans to preceptor daily in an organized and efficient manner.
  • Present patient and treatment plans using either a system based or problem based format.
  • Present a formal, written patient case to preceptor every other week using best evidence for recommendations.

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

Direct instruction
Modeling
Coaching
Facilitation

  • Present patient and treatment plans to preceptor daily in an organized and efficient manner.
  • Present patient and treatment plans using either systems based or problem based format
  • Identify medication-related errors and events, and submit through Patient Safety Net (PSN). Include lessons learned and ways to prevent similar events from occurring.

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

Direct instruction
Modeling
Coaching
Facilitation

  • Ensure that all recommendations given on rounds have been completed during pass off to evening pharmacist
  • Review iVents each afternoon to insure all items discussed on rounds have been completed

Objective R1.1.7: (Applying) Document direct patient care activities appropriately in the medical record or where appropriate.

Direct instruction
Modeling
Coaching
Facilitation

  • Complete maternal medication histories, pharmacokinetic notes and discharge counseling notes.
  • Identify medication-related errors and events, and submit through Patient Safety Net (PSN). Include lessons learned and ways to prevent similar events from occurring.

Objective R1.1.8: (Applying) Demonstrate responsibility to patients.

Direct instruction
Modeling
Coaching
Facilitation

  • Patient care items should be completed before working on projects or presentations
  • Present a formal, written patient case to preceptor every other week using best evidence for recommendations

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

Objective R1.2.1: (Applying) Manage transitions of care effectively.

Direct instruction
Modeling
Coaching
Facilitation

  • Provide pass-off to the swing shift pharmacist daily.
  • Ensure recommendations are made prior to leaving each day for assigned patients, and verify/double check orders entered by MD in EPIC and verified by pharmacists in central pharmacy

 
Readings and Preparatory Work:

Avery’s Diseases of the Newborn, 8th Edition

  • Bacterial Sepsis and Meningitis, pp. 551-577
  • Parenteral Nutrition, pp. 1061-1071
  • Acid-base, Fluid and Electrolyte Management, pp. 372-397
  • Patent Ductus Arteriosus in the Premature Infant, pp. 816-826
  • Bronchopulmonary Dysplasia, pp. 723-736
  • Surfactant Treatment of Respiratory Disorders, pp. 670-686
  • Pharmacologic Principles and Practicalities, pp. 427-437
  • Renal Vascular Disease in the Newborn (Hypertension in the Newborn), pp. 1326-1331

Essentials of Obstetrics and Gynecology, 3rd Edition

  • Preterm Labor and Premature Rupture of Membranes, pp. 312-323
  • Antepartum Hemorrhage, pp. 187-195

Readings from the literature as assigned

 
Project/Presentation Description:

The resident will prepare the monthly pharmacy article for the unit newsletter.

 
Typical Daily/Weekly/Monthly Activities:

07:00-09:00: Perform pharmacist review/monitoring of NBICU patients
09:00-12:00: Participate in multidisciplinary rounds and therapeutic decision making
12:00-14:00: Review/correct total parenteral nutrition orders
14:00-15:00: Topic discussions/presentations
15:00-16:00: Sign out to swing shift pharmacist

Other daily activities include:

  • Provide drug information to providers
  • Provide pharmacy support to neonatal resuscitation
  • Collaborate with attending physicians, resident physicians, neonatal nurse practitioners, nurses, dietitians and respiratory therapists to ensure positive medication use outcomes
  • Instruct/mentor resident physicians in neonatal pharmacotherapy

Evaluation:

Evaluations will be documented in PharmAcademic™.

At the midpoint of the rotation, the preceptor will evaluate the resident. 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