(PGY1 Rotation - Acute Care)
Benson Sederholm, PharmD, BCPS
Chad Condie, PharmD, BCCCP
Ryan McTish, PharmD
The Neuro Acute Care (NAC) unit located on the third floor of University of Utah Hospital is a 37-bed unit including neurology, neurosurgery, ENT, and medicine patients.
The pharmacist functions as part of a multidisciplinary team comprised of a neurology attending physician, neurology residents, medical students, and neuroscience nurses. Pharmacists on the Neurology service are expected to round daily on all neurology patients, respond as a member of the Brain Attack / Stroke team, provide drug information, perform medication histories, educate patients, and facilitate the resolution of medication-associated challenges and concerns. Didactic and experiential training includes a focus in the following areas: stroke, multiple sclerosis, epilepsy, headache, meningitis, myasthenia gravis, Parkinson’s disease, Guillain-Barre syndrome, anticoagulation management, and other medical and neurological disorders. Hypertension, hyperlipidemia, atrial fibrillation, diabetes, pain-related disorders, and other issues are included.
Role of the Pharmacist:
The role of the neuroscience pharmacist includes rounding daily on neurology acute care patients, formulating pharmacotherapy care plans for neurology patients, evaluating clinical and laboratory findings, and responding to questions from residents and staff on medication associated concerns. The pharmacist also performs drug histories, medication reconciliations, and reviews discharge medication orders for appropriateness of therapy.
While on rotation, the resident is expected to fully participate and actively engage in all pharmacist responsibilities for neurology inpatients including those roles listed above. The development of clinical skills, through patient interactions and active collaboration with physicians, nurses, and clinical staff members is emphasized. The resident will also perform daily patient presentations, lead one journal club presentation, and one in-service presentation to the neurology team.
- 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 (Applying) Interact with health care teams to manage patients’ medication therapy.
- OBJ R1.1.2 (Applying) Interact effectively with patients, family members, and caregivers.
- OBJ R1.1.4 (Analyzing) Analyze and assess information on which to base safe and effective medication therapy.
- OBJ R1.1.5 (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).
- OBJ R1.1.7 (Applying) Document direct patient care activities appropriately in the medical record or where appropriate.
- OBJ R1.1.8 (Applying) Demonstrate responsibility to patients.
- Goal R1.2 Ensure continuity of care during patient transitions between care settings.
- OBJ R1.2.1: (Applying) Manage transitions of care effectively.
- Goal R3.1: Demonstrate leadership skills.
- OBJ R3.1.1 (Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership.
- Goal R4.1: Provide effective medication and practice-related education to patients, health care professionals, students, and the public (individuals and groups)
- OBJ R4.1.1 (Creating) Design effective educational activities
- Goal R4.2: Effectively employs appropriate preceptor roles when engaged in teaching students, pharmacy technicians or fellow health care professionals
- OBJ R4.2.1 (Applying) When engaged in teaching, select a preceptor role that meets learners’ educational needs.
- OBJ R4.2.2 (Applying) Effectively employ preceptor roles, as appropriate.
Activities Evaluated and Taught:
|Goal, OBJ Number||Rotation Activity||Teaching Method|
|The resident will review all medications of patients on the neurology service daily, checking for appropriate indication, dosage, duration of each medication and checking for drug interactions and appropriate restarting of home medications.||DI, M, C, F|
|The resident performs medication histories on all new patients, educates patients on new drug therapies and is available to answer patient questions throughout the inpatient stay.||DI, M, C, F|
|The resident will follow and evaluate patient information in the electronic medical chart, as well as information from patient and family interviews. They will use primary, secondary, tertiary medical literature to provide evidence based therapeutic care plans.||DI, M, C, F|
|The resident is expected to formulate medication care plans for each neurology patient each day, and will be responsible to effectively communicate to the neurology team their recommendations to the team during interdisciplinary rounds.||DI, M, C, F|
|The resident will independently design and follow-up on an appropriate pharmacotherapy plan for each patient on the neurology service given a specific disease state (including diabetes, hypertension, hyperlipidemia, arrhythmias, stroke, MS, headache, etc.) They will follow-up to ensure that discharge orders are appropriate during a patient transition of care. The resident will also document patient care activities including recommendations and monitoring plans in the EPIC electronic medical record.||DI, M, C, F|
|The resident is expected to educate patients, nursing staff, medical residents, and pharmacists on medication related topics relevant to patient care and document this education appropriately in the medical record when needed. (e.g. anticoagulant patient education.)
The resident will give one 20-30 min in-service to neurology residents.
The resident will lead one journal club with other neuroscience pharmacists.
|The resident is expected to use appropriate and professional language throughout the rotation while interacting with MDs, RNs, PharmDs, patients and their families as well as any other person the resident may come in contact with during the rotation.
All written communication by the resident must be professional and comply with all medical-legal requirements of the rotation.
|DI, M, C, F|
|When an IPPE or APPE student is simultaneously on rotation with the resident, the resident is expected to precept students based upon the students needs and rotation requirements. The resident will do this by modeling and coaching clinical skill activities, appropriate for the development of the learner.||DI, M, C, F|
Readings and Preparatory Work:
Readings will include relevant clinical studies which impact patient care as well as available clinical guidelines for stroke, epilepsy, headache management, meningitis, and other conditions. Other readings include: disease state reviews found within the medical and neurology literature, chapters from Pharmacotherapy, as well as PSAP modules of interest. Residents preparing for the Neuro Acute Care inpatient rotation are encouraged to visit the Neuroscience link listed under the Clinical Pharmacy Teams heading, available through the Drug Info Resource Center Website on Pulse.
The trainee will present patient cases daily, provide an in-service topic discussion to members of the neurology team, and conduct one journal club in which an article relevant to clinical practice is discussed and reviewed.
Typical Daily/Weekly/Monthly Activities:
Include following patients admitted to the neurology service, participating in daily patient care rounds, outlining a pharmacotherapy care plan for a given disease states, patient medication education, and drug monitoring. The trainee will discuss patient cases daily and present one in-service and one journal club article.
The preceptors will observe, coach, model, and facilitate resident activities throughout the rotation. They will provide feedback regarding the resident’s clinical skills, knowledge and ability to integrate new information into clinical practice. The resident and preceptor will complete a snapshot of the resident’s ability to collect and organize data at the midpoint. A summative evaluation of the resident’s strengths and weaknesses at the midpoint and a full summative evaluation of the selected goals and objectives will be documented in PharmAcademic™.
Updated September 2017