Pharmacy Services

Pharmacy Services Residency

Neuroscience I

 (PGY1 Rotation - Acute Care)

 
Preceptors:

Benson Sederholm, PharmD, BCPS
Chad Condie, PharmD
Gary Davis, PharmD

 
Site Description:

The Neuro Acute Care (NAC) unit located on the third floor of University of Utah Hospital is a 34-bed unit including neurology, neurosurgery, ENT, and medicine patients.

 
Rotation Description:

The pharmacist functions as part of a multidisciplinary team comprised of a neurology attending physician, neurology residents, medical students, stroke nurses, and neuroscience nurses. Pharmacists on the Neurology service are expected to round daily on all patients, respond as a member of the Brain Attack / Stroke team, provide drug information, counsel patients, and facilitate medication delivery. 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.

 
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.
    • 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.

Activities Evaluated and Taught:

Goal, OBJ Number

Rotation Activity

Teaching Method

Goal R1.1
OBJ R1.1.4

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

Goal R1.1
OBJ R1.1.2

Perform medication histories on all new patients, educate patients on new drug therapies and be available to answer patient questions throughout the patients stay.

DI, M, C, F

Goal R1.1
OBJ R1.1.4
OBJ R1.1.5

Follow and evaluate patient information in electronic medical chart, as well as information from patient and family interviews. Use primary, secondary, tertiary medical literature to provide evidence based therapeutic care plans.

DI, M, C, F

Goal R1.1
OBJ R1.1.1
OBJ R1.1.4
OBJ R1.1.5
Goal R3.1
OBJ R3.1.1

Formulate medication care plans for each patient on neurology services each day that will be effectively communicated to the neurology team during interdisciplinary rounds. 

DI, M, C, F

Goal R1.1
OBJ R1.1.5
OBJ R1.1.7
OBJ R1.1.8
Goal R1.2
OBJ R1.2.1

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.) Follow-up to ensure that discharge orders are appropriate during a patient transition of care. Using IVents, document patient care activities including recommendations and monitoring plans.

DI, M, C, F

Goal R1.1
OBJ R1.1.1
OBJ R1.1.2
Goal R3.1
OBJ R3.1.1

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.)
Give 30 min in-service to neurology residents.
Lead journal club with other neuroscience pharmacists.

C, F

Goal R1.1
OBJ R1.1.2
OBJ R1.1.8

Goal R3.1
OBJ R3.1.1

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 must be professional and comply with all medical-legal requirements of the rotation.

DI, M, C, F

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

 
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.

 
Project/Presentation Description:

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.

 
Evaluation:

The preceptors will give daily feedback regarding the resident’s skills and knowledge. 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 strengths and weaknesses at the midpoint and a full summative evaluation of the selected goals and objectives will be documented in PharmAcademic™.

Updated March 2016