Pharmacy Services

Pharmacy Services Residency

Diabetes and Endocrinology

(PGY1 Rotation - Ambulatory Care)

 
Preceptor:

Vanessa B. Nielsen, PharmD

 
Site Description:

The Utah Diabetes and Endocrinology Center (UDEC) provides comprehensive endocrine care with the latest innovations and clinical therapies to patients living in Utah, Idaho, Nevada, Montana, and Wyoming. The clinic is composed of endocrinologists, endocrinology fellows, internal medicine residents, nurse practitioners, dietitians, a pharmacist, and support staff. UDEC commonly cares for patients with diabetes mellitus, both type 1 and 2, and disorders of the adrenal, parathyroid, pituitary, and thyroid glands, as well as bone. The pharmacist provides clinical pharmacy services including patient education, medication review and adjustment, lab ordering and interpretation, drug information, management of the sample program, and provider education. The clinical pharmacist provides information and education to all providers in the clinic as well.

 
Rotation Description:

The clinical pharmacist is responsible for providing education and medication recommendations to both the patients and providers at UDEC. The resident will have extensive interaction one-on-one with patients and side-by-side with providers, making medication adjustments and recommendations, providing diabetes education, and training on insulin pumps and continuous glucose monitoring systems. For patients not directly scheduled with the clinical pharmacist, the resident may complete medication reconciliation on selected patients, identify and resolve problems, and provide recommendations through communication with the UDEC team.

Most weeks there is a journal club and case-based discussion to attend. There are weekly topic discussions as well. Pharmacy students are often on site and precepting may be a part of the rotation. Projects are done on an as needed basis. Opportunities to work with glucometers and wear insulin pumps and continuous glucose meters are available. The resident is expected to be respectful and courteous to the patients, preceptors, members of the healthcare team, and others. The resident will need to demonstrate excellent communication skills, both written and verbal. Patient confidentiality should be maintained according to HIPPA and other clinic policies.

Upon completion of the rotation, the resident will have increased knowledge of the pathophysiology, diagnosis, and pharmacotherapeutics of diabetes and other endocrine disorders. It is expected that the resident will recognize and understand the basic pathophysiology, diagnostics, and pharmacotherapeutics of disorders commonly associated with diabetes such as the metabolic disorders as well. The resident will appreciate how all of the above have a role in the overall health of the patient.

 
RLS Goals:

  • Ambulatory Care 1
    • 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.
    • GOAL R1.2 Ensure continuity of care during patient transitions between care settings.
    • GOAL R3.1 Demonstrate leadership skills
    • GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public.
  • Ambulatory Care 2
    • 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.
    • GOAL R3.1 Demonstrate leadership skills
    • GOAL R3.2 Demonstrate management skills
    • GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups)

Activities Evaluated:

Ambulatory Care 1

Objective Number  (Level of Learning Required) & Description

Methods

Rotation Activities

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: Interact effectively with
health care teams to manage patients’
medication therapy

Instruction, Modeling, Coaching and
Facilitation

Identify medication-related problems through patient interactions (in clinic and via telephone) and medication reviews and communicate recommendations for modifying drug therapy directly to the provider on a daily basis.

Develop working relationships with providers and staff in the clinic by serving as a drug information resource and an additional provider and point of access for patients.

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

Instruction, Modeling, Coaching and
Facilitation

Daily patient interactions to review medications and collect information to develop recommendations (in person and via telephone). Information will be collected weekly to monthly, or as deemed necessary, from patients whose chronic disease states are managed by pharmacy through collaborative practice. 

Design of therapeutic regimens will consist of appropriately collecting and reviewing all patient information to develop a realistic plan in collaboration with the patient and health care team.

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

Modeling, Coaching and
Facilitation

Participate in clinic visits with providers and provide telephone follow up for a panel of patients on a daily basis. Activities include reviewing patient medications, treatment efficacy, side effects, and preventive care issues relevant to the patient, through chart review and direct patient interaction.

Objective 1.1.5 Design or redesign safe and
effective patient-centered therapeutic
regimens and monitoring plans (care plans)

Instruction, Modeling, Coaching and
Facilitation

Management of patients through collaborative practice agreements including medication management, dose adjustments, ordering of labs, and providing education for patients.

Document treatment plan in SOAP note format.

Labs for clinic patients may be ordered by pharmacists as appropriate for patients and monitored regularly according to current practice and organizational policies.

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

Instruction, Modeling, Coaching and
Facilitation

Documentation of all patient care activities and interactions will be provided in the electronic medical record for all pharmacist-patient interactions. Documentation will include pertinent information and will be forwarded to the appropriate health care professionals verbally or electronically in a timely manner. Types of documentation will be discussed on rotation.

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

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

Modeling, Coaching and Facilitation

After meeting with patients during clinic appointments or by telephone, pertinent information will be relayed securely to the provider verbally or through the electronic medical record.

Review appropriate documentation and assist patients with medication management for patients who are transitioning out of one health care setting and following up in the clinic.

GOAL R3.1 Demonstrate leadership skills

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

Coaching and Facilitation

Feedback will be provided to the resident on a daily to weekly basis as appropriate. The resident will be expected to be able to self-assess and engage in feedback discussions.

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

Objective R4.1.2: (Applying) Use effective presentation and teaching skills to deliver education.

Coaching and Facilitation

One short in-service on a clinical topic will be provided to staff and/or providers as appropriate.

Education on medications and disease states (e.g. insulin administration) will be provided to patients in clinic as they arise.

 
Ambulatory Care 2

Objective Number  (Level of Learning Required) & Description

Methods

Rotation Activities

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

Instruction, Modeling, Coaching and
Facilitation

Daily patient interactions to review medications and collect information to develop recommendations (in person and via telephone). Information will be collected weekly to monthly, or as deemed necessary, from patients whose chronic disease states are managed by pharmacy through collaborative practice. 

Design of therapeutic regimens will consist of appropriately collecting and reviewing all patient information to develop a realistic plan in collaboration with the patient and health care team.

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

Coaching and Facilitation

Daily patient work-ups and interactions to review medications and collect information to develop recommendations (in person and via telephone).

Address drug information questions that arise in clinic on a daily basis through review of primary literature and evidence-based recommendations.

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

Modeling, Coaching and
Facilitation

Management of a panel of patients through collaborative practice agreements including medication management, dose adjustments, ordering of labs, and providing education for patients.

Document treatment plan in SOAP note format.

Labs for clinic patients may be ordered as appropriate for patients and monitored regularly according to current practice and organizational policies.

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

Coaching and Facilitation

Management of patients through collaborative practice agreements includes frequent follow up. Plans for patients will include monitoring for safety and efficacy as well as a timeline for follow up. 

Objective R1.1.8 Demonstrate responsibility
to patients

Modeling, Coaching and Facilitation

Medication changes will be monitored to ensure safety and efficacy. Developing relationships with patients seen in clinic will take into account patient preferences in the decision-making process.

GOAL R3.1 Demonstrate leadership skills

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

Coaching and Facilitation

Feedback will be provided to the resident on a daily to weekly basis as appropriate. The resident will be expected to be able to self-assess and engage in feedback discussions.

GOAL R3.2 Demonstrate management skills

Objective R3.2.4 Manages one’s own practice effectively

Modeling, Coaching and Facilitation

Residents will be expected to work towards autonomy by the second half of the learning experience. Develop skills in time management to ensure completion of daily activities and address needs of the clinic.

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

Objective R4.1.2 Use effective presentation and teaching skills to deliver education

Coaching and Facilitation

One short in-service on a clinical topic will be provided to staff and/or providers as appropriate.

Education on medications and disease states (e.g. insulin administration) will be provided to patients in clinic as they arise.

 
Topics to be Covered During Experience:

  • Diabetes mellitus
  • Hyperlipidemia
  • Hypertension
  • Hypo/hyperthyroidism
  • Smoking cessation
  • Other primary care topics of interest to the resident
  • Review of topics will include pertinent pathophysiology, signs/symptoms, and treatment (patient case presentation, pharmacology, dosing, side effects, monitoring, education, and non-pharmacological recommendations)

Readings and Preparatory Work:

Residents are expected to become familiar with clinical practice guidelines for treatment of pertinent disease states, especially diabetes, dyslipidemia, hypertension, and hypo/hyperthyroidism, but may also include acromegaly, bariatrics, osteoporosis, growth-hormone deficiency, hypogonadism, hyperandrogenism, and supplements and nutraceuticals. Any familiarity with the primary literature for these conditions is also beneficial.

 
Project/Presentation Description:

The resident will participate in weekly endocrinology-based topic discussions, journal clubs, and case discussions. As situation dictates and opportunities avail themselves, the resident will do a project to benefit the clinic.

 
Typical Clinic Schedule:

The resident is expected to be punctual and to prioritize daily activities. A typical day will be from 7:30am – 4:00pm, but additional time may be required to complete daily responsibilities and ensure best outcomes for the patient. Residents are expected to answer questions and follow up with providers regarding patients seen at UDEC even when they are not physically on site.

 
Evaluations:

The resident will receive regular formative feedback related to patient care activities, patient education, communication/staff interaction, and presentations. Verbal evaluations will be provided on a daily basis, or as deemed necessary. Written and formal evaluations provided at the midpoint and at the conclusion of the rotation will be documented through PharmAcademic.

Updated March 2016