Pharmacy Services

Pharmacy Services Residency

Gastroenterology/Rheumatology

 (PGY1 Rotation - Ambulatory Care)

 
Preceptor:

Kami Roake, PharmD
kami.roake@pharm.utah.edu
Voicemail: 801-581-3212

 
Site Description:

The resident will spend 3 days per week in the gastroenterology clinic which serves patients with various disease states including inflammatory bowel disease (IBD), eosinophilic esophagitis, gastroesophageal reflux, IBS, motility dysfunction, and other general GI issues. The resident will spend 2 days per week in the rheumatology clinic which serves patients with rheumatoid arthritis, ankylosing spondylitis, lupus (SLE), scleroderma, glucocorticoid-induced osteoporosis, PMR, and gout. Both specialty clinics are located on the first floor of University Hospital, and serve patients across the greater Utah valley and surrounding states. Patients range from young adults transitioning to adult care to geriatric patients. The interprofessional team includes attending gastroenterologist and rheumatologist, gastroenterology and rheumatology fellows, advanced practice clinicians, medical assistants, nurses, and a social worker.

 
Rotation Description/Role of the Pharmacist:

The clinical pharmacist is responsible for providing drug information to both patients and the practitioners working the gastroenterology and rheumatology clinics. The role of the pharmacist includes evaluating the appropriateness, effectiveness, and safety of drug therapy, evaluating the adherence to drug therapy, providing medication education to drug therapy, evaluating labs, development of treatment plans, protocols and making recommendations to the providers in the ambulatory setting. The pharmacist completes medication reconciliation on selected patients, identifies and resolves problems, and provide recommendations through communication with the interprofessional team.

Residents are expected to function in the role of the clinic pharmacist by the end of the rotation. Residents will have extensive one-on-one interaction with patients, providers, and ancillary staff. Residents will also have the opportunity to attend gastroenterology grand rounds on a weekly basis.

Journal clubs, topic discussions, drug therapy updates, and in-service presentations will be part of the rotation. The resident will discuss with the preceptor a variety of gastroenterology and rheumatology related topics.

The day to day activities include medication review and reconciliation, evaluating drug regimens, optimizing drug therapy and adherence, drug therapy monitoring, medication education, disease state education, and answering drug information questions for patients, providers, and other healthcare professionals. See project section for additional rotation activities.

 
Residents are expected to:

  1. Demonstrate knowledge of common medical conditions encountered in the gastroenterology and rheumatology clinics
  2. Demonstrate knowledge of current immunization practices and recommendations
  3. Complete thorough medication histories and be able to communicate this information with providers efficiently and effectively
  4. Monitor patients’ drug therapy for efficacy and safety
  5. Make evidence-based treatment recommendations for each assigned patient
  6. Document pharmacy activities and medication histories in a progress note clearly and concisely
  7. Identify, assess, evaluate and report adverse drug reactions and interactions

 
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. (Am Care1)
    • 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. (Am Care 1 and 2)
    • Objective R1.1.4: (Analyzing) Analyze and assess information on which to base safe and effective medication therapy. (Am Care2)
    • Objective R1.1.5: (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans). (Am Care1 and 2)
    • Objective R1.1.6: (Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions. (Am Care 2)
    • Objective R1.1.7: (Applying) Document direct patient care activities appropriately in the medical record or where appropriate. (Am Care 1)
    • Objective R1.1.8: (Applying) Demonstrate responsibility to patients. (Am Care 2)
  • Goal R1.2: Ensure continuity of care during patient transitions between care settings.
    • Objective R1.2.1: (Applying) Manage transitions of care effectively. (Am Care 1)
  • Goal R3.1 Demonstrate leadership skills
    • Objective R3.1.2: Apply a process of on-going self-evaluation and personal performance Improvement. (Am Care 1 and 2)
  • Goal R4.1: Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups).
    • Objective 4.1.2 Use effective presentation and teaching skills to deliver education. (Am Care 1 and 2)

Rotation Activities and Teaching Methods Linked to Objectives:

Rotation Activity Teaching Methods Objective
Conduct 3-10 patient interviews per day to determine current drug therapy and relevant medication history. Modeling
Coaching
Facilitating
R1.1.3
R1.1.8
Evaluate medication therapy and identify medication-related problems on all patients interviewed in the clinic. Communicate recommendations for modifying drug therapy directly to the provider. Instruction
Modeling
Coaching
Facilitating
R1.1.4
R1.1.5
R1.2.1
Respond to drug information questions from providers and patients in the gastroenterology and rheumatology clinic. Instruction
Modeling
Coaching
Facilitating
R1.1.2
R1.1.8
Participate in the IBD Clinic team by providing medication information and education to the patients and providers and to ensure patient has access to drug therapy and has implemented recommendations from previous encounters. Modeling
Coaching
Facilitating
R1.1.1
R1.1.2
R1.1.6
Document all patient interventions and medication reviews. Coaching
Facilitating
R1.1.7
Provide patient education on the various drug treatments and design patient education handouts as needed. Modeling
Coaching
Facilitating
R1.1.2
R4.1.2
R1.1.8
Lead topic discussion and journal club Coaching
Facilitating
R4.1.2
Attend weekly GI & rheumatology conferences if applicable. Self-reflect throughout the rotation to ensure goals are being obtained Coaching
Facilitating
R3.1.2
Complete a GI or rheumatology related in service and relevant clinic project as needed Coaching
Facilitating
R4.1.2
Use and incorporate feedback from preceptors to continuously improve patient care activities (communication, documentation) Coaching R3.1.2

 
Rotation Topics:

  • Inflammatory Bowel Disease (IBD)
  • Eosinophilic Esophagitis (EoE)
  • GERD
  • Irritable Bowel Syndrome (IBS)
  • Rheumatoid Arthritis
  • Gout
  • Systemic Lupus Erythematosus
  • Psoriatic Arthritis

 
Readings and Preparatory Work:

  • Inflammatory Bowel Disease guidelines (AGA & ACG)
  • GERD/EoE guidelines
  • ACR rheumatoid arthritis, glucocorticoid-induced osteoporosis, psoriatic arthritis, & gout guidelines
  • Rheumatology Secrets Systemic Lupus Erythematosus chapter

 
Project/Presentations:

  • Prepare and present one 15-20 minute in-service to clinic personnel or providers or complete 1 major rotation project (i.e. patient education handout)
  • Prepare and give 3 informal and 1 formal patient case presentations weekly
  • Prepare and give 1-2 formal journal clubs or topic presentations per week
  • Prepare projects for clinic as the need arises

 
Facility Description:

The Gastroenterology Clinic and Rheumatology Clinic are located on the 1st floor of the University of Utah Hospital. Space is limited within the clinics, please be understanding. We have 2 small break rooms with refrigerators, microwaves, a water/ice dispenser, and a sink.

 
Dress Code:

  1. UUHC Pharmacy Department Specific Guidelines:
    1. Dress for staff that routinely sees patients or customers
      1. Professional dress is required, such as a dress shirt and tie.
      2. Interns working in these areas should comply with these standards.
    2. Dress for staff that does not routinely see patients and customers.
      1. Business professional wear such as a tucked in dress shirt, polo shirt or turtleneck is acceptable.
    3. Consequences
      1. Infractions of this policy may result in the employee or trainee being sent home to change clothing and will not be paid for the time away.
      2. Disciplinary action and appeals shall follow normal Hospital and Departmental Policy.
  2. See University of Utah Hospitals & Clinics policy at: http://healthcare.utah.edu/careers/docs/DressCodePolicy.pdf
  3. White coat not required.

 
Anticipated Weekly Schedule:

(Monday-Friday) *indicates optional meeting/conference
Monday Tuesday Wednesday Thursday Friday

0700-0800: *HCV ECHO

0800-1600: Rheumatology Clinic

0730-0830: Rheumatology Fellows topic discussion or GI ECHO

0800-1700: Gastroenterology Clinic

0730-0900: Rheumatology Conference or Topic discussion

0900-1700: Rheumatology Clinic

0730-1600: IBD in Clinic 3

Topic Discussion PM?

1600-1700: GI conference

1700-1800: *IBD conference

0730-1600: IBD in Clinic 3

1130-1300: *HCV ECHO

Topic Discussion PM?

Clinic times may vary depending on patient load and complexity of patients. You may be in clinic after 1700 some days or leave earlier some days. You may be required to work on projects at home after hours.

 
Resident Expectations:

  • Maintain courteous and professional behavior while at the rotation site.
  • Be on time every day and call immediately regarding unexpected absence or tardiness.
  • Refrain from making personal calls/text messages when engaged in patient care or other pharmacy activities.
  • Be prepared for topic discussions, case presentation and projects at the scheduled time.
  • Be flexible if changes are made to the schedule.
  • Be an independent learner and attempt to find answers to question independently first, then discuss findings with the preceptor to further clarification and understanding.
  • Communicate residency related meetings in advance.
  • Comply with the University of Utah HIPPA policy.

 
Evaluation:

  • Evaluations will be documented in PharmAcademic™.
  • At the midpoint of the rotation, the preceptor will evaluate the resident. At the end of the rotation, the resident will self-evaluate, the preceptor will evaluate the resident, and the resident will evaluate both the preceptor and the learning experience. A final summative evaluation will be completed at the end of the rotation.
  • The resident will receive regular formative feedback related to patient care activities, patient education, and inservice.

 
References:

University of Utah Hospitals & Clinics Policy: Dress Code - Pharmacy Services Employee Supplemental

Updated September 2017