Pharmacy Services

Pharmacy Services Residency

Geriatrics Clinic I & II

(PGY1 Rotation - Ambulatory Care)

 
Rotation Preceptor:

Melissa D Green, PharmD, BCACP

 
Site Description

The University of Utah Geriatric Clinic provides comprehensive primary care to geriatric patients and support to their family and/or caregiver(s). Patients are also seen in consultation based on referrals received from community primary care providers for evaluation of cognitive complaints and polypharmacy. The clinical pharmacist provides services including comprehensive medication review, disease state management, drug information, and patient, provider and staff education. The interprofessional team includes a pharmacist, physicians, geriatric fellows, psychiatry, advanced-practice nurse practitioners, an RN care manager, a licensed clinical social worker, nursing, medical assistants and guest relation specialists.

 
Rotation Description and Resident Expectations

The resident will work towards functioning as the Geriatric Clinical pharmacist for the interdisciplinary care team. The Geriatric clinical pharmacist is responsible for providing a comprehensive medication review for select new patients, transition of care appointments and other high-risk patients. Recommendations are discussed with the provider and/or interdisciplinary team and documented in the electronic medical record. Clinical pharmacy services align with the Pharmacy Primary Care Services and utilize multiple collaborative practice agreements including, but not limited to diabetes, hypertension, hyperlipidemia, asthma and smoking cessation to provide disease state management. The resident will be responsible for identifying and resolving drug therapy problems for patients referred to the clinic pharmacy service and actively manage their care and communicate the care plan with the patient, the family and/or caregiver, and the care team, as necessary. Emphasis is placed on providing care for the entire patient vs a single clinical problem and identifying and aligning the care plan to the patient’s goals of care. The clinical pharmacist provides drug information to patients, providers and the care team in the Geriatric Clinic. Additional educational activities include journal clubs, drug therapy updates and in-service presentations.

 
Activities Taught and Evaluated

Goals and Objectives

Teaching Method(s)

Related 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 care process.
  • Objective R1.1.1: (Applying) Interact effectively with health care teams to manage patients’ medication therapy.
    (Amb Care I)

Customized based on resident’s baseline skills and progression

Direct instruction
Modeling
Coaching
Facilitation
  • Regular interaction with interdisciplinary team members and patients via verbal and written communication
  • Independent clinical pharmacy visits based on CDTM protocols
  • Co-visits with care team members
  • Electronic and telephonic communication with patients regarding medication management
  • Use of available drug information resources to gather data necessary to conduct patient care
  • Efficient documentation of clinic visits in a way that clearly communicates the activities completed, recommendations made, outcomes expected, and time frame of follow-up.
  • Prioritization of daily clinic activities
  • Utilization of other care team members as appropriate via warm hand-off/or referral
  • Communication with clinic providers regarding pharmacy recommendations or plans provided to patients utilizing CDTM protocols
  • Objective R1.1.2: (Applying) Interact effectively with patients, family members, and caregivers.
    (Amb Care I and II)
  • Objective R1.1.3: (Applying) Collect information on which to base safe and effective medication therapy.
    (Amb Care I)
  • Objective R1.1.4: (Analyzing) Analyze and assess information on which to base safe and effective medication therapy.
    (Amb Care II)
  • Objective R1.1.5: (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans).
    (Amb Care I and II)
  • Objective R1.1.6: (Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions.
    (Amb Care II)
  • Objective R1.1.7: (Applying) Document direct patient care activities appropriately in the medical record or where appropriate.
    (Amb Care I)
  • Objective R1.1.8: (Applying) Demonstrate responsibility to patients.
    (Amb Care II)
GOAL R1.2 Ensure continuity of care during patient transitions between care settings.
  • Objective R1.2.1: (Applying) Manage transitions of care effectively.
    (Amb Care I)

Customized based on resident’s baseline skills and progression

Direct instruction
Modeling
Coaching
Facilitation
  • Completion of transitional care activities following hospital discharge, including medication reconciliation and recommendations to improve medication safety and efficacy
  • Coordination of care with patient pharmacies and other providers
GOAL R3.1 Demonstrate leadership skills
  • Objective R3.1.2: (Applying) Apply a process of on-going self-evaluation and personal performance improvement
    (Amb Care I and II)
Coaching
Facilitation
  • Self-assessment of baseline geriatric knowledge and ambulatory care experience prior to beginning rotation and communicate gaps to the preceptor
  • Apply feedback to future patient and provider encounters
  • Self-assess progress at the end of the rotation experience
GOAL R3.2 Demonstrate management skills
  • Objective R3.2.4: (Applying) Manages one’s own practice effectively
    (Amb Care I and II)
Modeling
Coaching
Facilitation
  • Goal will be for learner to independently run the Geriatric Clinic by the last week of rotation
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
    (Amb Care I and II)
Coaching
Facilitation
  • Prepare and present a journal club, case, or in-service to healthcare professionals as needed
  • Medication or other education to providers and patients
  • Utilize patient education to help patients reach their therapeutic goals
  • Preparation of educational materials for clinic providers

 
Rotation Assignment Summary

  1. Adequately prepare for patient visits by reviewing pertinent primary care pharmacotherapy and disease states.
  2. Report all adverse drug events according to the University of Utah Hospital protocols
  3. Present one journal club, case presentation, in-service or other assignment depending on resident and/or preceptor preference
  4. Function within the scope of the collaborative drug therapy management protocols approved by the Pharmacy and Therapeutics Committee for hypertension, dyslipidemia, smoking cessation, asthma, anticoagulation, refills, immunizations and diabetes
  5. Provide medication counseling and instructions as requested, and document all patient interactions with a progress note entered into EPIC
  6. Drug information projects may be assigned as they come up.
  7. Review the resident’s schedule and progress on activities and projects with the preceptor at least weekly to demonstrate adequate progress.

 
Preparation Prior to Rotation

Become familiar with the University CDTM protocols for hypertension, dyslipidemia, anticoagulation, refills, therapeutic interchange, immunizations and diabetes.

 
Orientation

Your preceptor will meet with you on the first day of rotation to make an individual rotation plan.

 
Typical Clinic Activities and Schedule

The doors to the Murray Park Medical Building, where the Geriatric Clinic is located, automatically unlock at 6:30 am and lock at 7:00pm. A typical day will be from 8:00am – 5:00pm, but additional time may be required to complete daily responsibilities and ensure best outcomes for the patient. The resident is expected to be punctual and prioritize daily activities. Residents are expected to answer questions and follow-up with providers regarding patients seen in clinic even when they are not physically on site.

Geriatric Clinic Monthly Schedule:

 

Monday

Tuesday

Wednesday

Thursday

Friday

1st Week

 

8am Geriatric Grand Rounds
9am Care Team Mtg

     

2nd Week

 

8am Geriatric Grand Rounds
9am Care Team Mtg
1230pm Barnes CC

8am Gottlieb CC
12pm Care Team Topic Discussion — SW (15min)

830am Sorweid CC
12pm Care Team Topic Discussion — SW (repeat)

 

3rd Week

 

8am Geriatric Grand Rounds
9am Care Team Mtg
1pm Supiano CC (quarterly)

1-5pm PPCS Staff Meeting
12pm Care Team Topic Discussion — PharmD (15min)

12pm Care Team Topic Discussion —PharmD (repeat)

 

4th Week

 

8am Geriatric Grand Rounds
9am Care Team Mtg

 

1pm Abueg CC (@SJHC)

8am Deweese CC

5th Week (last week of the month)

 

8am Geriatric Grand Rounds
9am Schlisman CC

     
CC = Care Conference

 
Evaluations

The resident will receive regular formative feedback related to patient care activities, patient education, written notes and any completed presentations.

Formal evaluations will be documented in PharmAcademicTM. 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.

Last updated September 2017