Pharmacy Services

Pharmacy Services Residency

Internal Medicine

(PGY1 Rotation - Ambulatory Care)

 
Preceptor:

Jenni Buu, PharmD, BCACP

 
Site Description:

University of Utah Health's Internal Medicine Clinic is located within University of Utah Hospital (Clinic 2). Clinic providers include attending internal medicine physicians and medical residents. Clinical pharmacy services provided at the clinic include chronic disease state medication management through collaborative practice, comprehensive medication reviews, refill authorizations, drug information services, and patient education.

 
Learning Experience Description:

The pharmacy resident will participate as an active member of the health care team and assist in providing clinical pharmacy services through collaborative practice agreements. He/she will be able to provide direct patient care assessments of patients seen at the clinic and develop plans together with primary care providers. Residents will also provide patient education for disease state management and new medications, evaluate drug therapy regimens, and provide recommendations for optimizing drug therapy, monitoring, and patient adherence. The resident will serve as a drug information resource for providers and staff. Other activities may include leading weekly topic discussions/patient presentations/journal clubs, presenting an inservice for nursing staff, and completing a clinic project.

 
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.
      • OBJ R1.1.1 Interact effectively with health care teams to manage patients’ medication therapy
      • OBJ R1.1.2 Interact effectively with patients, family members, and caregivers
      • OBJ R1.1.3 Collect information on which to base safe and effective medication therapy
      • OBJ R1.1.5 Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)
      • OBJ R1.1.7 Document direct patient care activities appropriately in the medical record or where appropriate
    • GOAL R1.2 Ensure continuity of care during patient transitions between care settings.
      • OBJ R1.2.1 Manage transitions of care effectively
    • GOAL R3.1 Demonstrate leadership skills
      • OBJ R3.1.2 Apply a process of on-going self-evaluation and personal performance improvement
    • GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public.
      • OBJ R4.1.2 Use effective presentation and teaching skills to deliver education
  • 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.
      • OBJ R1.1.2 Interact effectively with patients, family members, and caregivers
      • OBJ R1.1.4 Analyze and assess information on which to base safe and effective medication therapy
      • OBJ R1.1.5 Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans)
      • OBJ R1.1.6 Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate follow-up actions
      • OBJ R1.1.8 Demonstrate responsibility to patients
    • GOAL R3.1 Demonstrate leadership skills
      • OBJ R3.1.2 Apply a process of on-going self-evaluation and personal performance improvement
    • GOAL R3.2 Demonstrate management skills
      • OBJ R3.2.4 Manages one’s own practice effectively
    • GOAL R4.1 Provide effective medication and practice-related education to patients, caregivers, health care professionals, students, and the public (individuals and groups)
      • OBJ R4.1.2 Use effective presentation and teaching skills to deliver education

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 clinic interactions (in person and telephonic patient visits) 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 telephonic patient visits). Information will be collected weekly to monthly 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 primary care 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.

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.

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

Objective R1.2.1: 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: Use effective presentation and teaching skills to deliver education.

Coaching and Facilitation

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

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

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 telephonic patient visits). Information will be collected weekly to monthly 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 telephonic patient visits).

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.

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 as well as develop skills in time management to complete 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 nursing staff and/or providers as appropriate.

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

 
Topics to be Covered During Experience:

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

 
Readings and Preparatory Work:

  • University of Utah Hospitals and Clinics collaborative practice agreements
  • Current metabolic disease state guidelines
    • Diabetes – current ADA Guidelines
    • Hyperlipidemia – ACC/AHA 2013 Guidelines
    • Hypertension – JNC8 committee report 2014 Guidelines

 
Project/Presentation Description:

The resident will provide a 10-15 minute inservice to clinic nursing staff and/or providers and he/she will prepare two journal clubs for presentation to the preceptor/other pharmacists. The resident may also assist with other clinic projects as appropriate.

 
Typical Clinic Schedule:

Monday – Attending clinic 0800-1700
Tuesday – Resident clinic 0800-1200; attending/resident clinic 0800-1700
Wednesday – Resident clinic 0800-1200; attending/resident clinic 1300-1700
Thursday – Resident clinic 0800-1200; attending/resident clinic 0800-1700
Friday – Resident clinic 0800-1200; attending/resident clinic 1300-1700

 
Evaluations:

The resident will receive regular formative feedback related to patient care activities, communication/staff interaction, and presentations. Verbal evaluations will be provided on a daily to weekly basis. Midpoint and final written evaluations will be documented through PharmAcademic.

Updated March 2016