Pharmacy Services

Pharmacy Services Residency

Neurology Clinic

(PGY1 Rotation - Ambulatory Care)

 
Preceptors:

Sarah Dehoney, PharmD, BCPS
Erica Marini, PharmD, MS, BCPS

 
Description of Practice Site:

This site is an ambulatory Neurology Clinic located in the Clinical Neurosciences Center which is attached to the University of Utah Hospital. The clinic is staffed by physicians and mid-level providers who specialize in neurology. Sub-specialties include: neuromuscular disorders, epilepsy, stroke and general neurologists. The clinical pharmacist staffs the clinic Monday through Friday during normal business hours. There is a secondary neurology clinic site in Research Park. Providers at this clinic have sub-specialties of: multiple sclerosis, movement disorders, cognitive disorders and headache. Per the resident’s interest time spent at this location can be arranged on a case-by-case basis. Patients seen in these clinics come from many different areas across Utah and out of state to seek this specialty care.

 
Rotation Description

The resident will staff the clinic with the pharmacist at first and progress to functioning independently during this rotation. The pharmacist works as part of an interdisciplinary team with ALS (amyotrophic lateral sclerosis) patients one day a week. In this clinic the pharmacist sees all patients to perform medication reconciliation as well as work with the other providers to come up with a patient treatment plan. On the other days of the week the pharmacist provides services to all neurologists in clinic. These responsibilities include:

  • Patient education for new medications
  • Dose taper/titration schedules
  • Medication reconciliation
  • Medication laboratory monitoring
  • Telephone follow-up for therapy monitoring
  • Sample medication inventories

In addition to direct patient care the pharmacist also helps with patient population management. This involves setting up and organizing treatment and monitoring protocols. Involvement with this will depend on projects the pharmacist is currently involved with at time of rotation. The expectation is that the resident will display professionalism towards all staff and patients, and complete all patient care and project assignments during the rotation by the required deadline. If expectations are not met a plan for improvement will be drawn up with exact expectations that will be reviewed and signed by preceptor and resident. Adherence to the plan will be reviewed daily.

 
RLS Goals:

Goal

RLS #

As appropriate, establish collaborative professional relationships with members of the health care team.

R2.1

Place priority on the delivery of patient-centered care.

R2.2

As appropriate, establish collaborative professional pharmacist-patient relationships.

R2.3

Recommend or communicate regimens and monitoring plans.

R2.8

Document direct patient care activities appropriately.

R2.12

Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

R5.1

Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues.

E7.1

Balance obligations to oneself, relationships and work in a way that minimizes stress.

E7.3

 
Activities Evaluated:

Rotation Activity

Objectives
Covered

Teaching Methods

Patient Care Activities

Perform medication reconciliation to ensure a complete and accurate medication list is obtained from the patient and any medication changes are communicated to the patient verbally and in writing and are documented in the chart.

R2.3.1
R2.12.1
R2.12.2
R2.12.3
E7.1.1

M, C, F

Perform comprehensive medication histories of patients at their initial appointment with a neurologist. This includes a list of medications previously and currently used to treat their disease, their efficacy, side effects, frequency and duration of use, and reasons for discontinuing past medications.

R2.2.1
R2.3.1
E7.1.1

M, C, F

Recommend appropriate drug therapies for the treatment of various neurologic disease states (headache, stroke, PD, MS, ALS) based on patient specific information and current disease management guidelines.

R2.1.1
R2.8.1

I, M, C, F

Recommend appropriate monitoring for patients' medication therapies including effectiveness, adverse events, and laboratory tests.

R2.2.1
R2.8.1

M, C, F

Communicate with providers and other members of the interdisciplinary team patient requests, questions and drug therapy plan.

R2.1.1
R2.8.1
E7.1.1

M, C, F

Provide education to patients regarding proper dosing and administration of their medications, potential side effects, drug interactions, monitoring, cost etc.

R2.3.1
R5.1.1
R5.1.5
R5.1.6
E7.1.1

C, F

Appropriately document drug therapy recommendations, patient education activities, and reconciliation of the patients' medications in the electronic medical record.

R2.12.1
R2.12.2
R2.12.3

I, M, C, F

Other Activities

Help with ordering of high cost medications, and medications requiring prior authorizations for patients in clinic. As well as helping providers order medications that need to come from specialty pharmacies.

R2.1.1
R2.2.1

C, F

Lead topic discussions with the preceptor. Possible topics include headache, multiples sclerosis, Parkinson's disease, stroke, dementia, neuromuscular diseases and others.

R2.2.1
E7.3.1

I, C, F

Lead a journal club presentation for the preceptor and/or other providers including a thorough discussion of the clinical trial and how the results will impact pharmacy practice.

R5.1.1
R5.1.5
R5.1.6
E7.1.1
E7.3.1

C, F

Prepare or update patient education materials, such as drug information handouts, as needed.

R5.1.1
R5.1.5
R5.1.6
E7.1.1
E7.3

C, F

Help preceptor with current clinic projects including protocols as needed. This activity will be dependent on current projects pharmacist is involved with during the rotation.

R2.1.1
E7.3.1

I, M, C, F

Appropriately report medication errors and adverse drug reactions using Patient Safety Net.

R2.2.1

M, C, F

Attend weekly Neurology and/or Pharmacy Grand Rounds presentations as needed.

R2.1.1
R2.2.1

C, F

I=Direct Instruction, M=Modeling, C=Coaching, F=Facilitating

 
Readings and Preparatory Work:

The resident will be given review articles and/or practice guidelines relating to the neurologic disease states commonly encountered during the rotation.  These could include:

  • Headache/migraine
  • Multiples Sclerosis
  • Parkinson’s disease/movement disorders
  • Dementia/Alzheimer’s disease
  • Amyotrophic Lateral Sclerosis
  • Myasthenia Gravis /neuromuscular disorders
  • Stroke
  • Neuropathy
  • Seizure disorders
  • Depression/psychiatric disease
  • Sleep Disorders

The resident will be expected to complete these and/or other readings in preparation for topic discussions and patient care activities. The resident is also expected to seek out other guidelines, references, review articles on the above topics on their own to be able to answer questions from patients and providers. Other topics may be assigned at the preceptor’s discretion.

 
Project Descriptions:

  1. Topic discussion: Topic discussions will occur twice a week. Some topics will be assigned by preceptor and others can be chosen by residents. The topic discussions will include a brief background on disease state, medications used to treat, monitoring etc… These discussions are informal but require a handout.
  2. Journal club: One journal club will be required during the rotation; this will take the place of one topic discussion. Journal club presentations should include a thorough evaluation of a published clinical trial and any implications the results should have on pharmacy practice. The topic will be a neurology topic of resident’s choice. This is informal but requires a handout.
  3. Patient education handout: The resident will be required to prepare one patient information/education handout; others may be assigned depending on time and need. The topic will be determined by the preceptor depending on clinic need and resident interest. This handout can be incorporated into the electronic medication record, EPIC, or can be a separate word document.
  4. Project (optional): The resident may be involved with any ongoing projects the preceptor is currently working on. These might include medication therapy/monitoring protocols, global patient management, standardization of treatment etc…These will be assigned dependent on preceptor and clinic need, as well as time commitment.

Schedule of Activities:

  • The resident is expected to be in clinic Monday through Friday approximately 8:00am-5:00pm.
  • Project time or staffing will be allowed on Tuesdays after 1:00pm.
  • The resident should attend Neurology Department Grand Rounds. They are presented on Wednesday mornings at 9:00 AM on the first floor of the CNC building.
  • The resident can choose to attend Pharmacy Grand Rounds as time permits. They are presented on Wednesday afternoons in the pharmacy conference room.
  • The journal club will be due during the third week of rotation and the patient handout will be due the fourth week of rotation. The exact dates will be determined during the first week of rotation.
  • Topic discussions will occur twice a week usually on Wednesdays and Fridays. Exact days may change depending on clinic schedule.
  • The project (if assigned) will be due during the last week of rotation.

Evaluations:

The resident will receive regular feedback each week regarding their performance. A midpoint evaluation will be done to elicit discussion about performance to date. A formal summative evaluation will be done on the last day of rotation and submitted to ResiTrak.