Pharmacy Services

Pharmacy Services Residency

Infectious Diseases Consult Service

 (PGY1 Elective Rotation)

Preceptor:

Russell Benefield, PharmD, BCPS

 
Rotation Description:

The Infectious Diseases (ID) Consult Service is responsible for all inpatient consults for University Hospital (430 beds) and Huntsman Cancer Hospital (50 beds). There are 2 teams consisting of a General ID Consult Service and an Immunocompromised ID Consult Service. Each consult team carries an average patient load of 8-10 patients. The teams consist of an attending physician, fellow, and occasionally 1 medical resident. Additionally, a physician assistant is a member of the General ID team. An ID pharmacist (i.e. the preceptor) rounds regularly with the Immunocompromised ID service.

The resident is an integral member of each consult team and is responsible for optimizing anti-infective therapy for all patients of his or her team. The resident participates actively in daily patient-care rounds, literature evaluation, patient presentations, and disease and drug analyses and discussions. The rotation will consist of two, two-week blocks spent with each consult service to maximize the breadth of learning experiences available. The resident will round independently with the General ID team (with preceptor support), and with the preceptor on the Immunocompromised ID team. The resident is challenged to develop individualized therapeutic recommendations and monitoring plans daily. Development of critical thinking skills is paramount in this rotation. Each team has daily rounds in the afternoons, usually 1-6 pm. The resident will be responsible to round for the entire period the team is rounding.

Outcomes, Goals, Objective Number  (Level of Learning Required) & Description

Methods

Rotation Activities

Outcome R1: Patient Care

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

Modeling, Coaching, Facilitation

  • Daily rounding with both the general and immunocompromised ID consult teams
  • Develop productive, collaborative, professional relationships with each team
  • Recommend therapeutic and monitoring plans to the ID consult teams clearly and respectfully
  • Communicate with primary teams to ensure no barriers to ID consult service preferred plans of care

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

Direct Instruction, Modeling, Coaching, Facilitation

  • Develop knowledge base in medical microbiology and ID pharmacotherapy via daily topic discussions with preceptor
  • Self-directed reading/literature review to take care of patients followed by the ID consult services or prepare for topic discussions
  • Develop or refine process for collecting and assessing patient information
  • Discern infectious problems from other issues for patients followed by the ID consult services

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

Modeling, Coaching

  • Weigh risks and benefits of possible therapies and recommend the “best” treatment based on patient-specific factors
  • Redesign the pharmacotherapy plans to achieve stated goals and outcomes.
  • Discuss individualized plans with preceptor daily

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

Direct Instruction, Modeling, Coaching, Facilitation

  • Communicate individualized pharmacotherapy plan to the appropriate members of the ID consult teams
  • Communicate plans verbally and by chart documentation with clinical pharmacists and other members of a primary team
  • Work with central pharmacy to ensure access to specialty drugs for patients of the ID consult service when necessary

Goal R1.3 Prepare, dispense, and manage medications to support safe and effective drug therapy for patients

OBJ R1.3.2 Manage aspects of the medication-use process related to formulary management

Direct Instruction, Modeling, Coaching

  • Design treatment plans that take into account antimicrobial formulary status
  • Identify a situation(s) where a non-formulary medication is warranted based upon evidence-based medicine, literature, and/or practice guidelines

Outcome R3: Leadership and Management

Goal R3.2 Demonstrate management skills

R3.2.4 Manages one’s own practice effectively

Modeling, Coaching, Facilitation

  • Define personal goals for one’s own clinical practice
  • Self-assess progress towards each practice goal
  • Create plan for self-improvement towards each practice goal
  • Defend value of one’s own clinical practice from perspective of quality and financial impact

 
Readings and Preparatory Work:

The resident is expected to identify his or her own search strategy to retrieve relevant readings and literature with general guidance and supplementation from the preceptor.

 
Presentation Description:

The resident will prepare and lead topic discussions on specific topics related to infectious diseases with emphasis on medical microbiology and antimicrobial pharmacotherapy.  Operational and antimicrobial stewardship issues will also be presented and discussed with the preceptor. Patient care plans will be presented multiple times daily to the preceptor.  Additionally, in-services on a range of infectious diseases topics may be presented to the ID teams.

 
Typical Daily/Weekly/Monthly Activities:

Hours vary depending on the patient load and rounding schedule of the consult services as well as the level of preparation of the resident.  In general the rotation hours will be from 9:00 am to 6:30 pm Monday through Friday.  Residents may need to come in earlier or stay later to meet patient care needs.  Supplemental reading and preparation for topic discussions will require an additional time commitment outside of the rotation.

Morning topic discussions will be held Monday through Friday from 9:00 to 11:00 AM barring exceptional circumstances.  This time is intended for daily presentations of patient care plans, disease and drug reviews, and operational/stewardship issues.  Additionally, the residents are expected to attend the weekly Infectious Diseases Core Curriculum Conferences (Monday mornings from 8:00-9:00 am) and Case Conferences (Thursday afternoons from 5:00-6:00 pm)

Residents are expected to work to care for patients, read, and discuss patients for as long as it takes to ensure best patient care.

 
Evaluation:

The resident will receive regular oral feedback regarding his or her thought processes, therapeutic plans, and follow-up. The resident will have formative snapshot self and preceptor evaluations at the midpoint and summative self and preceptor evaluations of all goals at the end of the rotation.  The resident will complete preceptor and learning experience evaluations at the end of the rotation.  The evaluations will be documented in PharmAcademic.

Updated March 2016