Pharmacy Services

Pharmacy Services Residency

Cardiovascular (CV) Medicine

 (PGY1 Rotation - Transitions of Care)

 
Preceptors:

Teshia Sorensen, PharmD, BCPS, AACC
Joshua Sessions, PharmD
Adam Smith, PharmD
Angela Green, PharmD (Preceptor in Training)
Jessica Carey, PharmD (Preceptor in Training)
John Dechand, PharmD (Preceptor in Training)

 
Site Description:

At University of Utah Health, the Cardiovascular Medicine pharmacists provide comprehensive pharmaceutical care to patients in a variety of settings including the Cardiovascular Center (ambulatory clinic), the Cardiovascular Medicine Unit (acute care floor), and the Cardiovascular Intensive Care Unit. The primary service lines (i.e., teams) are General Cardiology, Interventional Cardiology, Heart Failure and Transplant, Cardiothoracic Surgery, and Electrophysiology.

Common medical conditions encountered include acute coronary syndromes (unstable angina, myocardial infarction), heart failure, arrhythmias, infections (endocarditis, LVAD infections, etc.), valvular heart disease, congenital heart disease, and pulmonary hypertension.

 
Role of the Pharmacist:

The pharmacist works collaboratively with members of the multidisciplinary teams, including providers (attending cardiologists and subspecialists, fellows, residents, interns, nurse practitioners, and physician’s assistants), nurses and medical assistants, case managers, social workers, and more. The pharmacist contributes to improved patient care by providing an array of clinical pharmacy services including individual and group patient education, medication review and optimization, drug information, and provider education.

 
Rotation Description:

The Cardiovascular Medicine Transitions of Care rotation provides learning experiences for the resident in multiple settings (clinic, acute care, ICU). The resident’s specific rotation structure (see options below) will be determined prior to the first day of the rotation based on resident interest and preceptor availability.

 
Resident Expectations:

The resident is expected to provide comprehensive pharmaceutical care to all patients on their service. Daily activities will include completing medication histories, analyzing all appropriate patient-specific data, developing complete therapeutic and monitoring plans, rounding with the multidisciplinary team, resolving all medication-related issues, and providing patient education and counseling. The resident will also complete topic and patient presentations, landmark clinical trial discussions, a journal club presentation, an in-service presentation, and observational learning experiences.

The resident will strive to develop excellent written and verbal communication skills. The resident is expected to supplement knowledge gaps by researching those topics via primary literature and/or clinical guidelines.

 
Rotation Structure Options:

Option Week 1 Week 2 Week 3 Week 4
A Cardiology Cardiology Cardiology Clinic
B Heart Failure Heart Failure Heart Failure Clinic
C Cardiology Cardiology or Heart Failure Heart Failure Clinic
D Clinic Cardiology or Heart Failure Cardiology or Heart Failure Clinic

 
Residency Goals and Objectives:

Transitions of Care Rotation:

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 R1.1.7 Document direct patient care activities appropriately in the medical record or where appropriate.

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

  • OBJ R1.2.1 Manage transitions of care effectively.

R3.1 Demonstrate leadership skills.

  • OBJ R3.1.1 Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership.

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 and Taught:

Objective Number (Level of Learning Required) & Description Teaching Method(s) Related Rotation Activities
Inpatient Clinic
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. Direct instruction
Modeling
Coaching
Facilitation
  • Round daily with multi-disciplinary team
  • Recommend evidence-based, patient-specific modifications to medication therapy
  • Identify and address medication-related issues from patient, nurse, and physician perspectives
  • Interview patients along with the cardiology and HF teams daily, and other subspecialty teams as needed
  • Communicate (face-to-face, by phone, or written) with patients, providers, health care facilities, and pharmacies as needed to facilitate therapeutic plans
OBJ R1.1.2 Interact effectively with patients, family members, and caregivers. Direct instruction
Modeling
Coaching
Facilitation
  • Interview patients and/or family members to complete medication histories
  • Provide education on medications to patients and/or caregivers
  • Communicate (face-to-face, by phone, or written) with patients, providers, health care facilities, and pharmacies as needed to facilitate therapeutic plans
  • Provide medication or other education as needed to patients and/or caregivers
OBJ R1.1.3 Collect information on which to base safe and effective medication therapy. Direct instruction
Coaching
Facilitation
  • Review pertinent patient-specific data in preparation for rounds daily
  • Review at least 5 patient charts prior to daily visit
  • Conduct at least 5 patient interviews daily to determine adherence to and issues with current medication therapy
  • Review charts and the medical literature as needed to answer medication therapy questions
OBJ R1.1.7 Document direct patient care activities appropriately in the medical record or where appropriate. Direct instruction
Modeling
Coaching
Facilitating
  • Interview patients and/or family members to complete medication histories
  • Provide thorough medication education to patients and/or caregivers
  • Appropriately document patient encounters in the electronic health record
R1.2 Ensure continuity of care during patient transitions between care settings.
OBJ R1.2.1 Manage transitions of care effectively. Direct instruction
Modeling
Coaching
Facilitation
  • Ensure patient specific medication access and affordability prior to discharge
  • Review all discharge orders and reconcile issues
  • Provide thorough medication education to patients and/or caregivers
  • Provide adequate written and verbal pass-off to receiving pharmacists (floor, ICU, clinic, etc.) at transfer
  • When selecting patients to interview, learner will make those with a recent transition a priority
  • Contact patients, providers, heath care facilities, and pharmacies as needed to manage transitions
  • If all needs cannot be met for a patient, learner will take initiative to pass along information needed to take care of the patient
R3.1 Demonstrate leadership skills.
OBJ R3.1.1 Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership. Direct instruction
Modeling
Coaching
Facilitation
  • Round daily with multi-disciplinary team
  • Work with multiple disciplines to ensure comprehensive pharmaceutical care
  • Collaborate with cardiology teams to optimize patient care
  • Demonstrate responsibility to patients
  • Goal will be for learner to independently run the Heart Failure, General Cardiology, and/or Dyspnea Clinic by the last week of rotation
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. Direct instruction
Modeling
Coaching
Facilitation
  • Complete an in-service presentation for physicians or nurses
  • Provide education on medications to patients and/or caregivers
  • Prepare and present a journal club, case, or in-service as needed to health care professionals
  • Provide medication or other education as needed to patients and providers
  • Assist in teaching the Heart Failure Education Class if it occurs during the course of the rotation

 
Readings and Preparatory Work:

Residents are required to be ACLS and BLS certified or actively pursuing certification. Readings will include landmark clinical trials, as well as more recent trials that may impact patient care, clinical guidelines for core cardiovascular conditions, and relevant Pharmacotherapy Self Assessment Program (PSAP) modules. Current lists of required and recommended readings are available at H:\Rx Residents\Rx Residents\Cardiovascular Medicine Rotations.

 
Project Description:

  1. Landmark Clinical Trials Discussion (4)
    1. Read each trial in preparation for an informal discussion with preceptors.
    2. Verbally describe each trial and discuss the trial’s impact on current practice.
    3. Handout not required.
  2. Journal Club (1)
    1. Topic must be related to cardiology.
    2. Article published within the last 6 months.
    3. Study should be likely to have impact on patient care.
    4. Formal presentation and handout required.
  3. In-service Presentation (1)
    1. Present medication related topic to cardiology team, heart failure team, clinical pharmacists, or nurses.
    2. Formal presentation and handout required.
    3. Approximately 15 minutes.
  4. Patient Presentation and/or Topic Discussion (2)
    1. Present patient in SOAP format.
    2. Topic discussion should focus on disease state(s) relevant to the patient presented.
    3. Formal presentation and handout required.
  5. MUE/System Improvement Project (1)
    1. Optional. May complete in place of (1) formal patient presentation/topic discussion.
    2. Project must be completed by the end of the rotation.
    3. List of potential projects will be provided during orientation.
  6. Observational Experiences (3)
    1. May include observing cardiac stress tests, cardiac catheterizations, and cardioversions.
    2. Preparation for each observational experience is required.

 
Typical Daily / Weekly / Monthly Activities:

The resident is expected to be punctual and to prioritize daily activities. A typical day will be from 0630 to 1600 on inpatient days or 0800 to 1700 on clinic days. Residents must arrive earlier than suggested below if needed to fully prepare for rounds or clinic appointments. Additional time is usually necessary to complete daily responsibilities and ensure best outcomes for the patient.

Inpatient Schedule:

  • 0630 - 0730 Daily - Patient monitoring and rounds preparation (Heart Failure)
  • 0730 - 0800 Daily - Patient presentations (brief) with preceptor (Heart Failure)
  • 0800 - 1200 Daily - Heart failure team rounds (active participation is required)
  • 0700 - 0830 Daily - Patient monitoring and rounds preparation (Cardiology)
  • 0830 - 0900 Daily - Patient presentations (brief) with preceptor (Cardiology)
  • 0900 - 1200 Daily - Cardiology team rounds (active participation is required)
  • 1200 - 1230 Daily - Patient presentations (in-depth) with preceptor, resolve remaining issues
  • 1300 - 1400 Daily - Core topic discussions and presentations with preceptor
  • 1400 - 1600 Daily - Patient education on high risk medications, medication histories
  • 1600 + Daily - The resident is expected to complete all pertinent patient care activities prior to leaving each day. Additional time outside of regular rotation hours will be required for reading, project research, and presentation preparation.

Clinic Schedule:

Typical Daily, Weekly, and Monthly Activities (Subject to Change):
Monday — General Cardiology 0800-1200, Heart Failure 1230-1700
Tuesday — General Cardiology or Dyspnea Clinic 0800-1200, Heart Failure 1230-1700
Wednesday — General Cardiology 0800-1200, Heart Failure 1230-1700
Thursday — General Cardiology or Dyspnea Clinic 0800-1200, Heart Failure 1230-1700
Friday — Heart Failure 0830-1200, General Cardiology 1300-1700
Monthly meetings — attend meetings with preceptor as needed

**Residency Conference is every Wednesday from 1400-1530. Residents are required to attend.

 
Evaluations:

The resident will receive verbal feedback (formative evaluation) on a daily basis from the preceptor. A short summative evaluation will occur at the midpoint and a full summative evaluation of all goals will occur at the end of the rotation. The final evaluation will be recorded in PharmAcademic. The resident self-evaluation is due by the last Wednesday of the rotation. All evaluations must be co-signed within 2 weeks of completion of rotation.

 
Updated August 2017