Pharmacy Services

Pharmacy Services Residency

Community Clinics

 (PGY1 Rotation - Transitions of Care)

 
Preceptors:

Stephanie Adams-Barrus, Clinical Pharmacist
Maureen Ghanem, Clinical Pharmacist
Brittanie Hatch, Clinical Pharmacist
Kevin McFarland, Clinical Pharmacist
Karen C. Thomas, Pharmacy Clinical Coordinator

 
Site Description:

This ambulatory care rotation is based at the Pharmacy Ambulatory Clinical Care Center (PAC3) associated with University of Utah Health Care and the University of Utah Community Clinics, located in Murray (with opportunities to practice at the South Jordan Health Center if desired). PAC3 is a team of pharmacists and pharmacy technicians who deliver high quality centralized pharmacy services to the Health Care system, including primary care providers in the Community Clinics.

This rotation focuses on transitions of care. PAC3 has teamed up with Community Clinics Nursing to provide transition services to established Community Clinic patients upon discharge from the University Hospital. We work collaboratively with the Community Nursing group to reach out to recently discharged patients and help identify, prevent, or manage medication issues that occur when patients transition from inpatient to outpatient care. Our pilot project showed a significant decrease in readmission rate for patients managed by this group. Patients are particularly vulnerable to medication problems and confusion after discharge from the hospital, and PAC3 is well placed to be able to help patients and caregivers navigate these changes. PAC3 transitions pharmacists work closely with Community Clinic pharmacists to make referrals for medication reconciliation or chronic disease state management. Pharmacy residents on the Transitions of Care rotation are expected to communicate clearly with patients and providers, to think critically, and problem solve to provide the best care possible to our patients. We provide transitions services to > 200 patients each month, with numerous meaningful and valuable interventions each day, which makes this practice site incredibly rewarding.

Residents will be provided with specific instruction, an accessible preceptor, as well as their own work station. By the end of the rotation, the resident is expected to be able to perform pharmacist-level work and function independently.

 
Rotation Description:

Rotation Assignment Summary:

  1. Review patient charts for medication-related changes or issues after hospital discharge and intervene where appropriate to prevent problems and keep patients from harm.
  2. Identify medication related issues or problems and appropriately intervene and counsel patients about these issues.
  3. Interact and effectively communicate with patients, pharmacists and health care providers.
  4. In-service: present a 20 minute informal in-service to pharmacists and pharmacy technicians (if available) on a topic chosen during the rotation.
  5. Weekly short literature projects (Journal Club or other) as defined by rotation site preceptor.
  6. Precept pharmacy students on rotation if applicable.

Residency Goals:

R1.1.1 - Interact effectively with health care teams to manage patients’ medication therapy

R1.1.2 - Interact effectively with patients, family members, and caregivers

R1.1.3 - Collect information on which to base safe and effective medication therapy

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

R1.2.1 - Manage transitions of care effectively

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

R4.1.2 - Use effective presentation and teaching skills to deliver education

 
Activities Evaluated:

Rotation Activity

Goal

Teaching Method

Review patient charts and medication changes upon discharge from the hospital and identify medication related issues or problems

R1.1.1
R1.1.2
R1.1.3
R1.1.7

Direct Instruction
Model
Coach
Facilitate

Participate in transitions of care by communicating with patients after discharge from the hospital

R1.2.1

Direct Instruction
Model
Coach
Facilitate

Interact and communicate with pharmacy technicians, pharmacists, nurses, and primary care providers to ensure optimal outcomes for patients

R3.1.1

Direct Instruction
Model
Coach
Facilitate

Prepare and present an educational in-service for specialty pharmacy staff

R4.1.2

Direct Instruction
Coach
Facilitate

Research and present short literature projects

R4.1.2

Direct Instruction
Coach
Facilitate

 
Readings and Preparatory Work:

Possible Topic Discussions and Readings involve the following topics:

  • Collaborative Practice Agreements
    • Medication Refills
    • Therapeutic Interchanges
  • Management of chronic disease states
    • Asthma
    • COPD
    • Diabetes
    • Hyperlipidemia
    • Hypertension
  • Transitions of Care
    • Measures of outcomes
    • Pharmacist participation in transitions of care

 
Project Description:

  1. In-service: the resident will provide one in-service to PAC3 staff on a topic applicable to the current needs of the group. The presentation will be verbal with a hand-out but no slides and will be about 15 to 20 minutes, presented at a weekly staff meeting.
  2. Literature projects: the resident will participate in a weekly literature project that may be a review of a journal article, a short literature search, or a review of clinical guidelines or other topic as applicable to the current rotation. Literature projects will initially be defined by the rotation site preceptor, but as the rotation progresses the resident will be pick their own short projects.

Typical Daily/Weekly/Monthly Activities:

The resident is expected to be reliable, punctual, and motivated. The typical schedule is Monday through Friday, 8-430 pm. Time for presentations and projects will be provided although some outside time may be required. Daily and weekly tasks will vary throughout the rotation as the resident becomes more autonomous.

 
Evaluation:

Formal evaluations will occur at the midpoint and on the last day of the rotation. Informal feedback will be regularly provided by the preceptor and other pharmacists working with the resident. The residents are also expected to provide feedback to the preceptor and site so that we may also improve.

Updated March 2016