Pharmacy Services

Family Medicine, Sugarhouse Clinic Rotation

Learning Experience:

Patient care activity/Quality Improvement/Emphasis on Transitions of Care

 
Preceptor:

Karen Gunning, PharmD, BCPS, FCCP

 
Site Description:

The family medicine clinical rotation is based at the University of Utah Sugarhouse Clinic, a family medicine residency training site. Sugarhouse Clinic provides care to a wide variety of patients, including pediatrics, obstetrics, geriatrics and every type of patient in between.   The interdisciplinary team at Sugarhouse Clinic includes attending physicians, physician assistants, family medicine residents, physician assistant students, medical students, pharmacy students, psychologists, care managers, dieticians, pharmacists, nurses, medical assistants, and laboratory personnel. Specific clinic experiences include geriatrics clinic and home visits, pharmacy clinic, and the Sarah Daft Home Assisted Living Clinic.

 
Rotation Description:

The resident will work as an integral participant on the family medicine team at Sugarhouse Clinic. The resident will be responsible for identifying and resolving medication therapy issues for patients referred to the pharmacy team, and will work towards providing independent care of the patients seen in the pharmacy education clinic via the use of multiple collaborative drug therapy management agreements. Patients are referred to this clinic by their primary care providers to address a variety of drug related issues, which may include but is not limited to smoking cessation, diabetes education and monitoring, hypertension, hyperlipidemia, anticoagulation, pain management, asthma, general medication therapy management, and patient assistance. The resident may also participate as the pharmacist member of the senior clinic team at Sugarhouse clinic, attend home visits with family medicine residents and the senior clinic team, participate in the refill collaborative agreement protocol, and, if certified,  provide immunization services to clinic patients and members of the community.

Emphasis is placed on the provision of patient drug related care for the entire patient, vs. a solitary view based on a single clinical problem.  Further emphasis is also placed on the development and pharmacotherapy education of the other learners in clinic, and on development of drug information skills in the primary care setting.

The resident will be expected to participate in the teaching of pharmacy students, if applicable; with participation to include direct precepting, and didactic small group teaching.  Residents may also be involved with clinic quality improvement projects, and didactic presentations at department of family and preventive medicine conferences.

The resident is expected to be respectful and courteous to the patients, preceptors, other members of the health care team, and others.  The resident will need to demonstrate excellent communication skills, both written and verbal.  Patient confidentiality should be maintained according to HIPPA and other clinic policies.

Upon completion of the rotation, the resident is expected to have a holistic understanding and increased competence and confidence in the diagnosis and pharmacological treatment of core disease states in primary care, including but not limited to hypertension, diabetes, hyperlipidemia, anticoagulation, core geriatric syndromes, women’s health, infectious diseases in ambulatory care, smoking cessation, depression/anxiety,  immunizations and wellness, and asthma.

 
RLS Goals:

  • R2.1 — As appropriate, establish collaborative professional relationships with members of the health care team.
    • OBJ R2.1.1 (Synthesis) Implement a strategy that effectively establishes cooperative, collaborative, and communicative working relationships with members of interdisciplinary health care teams.
  • R2.2 — Place practice priority on the delivery of patient-centered care to patients.
    • OBJ R2.2.1 (Organization) Choose and manage daily activities so that they reflect a priority on the delivery of appropriate patient-centered care to each patient.
  • R2.5 — When necessary, make and follow up on patient referrals.
    • OBJ R2.5.1 (Evaluation) When presented with a patient with health care needs that cannot be met by the pharmacist, make a referral to the appropriate health care provider based on the patient’s acuity and the presenting problem.
    • OBJ R2.5.2 (Synthesis) Devise a plan for follow-up for a referred patient.
  • R2.8 — Recommend or communicate regimens and monitoring plans.
    • OBJ R2.8.1 (Application) Recommend or communicate a patient-centered, evidence-based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and patients in a way that is systematic, logical, accurate, timely, and secures consensus from the team and patient.
  • R2.9 — Implement regimens and monitoring plans.
    • OBJ R2.9.1 (Application) When appropriate, initiate the patient-centered, evidence-based therapeutic regimen and monitoring plan for a patient according to the organization's policies and procedures.
    • OBJ R2.9.2 (Application) Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration.
  • R2.11 — Communicate ongoing patient information.
    • OBJ R2.11.1 (Application) When given a patient who is transitioning from one health care setting to another, communicate pertinent pharmacotherapeutic information to the receiving health care professionals.
    • OBJ R2.11.2 (Application) Ensure that accurate and timely medication-specific information regarding a specific patient reaches those who need it at the appropriate time.
  • R2.12 — Document direct patient care activities appropriately.
    • OBJ R2.12.1 (Analysis) Appropriately select direct patient-care activities for documentation.
    • OBJ R2.12.2 (Application) Use effective communication practices when documenting a direct patient- care activity.
    • OBJ R2.12.3 (Comprehension) Explain the characteristics of exemplary documentation systems that may be used in the organization’s environment.
  • R5.1 — Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
    • OBJ R5.1.1 (Application) Use effective educational techniques in the design of all educational activities.
    • OBJ R5.1.2 (Synthesis) Design an assessment strategy that appropriately measures the specified objectives for education or training and fits the learning situation.
    • OBJ R5.1.3 (Application) Use skill in the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching, and facilitation).
    • OBJ R5.1.4 (Application) Use skill in case-based teaching.
    • OBJ R5.1.5 (Application) Use public speaking skills to speak effectively in large and small group situations.
    • OBJ R5.1.6 (Application) Use knowledge of audio-visual aids and handouts to enhance the effectiveness of communications.
  • E7.1 — Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues.
    • OBJ E7.1.1 (Organization) Demonstrate sensitivity to the perspective of the patient, caregiver, or health care colleague in all communications.
  • E7.2 — Communicate effectively.
    • OBJ E7.2.1 (Analysis) Use an understanding of effectiveness, efficiency, customary practice and the recipient's preferences to determine the appropriate type of, and medium and organization for, communication
    • OBJ E7.2.2(Complex Overt Response) Speak clearly and distinctly in grammatically correct English or the alternate primary language of the practice site.
    • OBJ E7.2.3 (Application) Use listening skills effectively in performing job functions.
  • E7.3 — Balance obligations to oneself, relationships, and work in a way that minimizes stress.
    • OBJ E7.3.1 (Synthesis) Devise an effective plan for minimizing stress while attending to personal needs, maintaining relationships, and meeting professional obligations.
  • E7.4 — Manage time effectively to fulfill practice responsibilities.
    • OBJ E7.4.1 (Application) Use time management skills effectively to fulfill practice responsibilities.

Objective Number  (Level of Learning Required) & Description

Methods

Rotation Activities

Goal R2.1 — As appropriate, establish collaborative professional relationships with members of the health care team.

OBJ R2.1.1 (Synthesis) Implement a strategy that effectively establishes cooperative, collaborative, and communicative working relationships with members of interdisciplinary health care teams. 

Modeling,
Coaching
Facilitation

By being present in the interdisciplinary clinic environment, the resident will be able to observe and gain experience with skills in communicating with the interdisciplinary team

Goal R2.2 — Place practice priority on the delivery of patient-centered care to patients.

OBJ R2.2.1 (Organization) Choose and manage daily activities so that they reflect a priority on the delivery of appropriate patient-centered care to each patient.

Modeling,
Coaching
Facilitation

Direct patient care in pharmacist managed clinics, and in interdisciplinary clinics.

Goal R2.5 — When necessary, make and follow up on patient referrals.

OBJ R2.5.1 (Evaluation)  When presented with a patient with health care needs that cannot be met by the pharmacist, make a referral to the appropriate health care provider based on the patient’s acuity and the presenting problem.

Direct Instruction
Modeling
Coaching
Facilitation

Through direct patient care in pharmacist
managed clinics, as well as in the provision of
appropriate referrals and care in the transitions
of care process.

OBJ R2.5.2 (Synthesis)  Devise a plan
for follow-up for a referred patient

Direct Instruction
Modeling
Coaching
Facilitation

 

As above, with an emphasis on appropriate
follow up of the patient experiencing a
transition of care

Goal R2.8: Recommend or communicate regimens or monitoring plans.

OBJ R2.8.1 (Application)  Recommend or communicate a patient-centered, evidence-based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and patients in a way that is systematic, logical, accurate, timely, and secures consensus from the team and patient.  

Direct Instruction, Modeling, Coaching,
Facilitation

During and following patient visits (formal or informal):
Resident shall be able to:

  1. Determine the appropriate documentation strategy appropriate to the patient/pharmacist interaction type.
  2. Efficiently document the visit in a way that clearly communicates the activities completed, the recommendations made, outcomes expected, and time frame of follow up.
  3. Review with the patient and provide the patient a document outlining the plan and patient goals, and provide a mechanism for review of patient understanding of such plan and goals.
  4. Communicate verbally with the provider regarding recommendations or plans provided to the patient utilizing CDTM protocols.

Goal R2.9:  Implement regimens, monitoring plans, and provide patient education for patients.

OBJ R2.9.1 (Application)  When appropriate, initiate the patient-centered, evidence-based therapeutic regimen and monitoring plan for a patient according to the organization's policies and procedures

Direct Instruction, Modeling, Coaching,
Facilitation

In pharmacist managed clinics/direct consultation, utilizing the CDTM protocols of the health care system.

OBJ R2.9.2 (Application)  Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration.

Modeling, Coaching,
Facilitation

 In all patient encounters, in both independent and interdisciplinary clinics, remembering to always ensure the appropriateness, completeness and understanding by the patient of the medication list.

Goal R2.11 — Communicate ongoing patient information.

OBJ R2.11.1 (Application)  When given a patient who is transitioning from one health care setting to another, communicate pertinent pharmacotherapeutic information to the receiving health care professionals.

Direct Instruction, Modeling, Coaching,
Facilitation

Through daily transitions of care activities, in communicating with PCP’s, care managers, medical assistants, and other care providers (home health, specialists, caregivers).

OBJ R2.11.2 (Application)  Ensure that accurate and timely medication-specific information regarding a specific patient reaches those who need it at the appropriate time.

 Modeling, Coaching,
Facilitation

Through daily transitions of care activities, in communicating with PCP’s, care managers, medical assistants, and other care providers (home health, specialists, caregivers).

Goal 2.12 — Document direct patient care activities appropriately.

OBJ R2.12.1 (Analysis) Appropriately select direct patient-care activities for documentation.

Modeling, Coaching,
Facilitation

All patient care activities during this rotation must be documented.

OBJ R2.12.2 (Application) Use effective communication practices when documenting a direct patient- care activity.

Modeling, Coaching,
Facilitation

The resident will learn to adapt communication techniques to the appropriate activity – including phone calls, staff message consults, on the fly consults, and formal office visits.

OBJ R2.12.3 (Comprehension) Explain the characteristics of exemplary documentation systems that may be used in the organization’s environment.

Direct instruction

Discussion with preceptor during introduction regarding documentation in the ambulatory care environment.

Goal R5.1 — Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

OBJ R5.1.1 (Application) Use effective educational techniques in the design of all educational activities.

Direct instruction

Resident will (when applicable) develop rotation activities for students on FM rotation and/or other ambulatory care rotations

OBJ R5.1.2 (Synthesis) Design an assessment strategy that appropriately measures the specified objectives for education or training and fits the learning situation.

Direct instruction
Modeling
Coaching
Facilitation

Resident will develop a syllabus for a week of rotation (if a student is also on rotation) and develop an assessment for the week’s activities.

OBJ R5.1.3 (Application) Use skill in the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching, and facilitation).

Modeling
Coaching
Facilitation

Resident will, after appropriate modeling, be responsible for specific student activities during the rotation as agreed upon by resident and preceptor.

OBJ R5.1.4 (Application) Use skill in case-based teaching.

Modeling
Coaching
Facilitation

Resident will lead (if available) an ambulatory care student case discussion day, presenting his/her own case to the students.

OBJ R5.1.5 (Application) Use public speaking skills to speak effectively in large and small group situations.

Facilitation

As opportunities present – the resident will provide education/in-services.

OBJ R5.1.6 (Application) Use knowledge of audio-visual aids and handouts to enhance the effectiveness of communications.

Facilitation

 As above.

Goal E7.1 — Use approaches in all communications that display sensitivity to the cultural and personal
characteristics of patients, caregivers, and health care colleagues.

OBJ E7.1.1 (Organization) Demonstrate sensitivity to the perspective of the patient, caregiver, or health care colleague in all communications.

Modeling
Coaching
Facilitation

Every patient care activity in the family medicine clinic is an opportunity to practice this objective.

Goal E7.2 Communicate effectively.

OBJ E7.2.1 (Analysis)  Use an understanding of effectiveness, efficiency, customary practice and the recipient's preferences to determine the appropriate type of, and medium and organization for, communication

Modeling
Coaching
Facilitation

In direct patient care, resident will have to determine the appropriate method of communication for a variety of patients from different cultures, with health literacy concerns, and will also have to communicate back recommendations/thoughts to a variety of primary care provider personalities.

OBJ E7.2.2(Complex Overt Response)  Speak clearly and distinctly in grammatically correct English or the alternate primary language of the practice site

Facilitation

As above.

OBJ E7.2.3 (Application)  Use listening skills effectively in performing job functions

 

Facilitation

As above.

Goal E7.3 — Balance obligations to oneself, relationships, and work in a way that minimizes stress.

OBJ E7.3.1 (Synthesis)  Devise an effective plan for minimizing stress while attending to personal needs, maintaining relationships, and meeting professional obligations

Coaching

Resident will have many tugs at time when in clinic. Resident will need to prioritize importance, acuity, and depth to manage all tasks that present themselves.

Goal E7.4 — Manage time effectively to fulfill practice responsibilities.

OBJ E7.4.1 (Application)  Use time management skills effectively to fulfill practice responsibilities.

Coaching

As above.

 
Rotation Assignment Summary:

  1. The resident must prepare adequately for patient visits by reviewing pertinent primary care pharmacotherapy and disease states.
  2. The resident will report all adverse drug events according to the University of Utah Hospital protocols.
  3. The resident will present 2 primary care journal club presentations, with handout, during the course of the rotation.
  4. The resident will function within the scope of the collaborative drug therapy management protocols approved by the Pharmacy and Therapeutics Committee for hypertension, dyslipidemia, smoking cessation, asthma, anticoagulation, refills, immunizations, and diabetes.
  5. The resident will provide medication counseling and instructions as requested, and will document all patient interactions with a progress note entered into EPIC.
  6. The resident may be required to present an in-service to nursing staff or medical residents at either Sugarhouse Clinic or the Sarah Daft Home Assisted Living Center (20-30 minutes, powerpoint optional, brief handout required)
  7. The resident may (if a student is also on rotation) be asked to directly precept, develop a syllabus for a week’s period of time, and provide direct assessment to the student regarding their performance.
  8. Drug information projects may be assigned as they come up.
  9. The resident will review their schedule and progress on activities and projects with the preceptor at least weekly to demonstrate adequate progress.

 
Readings and Preparatory Work:

Residents are expected to become familiar with the University CDTM protocols for hypertension, dyslipidemia, anticoagulation, refills, immunizations, and diabetes. While not required, immunization certificate is desired, particularly for residents seeking rotation opportunities in the late fall and early winter.

 
Typical Daily/Weekly/Monthly Activities:

The resident is expected to be punctual and to prioritize daily activities.  A typical day will be from 800 am – 530 pm, but additional time may be required  to complete daily responsibilities and ensure best outcomes for the patient.  Residents are expected to answer questions and follow up with providers regarding  patients seen at  Sugarhouse/Sarah Daft Home even when they are not physically on site.

 
Evaluations:

The resident will receive formative evaluations of written notes, any completed presentations and patient care plans and recommendations. A midpoint summative evaluation will be documented in ResiTrak, and a full summative evaluation will be recorded in ResiTrak at the conclusion of the rotation.