General Surgery Rotation
Daniel Lee, PharmD
David Canann, PharmD
Ryan Nielsen, PharmD
Residents will rotate through three different units during this rotation: The Ortho & Trauma Surgical Specialty Unit (OTSSU), The Surgical Specialty & Transplant Unit (SSTU), and The Intermediate Care Unit (IMCU).
The Ortho & Trauma Surgical Specialty Unit (OTSSU) is located on the 6th floor of the University of Utah Hospital and is a busy, 41 bed step-down unit. The majority of patients on OTSSU are admitted after the OR for post-surgical care. Other patients are admitted from the emergency department, onsite outpatient clinics, or direct admit from other health care facilities (hospitals, skilled nursing facilities). Some patients are transferred from the intensive care units or other floor units. A variety of medical and surgical teams follow OTSSU patients. The majority of patients are under the care of the orthopedic surgery, trauma surgery, and internal medicine teams.
The Surgical Specialty & Transplant Unit (SSTU) is located on the 5th floor of the University of Utah Hospital and is a 26 bed step-down unit. The patient population on SSTU is similar but slightly more acute than OTSSU. The majority of patients are under the care of the general surgery, vascular surgery, trauma surgery, transplant surgery, and internal medicine teams. Other teams/services involved with patient care on OTSSU and SSTU include infectious disease, urology, otolaryngology, gynecology, dermatology, ophthalmology, nephrology, gastroenterology, and plastic surgery.
The Intermediate Care Unit (IMCU) is located on the 2nd floor of the hospital, next to the Surgical Intensive Care Unit (SICU). IMCU is mainly a step-down unit for the SICU, but also receives patients post-operatively or transfers from other floors when patient become more critical.
Pharmacists on OTSSU and SSTU function as part of a team comprised of the attending surgeon or internist, surgical and medical fellows and residents, the nursing staff, nutritionists, social workers, respiratory therapists, and physical therapists. Pharmacists are available to other hospital staff and patients to answer questions, identify and resolve medication-related problems, and facilitate medication delivery. The IMCU Pharmacist in addition the above duties also rounds daily. Primary responsibilities include conducting patient interviews to obtain accurate medication and allergy histories, analyzing patient data daily, reviewing inpatient medication profiles, watching for adverse drug reactions, conducting drug-therapy monitoring, making drug-therapy recommendations, and documenting appropriate data.
The resident will spend 1.5 weeks rotating on OTSSU, 1.5 weeks on SSTU, and 1 week on IMCU. On OTSSU and SSTU, mornings are usually spent conducting medication reconciliations, working-up patients, attending discharge rounds, making pharmacy interventions, and answering medication questions. Topic discussions will be held in the afternoon, in addition to new patient work-ups. During time spent on IMCU, the resident will work-up patients, round daily with the team, make pharmacy interventions, and conduct medication reconciliations.
- Demonstrate ownership of and responsibility for the welfare of the patient using all necessary aspects of the medication-use system (Goal R1.4).
- Establish collaborative professional relationships with members of the health care team (Goal R2.1).
- Recommend or communicate evidence-based therapeutic regimens and monitoring plans (Goal R2.8).
- Implement regimens and monitoring plans (Goal R2.9).
- Establish collaborative professional relationships with each patient (Goal R2.3).
|Rotation Activity||RLS Goal||Teaching Method|
|Conduct patient work-ups, collect relevant clinical information
• Up to 34 patients while on OTSSU/SSTU
• Up to 12 patient while on IMCU
|Formulate patient-specific therapeutic regimens, identify and resolve medication problems, implement pharmacy interventions (Some examples of possible interventions include: IV to PO therapeutic interchange, restart home medications, order vaccinations, antibiotic adjustments, renal dose adjustments, identify drug interactions, TPN recommendations, electrolyte replacement recommendations, stop unnecessary/duplicate medication, protocol/guideline implementation)||R1.4, R2.1 R2.8, R2.9||Coaching
|Present patients to preceptor – will spend on average 1 hour each day presenting patients to preceptor||R1.4, R2.8||Coaching
|Effectively interview patients to obtain an accurate medication reconciliation
• 2-10 medication reconciliations per day
• Examples of patient education/counseling resident may encounter during this rotation: anticoagulation education, new medications, formulary alternatives
|Participate in Rounds
• Daily while on IMCU (1 week of the rotation)
|R1.4, R2.1, R2.8||Modeling
• Resident will present 6 topic discussions throughout the rotation to preceptor (resident’s choice on topic)
• Resident will present one journal club during the second week of the rotation on a topic relevant to this rotation (resident’s choice on article)
• Resident will present one nursing in-service during the last week of the rotation
|Respond to drug information questions
• Resident will be expected to respond to drug information questions from nurses, providers, and/or patients on a daily basis
|R1.4, R2.1, R2.3, R2.8||Coaching
Readings and Preparatory Work:
- Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):S381-S453. PMID: 18574271
- The perioperative management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):S299-S339. PMID: 18574271
- Discontinuation and Reinstitution of Medications During the Perioperative Period. Am J Health Syst Pharm 2004;61(9):899-912. PMID: 15156966
- Stopping and Restarting Medications in the Perioperative Period. Med Clin North Am 2001; 85(5):1117-1128. PMID: 11565489
- Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project. Am J Surg 2005;189(4):395-404. PMID: 15820449
- Adherence to Guidelines for Antibiotic Prophylaxis in General Surgery: A Critical Appraisal. Journal of Antimicrobial Chemotherapy 2008;61(1):214-218. PMID: 17999981
- Role of NMDA Receptor Antagonists in Postoperative Pain Management. Curr Opin Anaesthesiol 2009;22(5):618-622. PMID: 19535974
- Emerging Trends and New Approaches to Acute Pain Management. Pain Manag Nurs 2008;9(Suppl 1):S33-S41. PMID: 18226793
- Pharmacotherapy for Acute Pain: Implications for Practice. Pain Manag Nurs 2008;9(Suppl 1):S22-S32. PMID: 18294591
- Prevention and Treatment of Postoperative Nausea and Vomiting. Drugs 2000; 59(2):213-243. PMID: 10730546
- New Pharmacologic Findings for the Treatment of PONV and PDNV. Am J Health-Syst Pharm 2009;66 (Suppl 1):S11-18. PMID: 19106333
- A Comprehensive Review of Evidence-Based Strategies to Prevent and Treat Postoperative Ileus. Dig Surg 2009;26:265-275. PMID: 19590205
- Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388-416. PMID: 15699079
- Stress Ulcer Px in the Postoperative Period. Am J Health Syst Pharm 2004;61:588-596. PMID: 15061430
- Chapters to read in Pharmacotherapy (DiPiro): Assessment of Nutrition Status and Nutrition Requirements, Parenteral Nutrition, Renal impairment, Quantification of Renal Function, Drug Therapy Individualization for patients with renal Insufficiency, Skin and Soft tissue Infections, Bone and Joint Infections, Diarrhea and Constipation, Kidney and Hepatic Transplant
- Residents are required to present a formal journal club presentation to their preceptors.
- Residents are required to lead two topic discussions while on rotation.
- Residents will coordinate with the OTSSU, SSTU, or IMCU floor nurse educator to prepare and present a minimum of one nursing inservice during the time of their rotation.
Typical Daily/Weekly/Monthly Activities:
- Attend discharge rounds while rotation on OTSSU
- Attend rounds while rotation on IMCU
- Gather patient data
- Review pressing issues with preceptor and make interventions
- Present patients/plans to preceptor
- Answer team questions
- Work on project
- Work on team presentation
The resident will receive verbal feedback daily from the unit pharmacist/preceptor on patient care, project and presentation quality and effectiveness. The resident will have a midpoint and final evaluation in ResiTrak.