Jewish Hospital Rotation Descriptions

Rotation/Location:   

Adult Hematopoietic Stem Cell Transplant – Jewish Hospital
Preceptor(s): 

Michael Bradley, PharmD...........................................................................pager:
.....................................................................................................................................513-686-3143

Outcomes/Goals:       

For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.

R1.4, R2.1, R2.2, R2.4, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R3.1

Overview:      

The adult hematopoietic stem cell transplant rotation at Jewish Hospital is a one-month rotation.  Patients are admitted to the hematology/oncology service through the Emergency Department, by transfer from another service/hospital, or via direct admit from a clinic or for schedule chemotherapy.  Patients covered by this service include a variety of leukemias, lymphomas, multiple myelomas, and hematological disorders.  The team is comprised of the attending, nurse clinicians, pharmacists, dietary, social worker, and the floor nurses.  Rounds generally start at 9 AM.  Pharmacy residents are expected to be fully prepared by rounds.

Prerequisite:  The resident must have completed 1 month of inpatient      hematology/oncology rotation with Michelle Rockey/ Jane Pruemer prior to the adult hematopoietic stem cell transplant rotation.

Activities/Assignments:        

• Participate in the care of patients as a member of a multidisciplinary team by evaluating and monitoring patients on the hematology/oncology service.  This will be accomplished through patient interviewing, medical record review, profile review, lab value assessment, and discussion with members of the team during and outside of daily rounds.
• Respond to and document requests for drug information from healthcare professionals.
• Prepare topic presentations for the “service” team upon request.
• Review patients with preceptor.
• Prepare a variety of discussion topics to the pharmacy team.   The resident will be required to complete the necessary readings for a topic and present the information and demonstrate an understanding of the topic.
• Write complete chemotherapy orders and admissions orders
• Complete other activities or projects per physician request.

Topic Discussions:

• Overview of BMT (autologous/allogeneic/transplant lite)
• Chemotherapy Drugs
• “Protocols”
• GVHD
• VOD
• Infections: bacterial/fungal/viral

Meetings to attend:

• BMT multidisciplinary team meetings (Wednesday 8:30am)
• Protocol meetings  (Thursday 8:30 am)

Evaluation:

The resident’s performance will be evaluated using the ASHP Residency Learning System.   Also taken into consideration will be preparedness for rounds and topic discussions, professionalism, motivation, and desire to learn.  Throughout the rotation, the resident is strongly encouraged to perform self-evaluations and provide feedback to the preceptor regarding any individual needs for ensuring the rotation objectives are met.  The resident should complete a preceptor/rotation evaluation at the end of the month.  The preceptor will complete a final evaluation and provide feedback to the resident throughout the month.

Internal Medicine

Rotation/Location:   

Internal Medicine – Jewish Hospital

Preceptor(s): 

Deanna Urasek, PharmD, BCPS......................................................... pager: 513-691-6722           
..................................................................................................................................513- 686-5055
Tricia Morris, PharmD..............................................................................pager: 513-691-0548
..................................................................................................................................513-686-5082
 Kimberly Pharris, PharmD.................................................................................513-686-5050
                       
Outcomes/Goals:       

For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.
                                   
R1.5, R2.1, R2.2, R2.4, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R2.12, R3.1, R5.1, R6.1 
                       
Overview:      

The Internal Medicine clinical pharmacists each day evaluate patients selected from the target drug list.  Evaluation includes, but is not limited to, medication profile review, renal dosing, kinetic dosing, IV to PO conversions, appropriateness of antibiotics/length of treatment, drug interactions and clarification of home medications.  IM pharmacists also follow selected patients on the Medicine Service census and all patients on the Pulmonary Care Unit (PCU) census.

Activities/Assignments:        

The pharmacy resident will be present Monday-Friday.  The start time is 0700 unless an earlier time is needed for rounds preparation.  Morning report (with the medicine service team) is each morning at 0730 for case presentations of new overnight admissions.  Medicine Service patient care rounds are daily at a time determined by that month’s attending physician.  Pulmonary care unit rounds are held on Mondays only at 1300.  Internal Medicine noon conference is held daily at 1200, and the pharmacy resident is encouraged to attend when there are topics of interest.  The resident will review patient profiles each morning, review and evaluate patient charts throughout the day and then meet with the preceptor to present patients and do any necessary follow-up each afternoon.  A topic discussion between the preceptor and pharmacy resident is held after patient care activities for the day are completed.

The pharmacy resident will also be assigned to:

• participation in topic discussions
• present one journal club to the clinical pharmacy staff
• present one 10-15 minute PCU discussion to PCU staff or one 10-15 minutes education topic to pharmacy staff
• present one formal case presentation with disease state to clinical pharmacy staff
• present one noon conference lecture to medical residents
• participate in any applicable research projects, MUEs, residency project, etc
• other assignments as dictated by workload, physician, and preceptor requests

Miscellaneous:          

The medicine service team is composed of: a teaching attending physician (conducts morning report), medicine service attending physician (conducts patient care rounds), two senior medical residents, multiple PGY1 medical residents, medical students, a clinical pharmacist, and pharmacy resident and/or student.

The PCU team is composed of: a pulmonologist (director of PCU), clinical nurse managers, PCU staff nurses, a social worker, physical/occupational therapists, a speech therapist, a dietician, a clinical pharmacist, and a pharmacy resident and/or student.

Evaluation:

Critical Care

Rotation/Location:

Critical Care – Jewish Hospital

Preceptor(s):

Wallace K. Sergent, Jr., PharmD.....................................................................pager: 513-396-4354
 ...........................................................................................................................................513-686-5054

Outcomes/Goals:

For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.

R2.1, R2.2, R2.3, R2.4, R2.5, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R2.12, R5.1, R.6.1

Overview:      

The critical care rotation is designed to develop the resident’s knowledge of and problem-solving skills in the drug therapy of critically ill patients.  This knowledge and skill-set is developed by participating in a multidisciplinary critical care team utilizing and refining appropriate and effective oral and written communications in order to ensure complete and accurate information is provided to team members and patients concerning drug therapy and patient response.

Upon completion of the rotation, the resident will be able to: 1) understand the pathophysiology and etiologies of cardiac arrhythmias, shock, acute exacerbations of congestive heart failure, acute exacerbations of COPD, pneumonia, diabetic ketoacidosis, adult respiratory distress syndrome, gastrointestinal bleeding, stress ulceration, and deep venous thrombosis, 2) discuss the etiologies and pathophysiologies of various electrolyte disorders, acid-base imbalance, and fluid therapies, 3) discuss the pharmacology, dosing, and monitoring of vasoactive agents, 4) discuss the pharmacology, dosing, and monitoring of agents for stress ulcer, pain, sedation, and DVT prophylaxis, adrenal insufficiency, and glycemic control, 5) discuss the pharmacology, dosing, and monitoring of antibiotics with particular respect to renal failure and dialysis and 6) discuss the pharmacology, dosing, and monitoring of drotecogin alpha.

Activities/Assignments:

The following activities are required of the resident:

1. participation in intensive care staff rounds which shall include check-in rounds with medical ICU residents at 7:30, Medical ICU rounds with attending physician and multidisciplinary rounds at 8:00 on Wednesdays,
2. monitoring patient therapy which shall include monitoring laboratory values, chart reviews, interviewing other health care professionals and physical assessment,
3. daily case discussions with preceptor,                 
4. pharmacokinetic consultations and
5. provision of drug information to other health care providers.

Specific assignments will include:

1. monitoring patient therapy using standard forms,
2. daily case presentations,
3. writing pharmacy notes in patient charts,
4. tracking pharmacy interventions with HealthProLink,
5. one presentation of an ICU drug therapy topic to medical ICU residents and attending physician,
6. discussion of selected readings from current literature,
7. one journal article presentation to clinical pharmacy staff and
8. one formal case presentation to clinical pharmacy staff.

Evaluation:

PGY1 pharmacy residents will be evaluated according to the Residency Learning System evaluation for Critical Care based on the Educational Outcomes and Goals listed above.  Also taken into consideration will be preparedness for topic discussions, motivation and initiative in learning, timeliness in meeting deadlines, communication skills and professionalism.

Critical Care Resident and Student Curriculum April 2006                

Core Topics (2-3 per week as open discussion; no specific order)

Journal Club (1-2 articles per month as resident/student presentation)

Critical Care Team In-service (1-2 per month as resident/student presentation)

Orientation

Rotation/Location:   

Orientation – Jewish Hospital

Preceptor(s):  Shawn Osborne, MBA., RPh........................................... pager: 513-230-0224
......................................................................................................................................513-686-5061

Outcomes/Goals:       

For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.

R1.1, R1.3, R1.4, R1.5, R2.2, R2.8, R3.1, R5.1, R6.1

Overview:

The first month of the residency will be directed toward orientation of the resident to the policies and procedures of the Health Alliance Pharmacy Services.  This is achieved by hands-on training at the resident’s primary practice site, as well as daily topic discussions.

Activities/Assignments:        

The pharmacy resident will be present Monday-Friday to train at their respective sites.  The time of each shift will vary in order to allow the resident to understand the workflow and perform the tasks associated with each shift.  The resident will spend time in various areas of central pharmacy, performing tasks such as: IV admixture, TPN preparation, and prescription order entry.  Residents may also work in decentralized areas as available by the individual practice site. 

Topic discussions with all Health Alliance pharmacy residents will be held on a daily basis to orient the resident to the policies of the department and teach various other skills that will be required throughout the residency year.  The pharmacy resident will be required to attend the Health Alliance orientation (one day), as well as the primary hospital orientation (one day). The residents will also be required to read several educational modules and complete the post-test for each module.

Miscellaneous:          

A final topic discussion will take place on the last day of the orientation to turn in the module tests, and evaluate the orientation process. 

Evaluation:

PGY1 pharmacy residents will be evaluated according to the Residency Learning System evaluation for Orientation based on the Educational Outcomes and Goals listed above.  Also taken into consideration will be motivation and initiative in learning, timeliness in meeting deadlines, communication skills, and professionalism.

Emergency Medicine

Rotation/Location:

Emergency Medicine – Jewish Hospital

Preceptor(s):

Jane Lee, PharmD........................................................................................pager: 513-844-9554                       
.......................................................................................................................................513-686-5054
 ...............................................................................................................................fax: 513-686-3183
                                                                       
Outcomes/Goals:

For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.

R1.3, R1.4, R1.5, R2.1, R2.2, R2.3, R2.4, R2.5, R2.6, R2.7, R2.8, R2.9, R2.10, R2.11, R2.12, R5.1 

Overview:

The Emergency Medicine Rotation is designed to develop the resident’s knowledge of and problem-solving skills in the drug therapy of a wide range of patients in the Emergency Department setting.

Activities/Assignments:

During this rotation, the resident will have the opportunity to:

1. Participate in the multidisciplinary care of patients in the Emergency Department
2. Develop an understanding of the management and care of a patient in the Emergency Department through readings and practical experience
3. Develop and refine the clinical skills that will allow the resident to rapidly and accurately assess an Emergency Medicine patient’s health status and formulate a therapeutic plan
4. Communicate effectively through oral and written communication to assure complete and accurate information to healthcare team members and patients concerning drug therapy and patient response.

In addition to Goals and Objectives listed in the attached Residency Learning System Summative Evaluation, upon completion of this rotation, the resident will be able to:

1. Discuss and understand the pathophysiology and etiologies of those disease states listed in the Resident and Student Curriculum general topic list (See attached Resident and Student Curriculum document).
2. Discuss the etiologies and pathophysiologies of disease states that are encountered most often in the Emergency Department.
3. Discuss and understand the etiologies of drug poisonings and toxicities presented to the Emergency Department setting.
4. The resident is expected to present 1 to 2 advanced topics per week (see attached Resident and Student Curriculum document).
5. The resident is expected to present at least one to two journal clubs per month.
6. The resident is expected to participate in 1 to 2 multidisciplinary in-services per month.

The following activities are required of the resident:

1. Be present in the Emergency Department Monday through Friday 10am – 6pm to participate in patient care.
2. Monitor patient therapy which shall include monitoring laboratory values, chart reviews, interviewing patients and health care professionals, and physical assessment
3. Participate in daily topic discussions and case presentations.
4. Pharmacokinetic consultations.
5. Provide proper communication for continuation of therapeutic drug monitoring to clinical staff when applicable.
6. Provision of drug information to other health care providers

Specific assignments will include:

1. Daily patient presentations
2. Writing pharmacy notes in patient charts
3. Tracking pharmacy interventions with HealthProLink
4. One to two presentations(inservices) to pharmacy, nursing, and/or medical staff.
5. Discussion of selected readings from current literature
6. One journal article presentation to Clinical Pharmacy Staff        

Evaluation:

Residents will be evaluated according to the Resident Learning System evaluation for Emergency Medicine.  In addition, there will be four weekly “Snapshot” evaluations.

Pharmacy Practice Management

Rotation/Location:

Pharmacy Practice Management – Jewish Hospital

Preceptor:

Shawn M. Osborne, MBA, RPh................................................................513-686-5061
 ....................................................................................................... pager:  513-230-0224          

Outcomes/Goals:

For a complete description of the educational outcomes and goals associated with this rotation, refer to the document at the beginning of this section.

R1.1, 1.2, R3.1, R3.2, R3.3, R4.1, R5.1
                       
Overview:

The Pharmacy Practice Management rotation will provide the resident with introductory experience in management supplemented by projects, discussions and participation in committees / work groups.  The resident is expected to be on rotation at a minimum Monday – Friday 0800 – 1700.  Residents may need to be present on rotation outside normal hours for certain meetings or project assignments

Activities/Assignments:

Regulatory – The resident will participate in the Medication Use Committee.  During this process, the resident will conduct audits for compliance with JCAHO, National Patient Safety Goals and Institute for Healthcare Improvement Initiatives.  The resident will read and understand the Medication Management Chapter for JCAHO.  Discussions will include applicable issues regarding State Board of Pharmacy and DEA regulations. 

Policy & Procedure – The resident will review and revise at least one policy / procedure while on rotation.  The resident will review the policy for current applicable standards of practice and regulatory compliance.  The resident will learn the process for revising policy and subsequent approval.  Experience in developing and presenting staff education may be included in this activity.

Human Resources – The resident will participate in recruitment initiatives with the management team.  Activities may include interviews, tours, student and residency showcases, and screening of applications.  The resident will become familiar with staff coaching, training, the progressive discipline process and hiring process.

Budget – The resident will learn through discussion and observation about the budgetary and financial processes of the department.  Topics to be discussed include operating budget, capital budget, revenue, personnel expenses and program modifications.  The resident will review monthly budget reports and assist in analysis of budget variances.

Operations Management – The resident will participate in all management meetings.  Time will be spent with other managers in the department to gain different perspectives on operations management from various levels within the department.  Activities will include narcotics handling (receiving, ordering, distribution, reconciliation, documentation and destruction), coordination of daily workflow, coordination of daily staffing, process change / implementation and in-services.  The resident will receive an overview of department automation and technology to include maintenance, troubleshooting, interface with vendors, workflow changes and productivity measurement.

Projects will vary depending upon time of year and current issues / initiative within the department or hospital.  Most projects will be discussed at the beginning of rotation and should be accomplished within the confines of the rotation.  The resident will be responsible for miscellaneous readings on pharmacy management issues.  One article must be selected for presentation at a management meeting similar to journal club.

Evaluation:

PGY1 pharmacy residents will be evaluated according to the Residency Learning System evaluation based on the Educational Outcomes and Goals listed above.  Also taken into consideration will be motivation and initiative in learning, timeliness in meeting deadlines, communication skills, and professionalism.