Acute Patient Care (Leukemia/Lymphoma) for PGY-1 residents @ EUH Learning Activities: Preceptors: Don Hutcherson, RPh; Katherine Sanvidge Shah, PharmD; Minal Surati, PharmD; Nikki Wilson, PharmD Office: EUH Room F624 Hours: ~ 7:30-6:00 Desk: 2-4092, 2-4019, 2-7425, 8-2548 Pager: Per Simon Web

General Description Leukemia/Lymphoma Service is a four week learning experience at Emory University Hospital. Patients are predominantly admitted to 6E, 7E, or 8E. Each team consists of an attending Hematologist, attending Internal Medicine physician (Dr. Allen Tindol), hem/onc fellow, 1 or 2 mid-level practitioners, oncology pharmacist, social worker, discharge coordinator, nurse, and medical student depending on the time of year. The rotation functions to teach residents the pathophysiology and pharmacology of various hematologic, oncologic, medical, and infectious disease states.

The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients admitted to the leukemia/lymphoma service. In addition, the resident will provide and document therapeutic drug monitoring services ( vancomycin or aminoglycosides) and education such as chemotherapy counseling to patients on service.

Good communication and interpersonal skills are vital to success in this experience. The resident must devise efficient strategies for accomplishing the required activities in a limited time frame. In addition to patient care, the resident must provide education to the team, pharmacists , and patients as the need arises.

Disease States Common disease states in which the resident will be expected to gain proficiency through literature review, topic discussion, and/or direct patient care experience include, but are not limited to: • Neutropenic Fever • Nausea and vomiting • Pain Management • Oncologic Emergencies • Leukemias – AML and ALL • Lymphomas – Hodgkin’s and Non-Hodgkin’s • Myelodysplastic and Myeloproliferative disorders • Multiple Myeloma

Goals Selected Goals selected to be taught and evaluated during this learning experience include:

June 2009 Goal R2.1 As appropriate, establish collaborative professional relationships with members of the healthcare team Goal R2.2: Place practice priority on the delivery of patient-centered care to patients. Goal R2.3: As appropriate, establish collaborative professional pharmacist-patient relationships Goal R2.4: Collect and analyze patient information. Goal R2.6: Design evidence-based therapeutic regimens. Goal R2.7: Design evidence-based monitoring plans. Goal R2.8: Recommend or communicate regimens and monitoring plans. Goal R2.9: Implement regimens and monitoring plans. Goal R2.10: Evaluate patients’ progress and redesign regimens and monitoring plans. Goal R2.12: Document direct patient care activities appropriately. Goal R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public

Activities Activity Goal Assess patients prior to 10 am (morning) rounds which include, but not limited to the R2.2 following: R2.4 1. Summarize pertinent patient history/physical exam R2.6 2. Accurately gather, organize, and analyze patient specific information R2.7 3. Identify drug related issues R 2.8 4. Determine possible solutions for each drug related problem by independently analyzing R2.10 each patients’ drug therapy and seeking out references to assist in their knowledge of the applied therapeutic situation 5. Select appropriate endpoints and monitoring parameters for each drug related problem The following, but not limited to, should be completed prior to check-out (evening rounds) 6. Utilize treatment guidelines and hospital formulary to aid in treatment decisions

The following, but not limited to, should be completed prior to check-out (evening rounds) 1. Complete all tasks such as drug information questions, patient chemotherapy counseling, preparing chemotherapy orders, and other questions from team members, in a timely manner and prior to check-out rounds Meet with preceptor to discuss issues to present during morning rounds R2.2 R2.4 R2.6 R2.7 R2.8 R2.10 Actively participate in leukemia/lymphoma team rounds in a professional manner R 2.1 R 2.2 R2.4 R2.6 R2.7 R2.8 June 2009 R2.9 R2.10 Provide pharmacokinetic monitoring services for patients receiving drugs requiring R2.1 monitoring including, but not limited to, aminoglycosides and vancomycin for patients on R2.6 service R2.7 R2.8 Compose accurate, concise pharmacokinetic notes on day of service R2.12

1. Lead at least 3 topic discussions R5.1

2. Resident presentations (optional but encouraged) • The resident will present a 15-30 minute power point presentation with supporting literature on a particular disease state, drug review or drug related problem as selected by the preceptor.

3. Research/drug evaluation participation • Aid in the research efforts of the Oncology/Hematology clinical pharmacist group • Project requirements will be assigned at beginning of rotation.

4. Participate in ongoing quality improvement activities (development of guidelines, preprinted order sets, protocol review, etc.)

Provide and document each chemotherapy patient education: R2.2 • Pertinent side effects R2.8 • Information regarding prophylaxis/treatment of possible side effects R2.9 • (Know your audience) discuss with patient any previous experience and side effects R5.1 of chemotherapy • Accurately answer patient’s questions (be able to acknowledge when you do not know the answer to a question) Ensure patients on the team have their medications reconciled. R2.2 Specific role: obtain or verify medication histories for patients on the team and review the patients’ discharge medication regimen. Discuss goals of therapy (i.e. pain management, nausea/vomiting management) with the R2.2 patient R2.7 R2.8 R2.9 R2.10 Initiate monitoring plans or medication therapy changes as per protocol or verbal orders R2.9

Attend Oncology Grand Rounds at 7:30 am Wednesday mornings R2.1 Attend leukemia/lymphoma conference at 11:30 am on Thursday afternoons Attend fellow’s lectures on Monday and Thursday mornings Attend other lectures as provided Document ADRs and interventions in Pharmacy One Source R2.12 (must document at least 2 drug information responses and at least 2 ADRs during rotation) June 2009 Document medication variances in STARS Event Reporting System R2.12 Serve as co-preceptor for pharmacy students when applicable R2.1 R5.1 Balance patient care and other residency responsibilities R2.2 Discuss time management strategy with preceptor R2.2

Preceptor Interaction Daily: -Preceptor available from 0800 to 1000 for pre-rounds with resident -Morning rounds start at 10 am -Evening rounds will start at ~3 pm -Preceptor available for patient presentations, reviewing progress notes, and/or topic discussions throughout the day

Evaluation Strategy

What Who When Formative Self-Evaluation Resident week 2 Formative Preceptor week 2 Summative Self- Resident End of learning experience – deadline to be signed Evaluation and submitted by 1300 the day following rotation completion. Summative Evaluation Preceptor End of learning experience – deadline 7 days post final day of rotation to meet with resident to discuss. Preceptor & Learning Resident End of learning experience – deadline 7 days post Experience Evaluation final day of rotation.

June 2009