Internal Medicine/Hospital Medicine @ EUHM Learning Activities:

Preceptor: Amy Jackson, PharmD

Office: EUHM Peachtree Building Room 2182

Hours: ~ 7:45-4:45

Desk: 404-686-8932

Pager: 12504

Emory cell phone: 404-831-6164

Personal cell phone: 404-840-1571

General Description

Internal Medicine (IM) is a four week learning experience at Emory University Hospital Midtown. There are two teaching IM hospitalist teams, Team Davis and Team Fischer. Team Davis predominantly admits to Unit 61. Each team consists of an attending Hospitalist, two PGY 1 medical residents, and usually two medical students depending upon the time of year.

The pharmacy resident is responsible for identifying and resolving medication therapy issues for patients admitted to Team Davis. In addition, the resident will provide and document therapeutic drug monitoring services for patients receiving vancomycin or aminoglycosides on unit 61 as well as any team patients located on alternate floors. Documentation must be completed within the electronic medical record on the day service was provided. The resident is responsible for providing and documenting education to patients on their team that are to be discharged on anticoagulation. Patient education is not limited to anticoagulation patients, but other team patients as deemed necessary. Education and documentation must be completed no later that the day of discharge. The resident is responsible for verifying the medication hsitory is documented correctly in the computer for each patient.

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 or pharmacists as the need arises. Educational presentations are required to be presented to the team during the learning experience.

6-10 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:

• Cardiovascular disorders: Hypertension, Heart Failure, Stroke

• Respiratory Disorders: COPD, Asthma

• Endocrine disorders: Diabetes Mellitus

• Infections: Urinary Tract Infections, Community Acquired Pneumonia, Skin and Soft Tissue Infections, Opportunistic Infections in the setting of AIDS

• Sickle Cell Disease (pain management)

Goals Selected

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

Goal R1.4: Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system. Goal R1.5: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients, health care providers, and the public. 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 R3.1: Exhibit essential personal skills of a practice leader. Goal R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

6-10 Activities

Activity Goal

Accurately gather, organize, and analyze patient specific information on team’s patients R 1.4 prior to pre-rounds with preceptor R2.2

R2.4

R2.6

R2.10

Meet with preceptor for pre-rounds R2.2

R2.4

R2.7

R2.10

Actively participate in IM team rounds R 1.4

R 1.5

R2.4

R2.6

R2.8

R2.9

R2.10

R3.1

Compose accurate, concise progress notes documenting direct patient care activities R2.12

(medication history, ADR, drug-drug interaction insulin IV to SC conversion, anticoagulation, R2.7 kinetics, monitoring of therapy) within time frame to be useful R2.8

R2.12

Provide 3 “mini-in-service” regarding drug information on rounds – topics requested by team R1.5

(or preceptor). At least one should be case based format. R5.1

Provide a “full” in-service reviewing primary literature review – topic requested by team R1.5 Five to ten minutes in length. Topic should be decided by the middle of the second week and approved by R5.1 preceptor. The handout should be 1 page front and back, prepared in Microsoft Word, and include references. A rough draft of the handout should be presented to preceptor 3 business days prior to presentation

.

6-10 Provide and document Teach Back education to patients/caregivers discharged from the R2.2

hospital. Patient selection for education: R2.3

• problem medications (anticoagulants, insulin or oral diabetic agents, narcotics) R2.8

R2.9 • diagnosis of diabetes, COPD, asthma, heart failure R5.1 • greater than 4 routine medications with at least one change to the regimen

• poor health literacy

• noncompliance

• prior non-elective hospitalization in last 6 months

Ensure patients on the team have their medications reconciled. R 1.4

R2.2 Specific role: obtain or verify medication histories for patients on the team and review the patients’ discharge medication regimen. R2.3

Discuss vaccination status and other goals of therapy (i.e. pain management, BP R2.2

management) with the patient R2.3

R2.8

Complete a minimum of 5 topic discussions as related to patients encountered on the R5.1 rotation. Resident should lead some of the discussions. If students or other residents are on the rotation concurrently then an outline must be prepared for the discussion

Provide pharmacokinetic monitoring services for patients receiving drugs requiring R2.4

monitoring including, but not limited to, aminoglycosides and vancomycin on one assigned R2.6 unit. R2.7

R2.8

R2.10

Initiate monitoring plans or medication therapy changes as per protocol or verbal orders R 1.4

R2.9

Weekend and day off sign-out for PK +/- team patients R2.11

Document ADRs and interventions in Pharmacy One Source R 1.5

R2.12

Document medication variances in STARS Event Reporting System R2.12

6-10 Present patients to preceptor in the afternoons – employing evidence based medicine R 1.4 knowledge gained via independent reading and learning R1.5

R2.4

R2.6

R2.7

R2.10

Provide educational in-services to nurses or pharmacists as requested by preceptor R3.1

R5.1

Serve as co-preceptor for pharmacy students when applicable R3.1

R5.1

Balance patient care and other residency responsibilities R2.2

R3.1

Discuss time management strategy with preceptor R2.2

Preceptor Interaction

Daily: -Preceptor available from 0900 to 1000 (time may vary based on team rounding schedule) for pre- rounds with resident -Team rounds can vary in time of day depending upon the attending on service -Preceptor available for patient presentations, reviewing progress notes, and/or topic discussions in the afternoons 1400 to 1600

Expected progression of resident responsibility on this learning experience:

Day 1 @ 0800: Preceptor to review IM learning activities and expectations with resident. Week 1: Resident to work up team patients and present to preceptor prior to team rounds. Preceptor may attend and participate in team rounds (modeling pharmacist’s role on the health care team) or may skip to coaching stage depending upon resident’s capabilities/prior experiences. Week 2: Resident to work up team patients and present select patients to preceptor prior to team rounds. Preceptor may attend and participate in team rounds (coaching the resident to take on more responsibilities as the pharmacist on the health care team) or may skip to facilitation stage depending upon resident’s capabilities/prior experiences. .

6-10 Week 3-4: Resident to work up team patients and present select patients to preceptor prior to team rounds. Preceptor may attend and observe the resident’s participation on, and/or may expect a summary report from the resident regarding rounding activities and use of recommendations made by the resident. Preceptor will always be available for questions and will follow patients independently to monitor resident skill development in all aspects of the learning experience (facilitating the resident as the pharmacist on the health care team).

Note: the length of time the preceptor spends in each of the phases of learning will depend BOTH on the resident’s progression in the current rotation and when the rotation occurs in the residency program

Evaluation Strategy

ResiTrak will be used for documentation of formal evaluations. For formative evaluations, residents will perform the activity appropriate to the snapshot with the preceptor. Resident and preceptor will then independently complete the snapshot. After both have signed the evaluation, the resident and preceptor will compare and discuss the evaluations. This discussion will provide feedback both on their performance of the activity and the accuracy of the self-assessment. Formative evaluation will also occur as verbal or written feedback on a daily basis.

What Snapshot Who When

Formative Self-Evaluation R2.12.2 Resident week 2

Formative R2.12.2 Preceptor week 2

Midpoint Summative Resident End of week 2 Self-Evaluation

Midpoint Summative Preceptor End of week 2 Evaluation

Formative Self-Evaluation R2.9.2 Resident week 3

Formative R2.9.2 Preceptor week 3

Summative Self- Resident End of learning experience – deadline to be signed and Evaluation 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 final Experience Evaluation day of rotation.

6-10

6-10