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Mayo Clinic
Hospital Pharmacy Services
Rotation Summary
Rotation Title: Medical Cardiology PGY2 (Pharmacotherapy)
Rotation Length: 4 weeks
Primary Preceptors Names:
Narith Ou, PharmD, BCPS
Phone: ext 5-9458 (N. Ou); 5-5477 (CCU RPh)
Pager: 127-09868 (N. Ou); 127-89723 (CCU RPh)
General Description:
Mayo's Cardiovascular Division is the largest Division in the Department of Medicine. Comprised of
110 consultants who are committed to provide the best possible care to patients with various forms of
cardiac and/or vascular disorders. The Cardiovascular Division cares for approximately 46,000 patients
annually. The field of cardiovascular medicine is truly dynamic and advances in diagnostic techniques,
imaging modalities, therapeutics, and interventions are continuously being introduced. For this reason,
most of our consultant staff are sub-subspecialists in different disciplines of cardiovascular diseases.
The practice is supported by many laboratories, sub-subspecialty clinics, and preventive health
programs. Saint Marys Hospital has over 180 beds dedicated to patients with cardiovascular diseases
including 16 coronary care unit beds serviced by 6 general cardiology services, 2 critical care services,
and specialty interventional services such as electrophysiology, device, and cardiac cath lab.
Participants in this rotation can expect to be exposed to a wide variety of cardiovascular disease states
and therapies.
Disease States:
Acute Coronary Syndromes
Acute Myocardial Infarction
Advanced Cardiac Life Support
Atrial Arrhythmias
Chronic stable angina
Hyperlipidemia
Heart Failure
Hypertension
Peripheral arterial disease
Venous embolism and thrombosis
Ventricular arrhythmias
Pulmonary hypertension
Goals Selected:
R1.1: Exhibit the ongoing development of essential personal skills of a pharmacotherapy practice leader.
 OBJ R1.1.1: Practice self-managed continuing professional development with the goal of improving the
quality of one’s own performance through self-assessment and change.
R1.3: Exercise practice leadership.
 Demonstrate a commitment to advocacy for the optimal care of patients through the assertive and
persuasive presentation of patient care issues to members of the health care team, the patient, and/or the
patient’s representative(s).
R2.1: Develop collaborative professional relationships with members of the health care team.
 OBJ R2.1.1: Implement a strategy that effectively develops cooperative, collaborative, and
communicative working relationships with members of the inpatient interdisciplinary health care team.
R2.2: For a caseload of patients, prioritize the delivery of pharmaceutical care.
 OBJ R2.2.1: Appropriately prioritize the care of patients if given limited time and multiple patient care
responsibilities
R2.4: Collect and analyze patient information.
 OBJ R2.4.1: Collect and organize all patient-specific information needed by the pharmacotherapy
specialist to anticipate, prevent, detect, and/or resolve medication-related problems and to make
appropriate evidence-based, patient-centered medication therapy recommendations as part of the
interdisciplinary team.
 OBJ R2.4.2: Determine the presence of or potential for all clinically significant problems in the patient’s
current medication therapy.
R2.6: Design evidence-based therapeutic regimens.
 OBJ R2.6.1: Specify therapeutic goals for a patient incorporating the principles of evidence-based
medicine that integrate patient-specific data, disease and medication-specific information, ethics, and
quality-of-life considerations.
 OBJ R2.6.2: Design a patient-centered regimen that meets the evidence-based therapeutic goals
established for the patient; integrates patient-specific information, disease and drug information, ethical
issues and quality-of-life issues; and considers pharmacogenomic and pharmacoeconomic principles.
R2.7: Design evidence-based monitoring plans.
 OBJ R2.7.1: Design a patient-centered, evidenced-based monitoring plan for a therapeutic regimen that
effectively evaluates achievement of the specified therapeutic goals.
R2.8: Recommend regimens and monitoring plans.
 OBJ R2.8.1: Recommend a patient-centered, evidence-based therapeutic regimen and corresponding
monitoring plan to other members of the interdisciplinary team in a way that is systematic, logical,
accurate, timely, and secures consensus from the team.
 OBJ R2.8.2: Discuss the proposed patient-centered, evidence-based therapeutic regimen and
corresponding monitoring plan with the patient and/or caregiver in a way that is systematic, logical,
accurate, timely, sensitive, and secures consensus from the patient and/or caregiver.
R2.10: Implement regimens and monitoring plans
 OBJ 2.10.4: Use effective patient education techniques to provide counseling to patients and caregivers,
including information on the disease state, medication therapy, adverse effects, compliance, appropriate
use, handling, storage, medication administration, and any other therapeutic interventions
R2.11: Evaluate patient progress and redesign regimens and monitoring plans.
 OBJ R2.11.1: Accurately assess the patient’s progress toward the therapeutic goal(s).
 OBJ R2.11.2: Redesign the patient’s regimen and monitoring plan as necessary, based on evaluation of
monitoring data and therapeutic outcomes.
R2.12: Communicate pertinent patient information to facilitate continuity of care.
 OBJ R2.12.2: Formulate a strategy for continuity of pharmaceutical care across all applicable treatment
settings.
R2.13 Document direct patient-care activities appropriately.
 OBJ R2.13.1: Appropriately select direct patient-care activities for documentation.
 OBJ R2.13.2: Write timely and authoritative consults and notes according to the organization’s policies
and procedures.
R3.1 Employ advanced literature analysis skills in preparing drug information.
 OBJ R3.1.1: Create an efficient and effective advanced search strategy to prepare a drug information
response.
 OBJ R3.1.9: When presented with limited evidence-based biomedical literature, synthesize a reasonable
response for the specific drug information need.
R4.1 Provide effective education and training to health care professionals and health care professionals in
training.
 OBJ R4.1.1: Use effective educational techniques in the design of an educational/training activity.
 OBJ R4.1.6: Use public speaking skills to speak effectively in a small group.
E2.1: Identify opportunities for improvement of the safety of aspects of the organization’s medication-use system.
 OBJ E2.1.1: Contribute to the organization’s evaluation of and response to a medication-related event.
Activities:
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Goals:
Participate in patient daily rounds from 8:30 a.m. to ~ noon daily, Monday through R1.1
Friday. Rounds are independent (preceptor is not with resident on rounds).
Attend service teaching session (usually daily, either before or after rounds
depending on the consultant).
For all patients, review electronic medical record (using MICS Last Word,
Synthesis, MICS anesthesia viewer, P-Care) to review chart notes and laboratories
prior to rounding. Pertinent information includes chief complaint, history of
present illness, past medical history, laboratory information, home medications,
medications ordered in the hospital, pertinent other history and tests, medicationrelated issues, monitoring plan for medications, and endpoints for therapy.
Review all patient medication histories and document in P-Care that medication
history complete, admission medication reconciliation complete, and (if a patient
transfers) transfer medication reconciliation complete. This means that home
medications are either ordered, or it is documented in the dismissal summary what
is changed/held & why.
Answer drug information requests from physicians and allied health professionals,
using literature searches when appropriate and pulling information from
guidelines.
Review patient medication profiles to identify and prevent medication-related
problems. Document findings discussed with service (interventions) in P-Care.
Evaluate/monitor drug therapy and recommend changes when necessary, based on
organ dysfunction, indication, renal replacement therapy, or other changes in
clinical status. Document recommendations (interventions) in P-Care, complete
warfarin protocols in P-Care and order doses in MICS Last Word, complete
“rules” and monitors in P-Care. With regards to antimicrobial kinetic monitoring,
a note is created in Synthesis also; this is part of the permanent medical record.
Report and document adverse drug reactions using medication error reporting
form on pharmacy services website.
Counsel patients about their medications as appropriate (required for dofetilide)
and upon request of nurses and prescribers.
Meet with the rotation preceptor daily to discuss patients and to review drug
therapy & disease state topics (approximately 2 hours/day)
Complete all readings assigned by the preceptor (for each topic & as interesting
R1.1, R2.2
R2.12
R2.1, R3.1
R2.4
R1.3, R1.6,
R1.7, R1.8,
R2.1, R2.5,
R2.11, R2.13
E2.1
R2.10
R2.6, R2.7,
R2.8, R2.10
R1.1
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patient cases come up).
Present at least one 30–minute case study or topic review to pharmacy residents,
students and staff.
R4.1
Preceptor Interaction:
Daily:
8:30 a.m. to ~ noon - Participate in patient daily rounds, Monday through Friday (preceptor or designee available
for questions that arise)
Afternoon - Patient discussions with preceptor or designee (approximately 1 hour/day)
Afternoon - Topic discussions with preceptor or designee (approximately 16-20 hours for the 4 weeks)
Case presentation, topic review, project, or other approved by preceptor
Evaluation Strategy
ResiTrak will be used for documentation of formal evaluations. For evaluations, resident and preceptor will
complete the evaluations separately. Prior to signing the evaluation, the preceptor and the resident will compare
and discuss the evaluations. This discussion will provide feedback for both the resident and preceptor on their
performance.
What type of evaluation
Snapshot(s)
Mid-point Evaluation
Summative
Summative Self-evaluation
Preceptor, Learning
Experience Evaluation
Who
Preceptor, Resident
Preceptor, Resident
Preceptor, Resident
Resident
Resident
When
As necessary
Middle of learning experience
End of learning experience
End of learning experience
End of learning experience