Download PHA 510 Adult Internal Medicine Advanced Pharmacy Practice

PHA 510: Adult Internal Medicine Advanced Pharmacy
Practice Experience
Learning Contract
Regional Hospital of Scranton
Scranton, PA
Wright Center for Graduate Medical Education
CONTACT INFORMATION
Preceptor
Scott Bolesta, Pharm.D., BCPS, FCCM
Associate Professor
Department of Pharmacy Practice
Nesbitt College of Pharmacy and Nursing
Wilkes University
Office location: SLC 334D
Pager: (570) 340-8242
University office: (570) 408-4203
E-mail: [email protected]
Webpage: http://web.wilkes.edu/scott.bolesta
Other Important Numbers
Central Pharmacy: ext. 7764
CLERKSHIP DESCRIPTION
PHA 510 is an adult internal medicine experience in an institutional acute care setting designed
to provide the student with the opportunity to develop and refine the skills necessary to deliver
pharmaceutical care, with an emphasis on rational drug therapy and patient outcomes. This will
be accomplished by participation in the daily activities of work rounds with the internal medicine
team and through consultation with other health care providers involved in the care of patients.
Students will have the opportunity to apply basic pharmaceutical and pharmacological
knowledge to various therapeutic issues and be introduced to various disease states encountered
in clinical practice. Interaction and communication with other health care professionals for the
promotion of optimal drug therapy are stressed to help the student develop a sound professional
approach to the practice of pharmacy. In addition, students are encouraged to broaden their
existing competencies and incorporate their professional and personal goals into this clerkship.
This clerkship is a 5-week clerkship with a minimum requirement of 40 hours per week of
clerkship related work. This work does not have to be conducted at the clerkship site unless it is
related to patient care, but should be conducted at a location suitable for clerkship activities (e.g.
Scott Bolesta, Pharm.D., BCPS, FCCM
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PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
Pharmacy Information Center, Farley Library, etc). Students should generally not begin
clerkship related work later than 0830 nor complete their work for the day before 1630 without
specific permission from the preceptor. Failure to adhere to these minimum standards is grounds
for course failure.
Development and utilization of the following skills will be emphasized throughout this clerkship:
communication, patient interaction, patient monitoring, provision of drug information to
healthcare professionals/patients/families, and appropriate pharmacotherapy interventions.
EDUCATIONAL OUTCOMES
1.1.1. Demonstrate skills in mathematics for accurate prescription preparation, analysis of biophysical processes and/or socioeconomic data.
1.1.2. Utilize concepts in biochemistry, molecular biology, pharmacology, and immunology to
understand the actions and uses of current and future drugs.
1.1.3. Demonstrate knowledge of the functional groups of drugs and other aspects of medicinal
chemistry important for drug disposition and drug- target interactions.
1.1.4. Demonstrate knowledge of drug mechanisms of action and toxicities.
1.1.5. Demonstrate knowledge of physiochemical, pharmacokinetic, and pharmacodynamic
principles underlying drug disposition and elimination.
1.1.6. Demonstrate knowledge of pharmacogenomics pertinent to the individualization of drug
therapy.
1.1.7. Demonstrate knowledge of pharmacoeconomics.
1.2.3. Determine the appropriateness of drug doses, dosage forms, routes of administration, and
frequencies of administration.
1.2.4. Perform calculations required to compound, dispense, and administer medications.
1.3.1. Recognize and articulate an information need
1.3.2. Efficiently retrieve information and evaluate it for relevance and validity
1.3.3. Synthesize and apply the information in context of the situation or question/need
1.3.4. Use the information gathered to formulate evidence-based answers
1.3.5. Effectively communicate medical information with appropriate written and/or verbal
language.
1.4.1. Interview patients and healthcare providers.
1.4.2. Perform basic physical assessments.
1.4.3. Acquire patient information from the patient record.
1.4.4. Use subjective and objective data to develop a complete and prioritized problem list.
1.5.1. Explain the etiology and risk factors for drug related problems.
1.5.2. Explain the purpose / indication for drug therapy.
1.5.3. Calculate and interpret population and individual pharmacokinetic and pharmacodynamic
data.
1.5.4. Explain the risks and benefits of current and alternative therapies.
1.5.5. Assess the patient for potential drug interactions.
1.5.6. Assess the patient for possible adverse drug reactions.
1.5.7. Identify toxic and suboptimal drug therapy.
1.5.8. Assess patient adherence and identify potential barriers to adherence.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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1.6.1. Utilize basic science, math, economic and therapeutic principles in selecting and
justifying drug therapy for a patient.
1.6.2. Recommend drug therapies based on patient-, drug-, and disease-specific parameters.
1.6.3. Recommend appropriate preventative medicine and non-pharmacologic therapy including
dietary and alternative medicine.
1.6.4. Develop therapeutic goals and measurable outcomes for a patient’s drug therapy.
1.6.5. Justify recommendations with supporting evidence from appropriate sources.
1.6.6. Communicate pharmaceutical care plan to other health care professionals.
1.6.7. Counsel patients and caregivers about appropriate therapy.
1.6.8. Ameliorate barriers that interfere with a patient’s ability to adhere to recommended
therapy.
1.6.9. Provide drug and disease information to patients, caregivers and health care providers.
1.7.1. Formulate a monitoring plan for optimizing drug safety and efficacy utilizing
pharmacokinetic, pharmacogenomic and pharmacodynamic principles.
1.7.2. Interpret clinical lab data to monitor and adjust therapy.
1.7.3. Revise the pharmaceutical care plan as necessary.
1.7.4. Document pharmacy practice activity in the patient's medical record.
2.5. Use strategies to stay current with changing practices in pharmacy.
2.8. Implement or improve practice to reduce medication errors.
2.10. Use appropriate systems (institutional and government) to report adverse drug reaction
and medication errors.
4.1. Find, observe, analyze, evaluate, apply and synthesize information to solve problems and
make informed, rational, responsible and ethical decisions. (Cognitive Abilities).
4.2. Relay and respond to information effectively and appropriately using verbal, non-verbal,
written and technological methods of communication. (Ability to Communicate).
4.3. Demonstrate an ability to lead others and conduct oneself according to current
professional standards. (Professionalism).
4.4. Demonstrate an awareness and sensitivity of social and cultural issues and actively
participate in community and civic initiatives. (Citizenship).
4.5. Effectively self-assess and improve personal and professional abilities on an ongoing
basis. (Continuous Professional and Personal Development).
4.6. Actively, effectively, and appropriately participate in group interactions to achieve
common goals. (Group Collaboration).
4.7. Practice pharmacy (or carry out duties) in accordance with legal, ethical, social,
economic, and professional guidelines.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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CLERKSHIP LEARNING OUTCOMES
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Organize and present patient case information to other health care professionals.
Analyze individual patients’ disease states and pharmacotherapeutic regimens for optimal
therapy.
Interview patients to obtain data necessary to optimize their pharmacotherapy.
Communicate both verbally and nonverbally with other health care professionals about
the pharmaceutical care of patients.
Make recommendations to other health care professionals regarding necessary changes to
patients’ pharmacotherapeutic regimens.
Use appropriate references to justify recommendations for patients’ pharmacotherapeutic
regimens.
Counsel patients about their medication therapy.
Analyze the medical literature and extrapolate the information into practice.
Present formal and informal lectures to peers and various health care professionals.
Write reports that detail patient events involving their pharmaceutical care.
DAILY ACTIVITIES/RESPONSIBILITIES
Typical daily schedule
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Preparation for rounds:
Patient rounds:
Lunch, conferences/meetings:
Patient/Drug Info. follow-up:
Patient/Topic discussions:
Patient follow-up:
08:00 – 09:00
09:00 – 12:00
12:00 – 13:00
13:00 – 14:00
14:00 – 15:00
15:00 – 16:30
Medical Morning Rounds
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Students will round daily with one of the internal medicine teaching services of the
Wright Center for Graduate Medical Education.
Students are expected to be proactive on rounds, making appropriate recommendations
regarding the pharmaceutical care of the patients on their service. Students are also
responsible for researching and responding to drug information questions posed during
rounds or assigned by the preceptor.
Students are expected to know the medical history and progress to date of the patients
they are assigned.
Expectations for Rounds
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Students will arrive to site early enough to collect all new and pertinent patient
information prior to rounds (i.e. medication changes, labs, test results, consult reports,
etc.). This time will vary due to many factors, but a minimum of one hour is
recommended at the beginning of the clerkship.
Students will have researched disease states and will be familiar with the appropriate
therapy for the diseases states of each patient.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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Students will have reviewed patient profiles looking for drug interactions, appropriate
dosage regimen, potential adverse reactions, IV to PO switches, as well as any other
pertinent information pertaining to the appropriate pharmaceutical care of their patients.
Students should be proactive in making recommendations and answering drug
information questions. You are expected to use pocket drug reference sources while on
rounds to answer the questions you are able to without preceptor assistance. However,
follow up with a more in depth search after rounds may be necessary. For complex
recommendations, drug information questions and patient care issues the student is
expected to seek out the advice of the preceptor prior to making a final recommendation
to the appropriate health care provider.
Patient Contact
Students should visit their patients on a daily basis. Initially your visits may be to gather
information that is needed such as a medication history. Sometimes it might just be to greet
the patient and follow-up on their condition. If patient education is needed the educational
materials and content need to be approved by the preceptor before presentation to the patient.
Meetings and Conferences
Attendance at noon conference, Grand Rounds and other conferences/meetings as assigned
by the preceptor is required.
Pharmacy Rounds/Patient Discussions
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Students will meet with the preceptor regularly (daily in the beginning) to review
patients. Students should be prepared to present new patients and lead a discussion of the
patients’ most important disease states during these presentations.
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During these patient discussions/presentations students are expected to:
1. Extract pertinent information from the medical record and construct a data base for
each assigned patient including, but not limited to, the following:
 Chief complaint or symptoms
 History of present illness (HPI) and demographic information
 Allergies
 Past medical history (PMH)
 Medication history
 Family medical history
 Social history relevant to the patient's condition
 Review of systems (ROS) relevant to the patient's condition
 Physical exam (PE) relevant to the patient’s condition
 Laboratory data and other diagnostic data
 Progress notes
2. Describe and explain the pathophysiology of the patient’s primary disease states and
associated complications.
3. Identify any abnormalities in the patient data base which are the result of current or
past drug therapy.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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4. Discuss the potential for and the clinical relevance of:
 Drug-induced disease(s), symptoms and physical findings
 Drug interference with laboratory tests
 Drug-drug interactions
 Drug-food interactions
5. State the therapeutic goal (endpoints) for each patient problem (i.e. disease process,
abnormal laboratory values, symptoms, and/or physical findings).
6. State therapeutic alternatives for each patient problem.
7. Evaluate and select the most appropriate therapeutic regimen for each problem in the
individual patient based on a knowledge of:
 The clinical efficacy of each alternative
 The pharmacology and pharmacokinetics of the drug
 The side effects and toxicities of the drug
 The potential complications with other disease processes
 The patient variables (i.e. sex, age, organ function, etc.)
8. State the subjective and objective criteria used to monitor therapy and assess the
patient for the therapeutic effect of the medications and any iatrogenic problems.
Students are expected to participate in Therapy/Topic Reviews as assigned by the
preceptor during the clerkship. These reviews will not be evaluated individually, but the
completion of them will contribute to your overall clerkship evaluation. Your final
course evaluation may be affected if these reviews are not completed in a timely and
appropriate manner. Students should not base these reviews solely on their class notes.
Instead, students should find relevant studies, guidelines and review articles to prepare
for these sessions.
CLERKSHIP ASSIGNMENTS
Formal Topic Presentation
Each student on acute care faculty clerkships will present a topic that is applicable to their
clerkship at a single session with all the other acute care faculty students. It is a formal
presentation and must be done in PowerPoint. The evaluation rubric is located in the APPE
manual. General guidelines for preparation will be provided for review. At the preceptor’s
discretion this presentation may be repeated for a health care group at Regional Hospital of
Scranton.
Journal Club Presentation:
Each student must select and present at least one journal article from the primary literature
that pertains to the drug therapy or the treatment of a disease state pertinent to one of their
patients or a topic relevant to clinical pharmacy. The preceptor must pre-approve the article.
The guidelines for the journal club are different from those found in the APPE manual and
will be provided for review. The evaluation criteria can be found in the APPE manual.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
6
Adverse Drug Reaction Reports:
All ADRs encountered on rounds or otherwise should be reported to the Clinical Pharmacy
Office and discussed with the preceptor during patient discussions. In addition, students will
formally write up at least one ADR in the format of a case report. General guidelines for
preparation will be provided for review.
Clerkship Project(s):
Each student may also have the opportunity to complete one or more clerkship projects as
assigned by the preceptor. These may include: newsletter articles, in-service presentations
to the pharmacy and/or medical or nursing staff, medication use evaluations (MUEs), or
other projects as deemed appropriate. The preceptor must pre-approve any additional
project(s) the student wishes to undertake. Formal written guidelines are not provided for
additional projects as they may differ for each clerkship block and for each student. If
students complete an additional project(s) the time spent on the project will be accounted for
accordingly to account as part of the APPE evaluation. Projects will generally be evaluated
based on quality, independence and timeliness of work.
ADDITIONAL INFORMATION
Plagiarism
See the APPE manual for a definition. If you are unsure of what constitutes plagiarism
discuss it with the preceptor immediately. Using the words or ideas of another, even if
referenced or done unintentionally, may be considered plagiarism. Plagiarism of any kind is
grounds for project and/or course failure in addition to other penalties as outlined in the
Pharmacy Student Handbook.
Internet Use
Use of the internet at Regional Hospital of Scranton for purposes other than patient care and
clerkship or school related activities is strictly prohibited. Any such use will result in
immediate expulsion from the clerkship site and failure of the clerkship.
Photocopying and Printing
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DO NOT use the PIC printer as a photocopy machine (no multiple copy printing)!
Do not print articles or handouts using the PIC printer, unless necessary. Be aware of
the length of articles you do wish to print.
Judicious use of the Regional Hospital of Scranton Pharmacy Department photocopy
machine is permitted, especially for patient monitoring sheets and other regularly used
forms.
Judicious use of the printers at Regional Hospital of Scranton is permitted, but they are
not to be used as photocopiers (no multiple copy printing).
All other printing and copying costs are the responsibility of the student.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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Phone Use
The phones at the clerkship site are only to be used for in-house and local calls pertaining to
patient care and clerkship or school related activities. Any other use is strictly prohibited.
The phones are not to be used to place long-distance calls unless authorization has been
given for the specific call by the preceptor or appropriate member of the Pharmacy
Department.
Parking
Students are provided with a Wilkes parking pass(s) to allow on-campus parking during the
clerkship. These passes are entrusted to the student to facilitate commuting between the site
and the university. Be aware:
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Parking passes are the student's responsibility. Financial penalty for lost passes are
the responsibility of the student.
Students will NOT share the pass with others.
Students are fully responsible for any financial or other loss due to parking on
campus.
Evauations will not be released until parking passes are returned at the end of the
rotation.
Hazardous Weather Policy
The hazardous weather policy for the School of Pharmacy as it pertains to clerkships can be
found in the APPE manual. In addition to this policy any compressed schedule, delayed start
or other change in the University’s schedule for the day due to hazardous weather will also
apply to the clerkship schedule for that day. This policy addition does not apply to any
changes in the University’s schedule for reasons other than hazardous weather. For up-todate information on the University’s schedule call (570) 408-SNOW.
GRADING
Grading for this clerkship is pass/fail and will be based on the applicable guidelines for this
clerkship found in the APPE Student manual. The majority (approximately 75%) of an
evaluation will be based on the outcomes related to clinical knowledge and skills and
professionalism. The remainder of the clerkship evaluation will be based on any additional
projects and assignments.
EVALUATIONS
The preceptor will provide student feedback on an ongoing basis, with formal written/oral
evaluations performed at the approximate midpoint and at the end of the clerkship experience.
Students may be required to perform self-evaluations.
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Extreme non-professionalism is grounds for failure of the clerkship.
Late assignments may result in an incomplete for that assignment and potential failure of
the clerkship.
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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DISCLOSURE
I have received the internal medicine learning contract and reviewed the assessment methods
with my preceptor. I understand all methods by which I will be assessed in this clerkship.
I understand all patient data reviewed or discussed during the clerkship must be kept
confidential. Cases should only be discussed with the preceptor or members of the health care
team. Any breach of patient confidentiality, however minor, will result in failure of the clerkship
(i.e. discussions in the cafeteria or with "friends” working at the institution).
My preceptor has reviewed my portfolio and is aware of my performance in previous clerkships.
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Student Name (please print)
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Date
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Student Signature
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Date
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Preceptor Signature
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Date
Scott Bolesta, Pharm.D., BCPS, FCCM
PHA 510: Adult Internal Medicine APPE Learning Contract
Revised: 5/14
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