Download Pediatric Infectious Disease

PGY1: Pediatric Infectious Diseases
Riley Hospital for Children
Indiana University Health
Preceptors
Kristen Nichols, PharmD, BCPS (AQ-ID)
Office: 948-4239/Pager: 312-4298/Cell: 8120457-3960
General Description
This month-long pediatric infectious diseases (ID) rotation satisfies the pediatric rotation requirement
for PGY1 Pharmacy Residents. The Pediatric ID service provides care for patients admitted to the
service (approximately 1-6 daily) as well as consultations on other primary services. The Pediatric ID
team consists of an attending physician, pediatric or adult ID fellows, pediatric medical residents, and
3rd and 4th year medical students; rounds are typically held at 8:30 AM in SFT7WB M-F. Residents
will have the opportunity to apply knowledge & skills to a new population and to learn how to provide
care for children. Patients cared for range from premature neonates to young adults.
The clinical pharmacy specialist on the team is responsible for ensuring safe and effective medication
use for all patients admitted to the team. This includes maintaining a high degree of intellectual
curiosity and ensuring knowledge of rationale for all drug therapy choices. Routine responsibilities
include: reconciling medications for all patients admitted to the team, therapeutic drug monitoring,
anticoagulation management, medication allergy clarification, and patient discharge counseling. The
pharmacist will also provide drug information and education to healthcare professionals as well and
patients and caregivers. For patients that are Pediatric ID consults (vs primary Pediatric ID team
patients), the clinical pharmacy specialist is responsible for evaluating medication therapy as it pertains
to the ID problems (including impact on other disease states or medications where applicable) and
ensuring safe and effective medication use for these problems. This includes open and detailed
communication with the patient’s primary clinical pharmacist. Pediatric Antimicrobial Stewardship
activities may include: review of positive blood cultures, review of patients receiving anti-infectives,
evaluation and optimization of anti-infective dosing, development of standard dosing or therapy
recommendations, or medication use evaluations. Residents are expected to attend Peds ID conference
each Thursday.
Disease States
The resident will be expected to gain proficiency through direct patient care experience for common
diseases including, but not limited to:
• Common pediatric disease states
• Asthma
• Diaper rash
• Thrombosis
• ADHD
• Seasonal allergies
• Constipation
• Pain
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•
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•
Fluid & electrolyte management
Pediatric infectious diseases
• Kawasaki disease
• Bone & joint infections
• Skin & soft tissue infections
• Neonatal herpes infections
• Bacterial meningitis
• Viral infections
• Acute otitis media
• UTI
• Pneumonia
• Endocarditis
• Intra-abdominal infections
Nosocomial pediatric infectious diseases
• Neutropenic fever
• Pneumonia
• Catheter-associated infections
• Clostridium difficile infections
Topic discussions and reading of text book chapters and key articles will be used to help develop the
resident’s patient care skills for common disease states and for acquiring knowledge about diseases seen
infrequently on the service.
Goals and Objectives
Competency
Area
GOAL R1.1
Activities
Objective
In collaboration with the health care team,
provide safe and effective patient care to a
diverse range of patients…following a
consistent patient care process.
(Applying) Interact effectively with health
Objective R1.1.1 care teams to manage patients’ medication
therapy.
Round with the Pediatric ID team
daily. Provide recommendations in
an acceptable, non-threatening way
and assess response. Determine
desired timing and mode for
communication with team
members, including RNs and MDs.
Respond to requests for patient or
drug information in a timely manner
and in a format acceptable to
requestor.
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Objective R1.1.2 (Applying) Interact effectively with patients,
family members, and caregivers.
Obtain necessary medication history
from patient and/or caregiver.
Counsel patient and/or caregiver,
using a careful determination based
on age and cognitive level, on home
medications and evaluate concerns.
(Applying) Collect information on which to
Objective R1.1.3 base safe and effective medication therapy.
List all medication doses,
frequencies, routes, and dosage
forms for each inpatient and all
anti-infectives for each consult
patient (weight-based and total
dose). Determine indication for
each medication. Determine and
collect necessary monitoring
parameters (baseline and follow-up)
for each medication.
Objective R1.1.4 (Analyzing) Analyze and assess information
on which to base safe and effective
medication therapy.
Evaluate appropriateness of
medication doses based on available
resources. Evaluate response to
medications, including
determination of benefit or harm.
Assess choice of medication based
on indication and currently
available best evidence, including
activity of chosen antimicrobials
against known or suspected
pathogens. Weigh risks and
benefits in a chosen treatment
approach.
(Creating) Design or redesign safe and
Objective R1.1.5 effective patient-centered therapeutic
regimens and monitoring plans (care plans).
Determine optimal treatment
regimen for each patient problem
based on currently available best
evidence and patient factors.
Determine need for monitoring
parameters including: clinical
parameters, who will monitor and
how often; laboratory parameters and
how often. Compare needed
monitoring to current level of
monitoring.
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Objective R1.1.8 (Applying) Demonstrate responsibility to
patients.
GOAL R4.2
Ensure thorough and timely followup to patient questions or requests
for pharmacy or that that need to be
referred to another healthcare
provider. Prioritize patient care
effectively, addressing urgent issues
first and ensuring that needed tasks
are completed prior to leaving for the
day (or from home as necessary).
Acknowledge and admit when
unsure about patient’s therapy or
monitoring, and ask for assistance if
unable to find an answer alone.
Effectively employs appropriate
preceptors’ roles when engaged in
teaching.
Objective R4.2.1 (Analyzing) When engaged in teaching,
select a preceptors’ role that meets learners’
educational needs.
Determine APPE student’s current level
of performance and utilize information
to determine whether direct instruction,
modeling, coaching, or facilitating is
most appropriate for each situation.
Objective R4.2.2 (Applying) Effectively employ preceptor
roles, as appropriate.
Provide direct instruction as needed to
APPE students. Ask thought-provoking
open-ended questions to engage
students in the learning process.
Demonstrate thought & care processes
as the need arises and ask the student to
demonstrate use of similar process.
Demonstrate positive, effective
interactions with team. Where possible,
encourage student to answer questions,
make recommendations and take on
responsibility. Provide assistance &
feedback to students where necessary.
Preceptor Interaction
The preceptor’s schedule is highly variable, making a “norm” difficult for this rotation.
However, the preceptor is almost always available for questions and assistance even when
physically located at another campus. Some discussions may need to occur via phone. A
tentative schedule for the month will be provided to the resident by day 1 of the rotation, and
needed changes will be made based on resident feedback.
8:00 – 8:30
Pre-rounds with resident ± students; it may be possible to phase
this out as the rotation progresses
12:00 – 12:30 Preceptor available in office (or by phone) to touch base regarding
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2:40 – 2:50
patient needs, resident responsibilities, and plan for the remainder
of the day
Resident, preceptor, and students (where available/possible) to
attend huddle in inpatient pharmacy
Communication:
A. Daily check-ins: Residents will need to prioritize questions and problems to discuss
during scheduled or unscheduled meeting times as listed above. Urgent requests should
be handled as such. Necessary information will be shared with preceptor when resident
is transitioning between learning experiences (example, leaving site to attend clinic
responsibilities.)
B. Daily scheduled meeting times: Residents will need to prioritize questions and problems
to discuss during scheduled or unscheduled meeting times as listed above.
C. E-mail: Residents are expected to read e-mails at the beginning, middle and end of each
day at a minimum for ongoing communication. This is appropriate for routine, nonurgent questions and problems.
D. Office extension: Appropriate for relatively urgent questions pertaining to patient care.
E. Pager: Residents to text message or page preceptor for urgent/emergency situations
pertaining to patient care
Expected progression of resident responsibility on this learning experience:
(Length of time preceptor spends in each of the phases will be personalized based upon
resident’s abilities and timing of the learning experience during the residency training year)
Day 1: Preceptor to review learning activities and expectations with resident. Resident to work
up all of the team’s inpatients and attend rounds with preceptor.
Week 1: Resident to work up all of the team’s inpatients and approximately 1/2 of the team’s
consults and present to preceptor daily. Preceptor to attend and participate in team rounds with
resident for first 2-3 days, modeling pharmacist’s role on the health care team and beginning to
coach resident in team involvement. Preceptor will model interactions with APPE students and
begin to shift small responsibilities to resident.
Weeks 2-3: Resident to work up all of the team’s inpatients and consults, present to preceptor
once/weekly, and discuss problems with preceptor daily. Preceptor available to attend rounds
with resident if desired by resident, but likely that resident will round alone for the majority of
days. Resident to discuss patients with students if applicable. Preceptor will coach resident on
patient care and begin the transition to facilitation of resident. Preceptor will continue to coach
resident in student precepting.
Weeks 4 through the end of rotation: Resident should continue to work up the team inpatients &
consults, taking on more of a primary role in communicating with clinical pharmacists from
other teams and precepting APPE students.
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Evaluation
PharmAcademic will be used for documentation of scheduled evaluations (see chart below). The
resident and the preceptor will independently complete the assigned evaluation and save as draft.
The resident and the preceptor will then compare and discuss the evaluations. This discussion
will provide feedback both on performance of the activities and the accuracy of the resident’s
self-assessment skills. Evaluations will be signed in PharmAcademic following this discussion.
• Summative evaluations: This evaluation summarizes the resident’s performance throughout the
learning experience. Specific comments should be included to provide the resident with
information they can use to improve their performance in subsequent learning experiences.
• Preceptor and Learning Experience evaluations must be completed by the last day of the
learning experience.
What
Summative
Preceptor/Learning Experience
Evaluation
Who
Preceptor
Resident
When
End of month
End of month
An informal mid-point evaluation will occur at approximately midway through the rotation. This
will involve a discussion of resident’s performance (things to continue and things to improve) as
well as ways for preceptor to maximize the learning opportunity. This evaluation will be
documented in PharmAcademic or in another manner as desired by preceptor/resident.
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