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Pharmacy Residency Learning ExperienceROTATION TITLE: Acute CardiologyPRE-REQUISITES: NoneROTATION PRECEPTOR(S): Scott YostSITE DESCRIPTION?: The acute cardiovascular unit has 28 non-ICU acute care beds. The patient mix includes?: heart failure, ACS, electrophysiology, ICU step-down patients, endocarditis, hypertensive crisis, thrombosis, cystic fibrosis, pulmonary hypertension and vascular. DAILY ACTIVITIES/RESPONSIBILITIES: Hours: 7am – 3:30pm no on call responsibilities.Daily Activities: Profile review, collaborative practice medication dosing (antibiotics, warfarin, insulin and Tikosyn), renal dose adjustments per P&T protocol, IV to PO dose adjustments per P&T protocol, answering “Vocera”, drug information requests, medication reconciliation, patient counseling and attending care coordination rounds.Rounds: No physician rounds, care coordination sit down rounds from 10:15-11:00am consist of nurses, pharmacists, case managers and cardiac rehab therapists.Adverse drug event reporting and management: Resident will review report any adverse drug event to the “web event” system and review all events for the unit as well.Counseling: Residents will counsel patients on antithrombotic therapy (warfarin, apixiban, rivaroxaban etc.), discharge medications, heart failure medications, and Tikosyn therapy. The resident will not be expected to perform all the counseling on the floor, but will be expected to assist the clinical pharmacist in counseling of some of the assigned patients.Teaching: Residents will be expected to help precept students during their rotation. This includes, coaching, assigning readings, review students work and giving feedback for ic Discussions: Residents will be required to present two topic discussions to student learners during their rotation. The first topic discussion will be presented to the students on rotation on the topic of acute coronary syndrome. The second topic discussion will be on a topic of the residents’ choice. Topics may include: heart failure, arrhythmias, acute coronary syndrome, endocarditis, hypertension, hyperlipidemia, and other topics approved by preceptor.Journal Article Review: Residents will be required to present a journal article discussion with the pharmacy staff and learners during the rotation on a topic related to cardiology.In-Service Presentation or Written Project: One presentation to the nursing or pharmacy staff on a cardiology topic assigned at the beginning of the rotation. This presentation should last no more than 30 minutes. The presentation topic is flexible depending on the needs of the unit. Examples include: new cardiology medication review or a review with nurses on insulin management. The resident may also choose to work on a written project during their rotation instead of an in-service presentation. A few examples of an acceptable project include: the writing of a therapeutic review for either the ACVU nursing staff monthly newsletter or the pharmacy monthly newsletter, the creation of education documents for new cardiology medication, or patient information handouts on cardiology medications. The topic and assignment will be assessed and agreed upon with the resident at the beginning of the rotation. ROTATION LEARNING OBJECTIVES: Goals and ObjectivesAssociated ActivitiesCompetency R#1Patient CareGoal R#1.1In Collaboration with the health care team, provide safe and effective patient care to a diverse range of patients, including those with multiple co-morbidities, high-risk medication regiments, and multiple medications following a consistent patient care process.The resident will work in conjunction with nurses, physicians, mid-level practitioners, dietitians, respiratory therapists and dietitians to deliver care to the patient. This will be accomplished through collaborative practice agreement medication management (including high risk medications warfarin and insulin), direct medication interventions with physicians, and heart failure patient education.OBJ R#1,1,1(Applying) Interact effectively with health care teams to manage patients’ medication therapy.The resident will monitor and dose insulin, warfarin, dofetilide, antibiotics, renal dose adjustments through collaborative practice medication management.Resident will attend care coordination rounds with nurses, case managers and cardiac rehab therapists.Resident will carry a vocera device and answer medication therapy questions from nurses, respiratory therapists and physicians.Participate in individual consultation with physicians or mid-level practitioners on medication therapy management.OBJ R#1,1,2(Applying) Interact effectively with patients, family members, and caregivers.1. The resident will educate patients (or family members, caregivers) on anticoagulation therapy, insulin therapy, heart failure therapy and discharge medications.2. The resident will introduce themselves and explain a clinical pharmacists services during medication history gathering.3. The resident will be available to answer any medication information questions that a patient or caregiver may have.OBJ R#1,1,8(Applying) Demonstrate responsibility to patients.Residents will be expected to perform discharge counseling on high risk heart failure patients. They will help explain their medications, anticipate any financial barriers to obtaining their medications and working with case managers to help patients receive medications.The residents will also be expected to help set up appointments in the CPAS clinic for patients discharging from the hospital as well as educating the patient on their anticoagulation therapy.The residents will be available for consults from patients who have questions about their medication therapy.Goal R#1.2Ensure continuity of care during patient transitions between care settings.The resident will be responsible for proper pass off to pharmacists where patient are transferred to or from. The resident will also help coordinate transitions into the outpatient setting.OBJ R#1,2,1(Applying) Manage transitions of care effectively.The resident will give the oncoming floor pharmacist a thorough pass off of patients at the end of each day.The resident will communicate with unit pharmacists when patients are transferred to the ICU setting.The resident will receive communication from ICU/Floor pharmacists when patients are transferred onto the floor.Residents will help set up appointments with CPAS when a patient is being discharged from the hospital to home. The residents will also send the CPAS team the inpatient flow sheet for their anticoagulation management in the hospital and verbally communicate any issues.Residents will help with discharge teaching of high risk heart failure patients. These patients will be taught about their new medications as well as their heart failure medications. The resident will also ensure that the patient is able to pay for their medications and if this is a barrier, work with the case manager to ensure the patient is able to obtain their new petency R#3Leadership and ManagementGoal R#3.2Demonstrate management skills.Build rapport with members of the interdisciplinary team. Be able to perform all responsibilities of the CVU pharmacist.OBJ R#3,2,4(Applying) Manages one’s own practice effectively.The resident will be expected to be the main contact pharmacy representative on CVU. This includes answering vocera calls, discussing therapy with physicians and other providers when approached and seeking out providers when an intervention is needed.The resident will be responsible for managing “med monitor” by filling in daily notes into the system and adding and deleting patients that we are consulting on. The resident will also be expected to enter notes into the Help2 system when changes are made.The resident will also be required to enter medication orders into the EMR and manage the iRx que (CPOE que once Icentra starts). The resident will be expected by the end of the rotation to perform all tasks that a pharmacist is responsible for on the floor during daily practice. ADDITIONAL REQUIREMENTS:Required meetings: Cardiology grand rounds on Wednesday mornings during rotation block.Required presentations: Two topic discussions to pharmacy learners and cardiology pharmacists. The topic discussions will include a lecture on Acute Coronary Syndrome to the pharmacy students on rotation at IMC. A PowerPoint presentation or handout is optional for the discussion. In addition the resident will be assigned a topic of their choosing for discussion with the pharmacy staff at the end of the rotation. A PowerPoint presentation or handout is optional for the discussion.Journal club presentation: Journal presentation on an article with a cardiology focus. Article must have been published within past year and be published in a major medical journal (JAMA, NEJM, Heart, etc.). A 1 page front and back handout will be given to audience members of the journal presentation.In-service presentation or written project: One presentation to the nursing or pharmacy staff on a cardiology topic assigned at the beginning of the rotation. This presentation should last no more than 30 minutes. The presentation topic is flexible depending on the needs of the unit. Examples include: new cardiology medication review or a review with nurses on insulin management. The resident may also choose to work on a written project during their rotation. A few examples of an acceptable project include: the writing of a therapeutic review for either the ACVU nursing staff monthly newsletter or the pharmacy monthly newsletter, the creation of education documents for new cardiology medication, or patient information handouts on cardiology medications. The topic and assignment will be assessed and agreed upon with the resident at the beginning of the rotation. CORE DISCUSSION TOPICS:Discussion TopicRequired?Required Readings (List References)ACSYesUA/NSTEMI + STEMI guidelines Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG,Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014ACC/AHA guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344–e426.O’Gara PT, Kushner FG, Ascheim DD, Casey DEJr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK,Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management ofST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on PracticeGuidelines. J Am Coll Cardiol 2013;61:e78 –140, doi:10.1016/j.jacc.2012.11.019.Heart FailureYesAHA Heart Failure guidelinesYancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240–e327HyperlipidemiaNoAHA Blood Cholesterol guidelines Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;00:000–000.HypertensionNoJNC8Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; William C. Cushman, MD; Cheryl Dennison-Himmelfarb, RN, ANP, PhD; Joel Handler, MD; Daniel T. Lackland, DrPH; Michael L. LeFevre,MD, MSPH; Thomas D. MacKenzie,MD, MSPH; Olugbenga Ogedegbe,MD, MPH, MS; Sidney C. Smith Jr, MD; Laura P. Svetkey,MD, MHS; Sandra J. Taler, MD; Raymond R. Townsend, MD; Jackson T.Wright Jr,MD, PhD; Andrew S. Narva, MD; Eduardo Ortiz, MD, MPHJAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427Published online December 18, 2013.EndocarditisNoAHA/IDSA Endocarditis guidelinesJ. Pallasch, Masato Takahashi and Kathryn A. TaubertStanford T. Shulman, Jane C. Burns, Donald A. Falace, Jane W. Newburger, Thomas Michael H. Gewitz, David C. Tong, James M. Steckelberg, Robert S. Baltimore, Bolger, Matthew E. Levison, Patricia Ferrieri, Michael A. Gerber, Lloyd Y. Tani, Larry M. Baddour, Walter R. Wilson, Arnold S. Bayer, Vance G. Fowler, Jr, Ann F. Circulation 2005;111;e394-e434Atrial FibrillationNoAHA/ACC Afib guidelinesJanuary CT, Wann LS, Alpert JS, CalkinsH, Cleveland JC, Cigarroa JE, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG,Tchou PJ, Tracy CM, Yancy CW. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: areport of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the HeartRhythm Society. Circulation 2014;129Optional readings: None EVALUATIONS/FEEDBACK:Verbal Feedback (i.e. daily, weekly): Verbal feedback will be given daily as needed based on activities of resident.Formal Written Evaluations (i.e. snapshots, midpoint, final): Written evaluations will include midpoint, final, and transition evaluations. ................
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