Rotation Information

 

Acute Care Rotation – Mercy Medical Center

Dr. Erik D. Maki, PharmD, BCPS erik.maki@drake.edu  (515) 326-0171

 

Description

In this rotation, students will work with the preceptor to optimize medical therapy for patients admitted to the Internal Medicine teaching services at Mercy Medical Center.  This medical service consists of 3 teaching teams that provide care to an average of ~ 45 patients per day (15 per team).  The rotation has the opportunity to interact with many disease states and is designed to be flexible to meet the needs of each student.  Students may also have the opportunity to work with both P3/P4 students and/or Mercy’s PGY-1 pharmacy residents.  Activities include reviewing patient profiles for actual and potential drug therapy problems, making pharmaceutical recommendations, reviewing drug therapy decisions, serving as a drug information resource, and educating health care members about pharmacy issues.  In addition, students will collaborate with Mercy Pharmacy staff to collect best possible medication lists and provide discharge education.

 

Rotation Objective

  • Develop clinical skills necessary to provide care to patients on a general medical service that can be applied in many practice settings.  More specifically by the end of the rotation, students should be able to:
    • Develop and refine a systematic method for the collection and assessment of pertinent patient specific information
    • Determine and prioritize clinical information needed for clinical decision making for commonly encountered disease states
    • Describe the significance of commonly encountered objective data documented in the electronic health records (e.g. laboratory values, physical signs/symptoms, imaging, diagnostic testing, etc.)
    • Understand common clinical pathways to be able to anticipate drug therapy needs and opportunities for interventions
    • Identify drug therapy problems and determine the appropriate and optimal time for implementation
    • Develop a communication strategy with interprofessional members of the health care team that are effective, compassionate, caring and respectful
    • Demonstrate the steps necessary to collect the best possible medication list
    • Construct effective patient specific medication education strategies
  • Students will also work with the preceptor to identify five specific objectives for the rotation

 

Schedule

  • Monday – Thursday
    • There are no predefined set hours for the rotation.  You are responsible for your own time management.
    • Students are expected to have evaluated and to be prepared for patient discussions at 7:30 am
    • Typically, students begin this preparation around 6 am but this may depend on each students’ baseline knowledge, ability and skills.
    • Students can complete their preparation off site but must ensure they are abiding by the HIPAA standards and protecting patient privacy and confidentially.
    • Students will typically be excused after completion of their direct patient care responsibilities.  This typically occurs around 12 noon.  It is the expectation that students will use this additional time to complete their daily readings, work on any specific homework assignments or their presentations.
    • Most Thursdays, the pharmacy department has a weekly conference scheduled form 1 pm to 2 pm, all students are expected to attend unless excused in advance.
  • Fridays
    • To increase the amount of direct patient care, Fridays have been reserved for transitional care activities.  Students will receive a separate schedule that will include opportunities to collaborate with pharmacy technicians and our decentralized pharmacist to provide assistance with medication histories or discharge education.

 

Rotation Activities

  • Active participation in daily patient care
  • 1 topics discussion of your choice (15 min)
    • Please provide a review article or key article at least 2 days in advance to the pharmacy team
    • Discussion should be evidence based, with a journal club like review and evaluation of the literature.
    • Include references on each slide
    • Preceptor must review materials prior to presentation, ideally 1 week in advance of the presentation.
    • Sharing and Reflecting http://maki.wp.drake.edu/forum/
    • We will my WordPress site to share information about what we are doing and things we are learning
      • Interventions
        • Describe in general the intervention and when possible provide references
        • Do not include any patient identifiers
      • Article summaries
        • Must read at least one review article per day and enter information the same day.
        • Use as a “journal” of what you looked up and/or new information learned for the day
        • Please include why you chose to read that particular article and what you learned
      • Tips, tricks and suggestions
        • Please share anything that would be helpful to future students
      • Presentations
        • Examples of previously given presentations
  • Drug information PRN

 

General Expectations

  • Work should be fun, be positive, be prepared, and be enthusiastic to learn.
  • Your learning is self-directed and I expect you to take advantage of the opportunities provided.  It is my job to create the learning opportunities and your job to take advantage of them.
  • Be reflective and finds ways to improve each day
  • Track areas of need and priorities these in your daily work
  • Ask for help, ask me to explain, ask questions when you don’t understand, ask for feedback, ask for affirmation
  • You represent the profession of pharmacy to young physicians, medical students and other healthcare providers, impress them.
  • You are practicing under my license and supervision

–        Verify that all information you give out is 100% correct

–        Physicians will often follow your recommendation w/out question

–        When you are asked a question, it is OK to say “let me double check.”

  • All drug-information requests MUST be responded to ASAP (ask for assistance if needed)
  • Patient presentations

–        Should short and cover pertinent information including your assessment and plan (be efficient)

–        You are expected to listen while other student presents and ask pertinent questions

  • Communicate all concerns to me as soon as possible so I can help fix any problems
  • Come to discussions ready to discuss

–        If I ask you to look something up come prepared the next day ready to discuss

  • Its okay to not know something once, but repeated not knowing something creates a perception that you don’t know and are not putting sufficient effort into learning
  • Textbooks, Up to Date and class notes are typically not acceptable references.  You can use these only when you don’t have time to look something up.

–        If you need help using Pubmed, EBSCO or other sources please ask.

–        Use review articles to guide you

  • Track your interventions and report to the pharmacy team the outcomes
  • Do not

–        Give out any patient information (to family members, others)

–        Discuss patients with anyone outside your rotation

–        Pretend you know the answer

–        Provide unsupervised care to prisoners

–        Provide care to faculty/staff/students

–        Go into patient rooms that may have TB or any other condition that would require gowning up or additional personal protective gear

–        Put yourself in situations where you are uncomfortable/unsafe

  • Bring a notebooks or electronic devices

–        Use during the day to write down anything you don’t know that you will want to look up later

  • Use board review to self-assess and determine where your strengths and weaknesses are

–        APhA Complete Review  http://pharmacylibrary.com.cowles-proxy.drake.edu/naplex/dashboard

–        Must create an account but it is free for you to use as a Drake student

 

Accessing the Electronic Health Records

o   PowerChart is the main app you will use to access medical information

 

Presenting Patients

  1. Room number
  2. Age and gender
  3. Actual body weight and Ideal body weight
  4. Allergies (including reactions)
  5. Estimated functional range of CrCl
  6. Functional range is CrCl calculated with ideal body weight and adjusted body weight
  7. Adjusted body weight = (actual body weight – ideal body weight) x 0.4
  8. Acute problem list
  9. Chronic problem list
  10. Medication list
  11. Home medications discontinued or held
  12. Home medications continued
  13. PRN medications only if they are being utilized (please quantify)
  14. Labs (with trends), diagnostics and vitals specific to acute or problem lists (e.g. … for heart failure the pt BNP was xxx, I/O were xxx with a net of xxx, weight is xxx which is down xxx… CXR showed pulm edema..)
  15. Interventions
  16. Today
  17. Tomorrow
  18. Before discharge
  19. At some point after patient goes home
  20. F/U plan (e.g. tomorrow I am going to look for culture, SCr, vanco level…)