PGY1 Surgery: Kidney and Pancreas Solid Organ Transplant University Hospital Indiana University Health

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1 PGY1 Surgery: Kidney and Pancreas Solid Organ Transplant University Hospital Indiana University Health Preceptor Jeanne Chen, BS, PharmD, BCPS Office: (317) /Pager: (317) General Description The Abdominal Transplant Program at IU Health is one of the largest in the country. The Kidney/Pancreas Team provides care for patients before, during, and after the time of transplantation with a broad scope of acuity ranging from intensive care to outpatient needs. All patients receiving a kidney and/or pancreas transplant will be admitted to either the Kidney and Pancreas Transplant Surgical Service or Transplant Nephrology Service at Indiana University Hospital when they require hospitalization for any reason. The teams also run the Surgery Outpatient Clinics as well as the Transplant Nephrology Outpatient Clinics where care is routinely provided to all kidney and pancreas transplant recipients indefinitely. The one-month rotation is designed to expose the resident to the role of the pharmacist on the Transplant Team and to provide the resident with exposure to pharmacologic issues found adult kidney and pancreas transplant recipients. Throughout the rotation the resident will focus on identifying pharmacologic issues pertinent to transplant patients, communicating therapeutic recommendations, documenting consultations, applying of pharmacokinetic principles, and providing drug information to patients and other health care providers on the team. The resident will be an active member of the transplant multidisciplinary team, and will be expected to follow the solid organ transplant patients in both the intensive and acute care setting. The resident will also be given the opportunity to provide pharmacy services in the post-operative surgery clinic. Disease State Management The resident will be expected to gain proficiency through direct patient care experience with the following disease states encountered in transplant patients including, but not limited to: Endocrine disorders peri-operatively and post solid organ transplant Diabetes management (new onset and chronic), adrenal insufficiency Fluid, Electrolyte, and Acid/Base disorders Respiratory acid/base disorders, metabolic acid/base disorders, dehydration Immunosuppression management Induction and maintenance immunosuppression Treatment of transplant allograft rejection Infectious diseases in immunocompromised patients UTI, pneumonia, catheter-associated blood stream infections, sepsis, fungal infections, CMV, EBV, BK virus Renal diseases most commonly leading to transplantation Hypertension, Type I and II Diabetes, Polycystic Kidney Disease, Focal Segmental Glomerulosclerosis, Alport s Syndrome, Drug Induced Nephropathy Diabetes Complications Neuropathy, Gastroparesis, Orthostatic Hypotension Post-operative Prophylaxis Stress ulcer prophylaxis, VTE prophylaxis, management of bowel function 1

2 Post-transplant complications Post transplant lymphoproliferative disease Rejection of the transplanted organ Management of Cardiovascular Disease Post Transplant including Hypertension management Diabetes management Hyperlipidemia post transplant Periodic discussions between the resident and instructor will be held to discuss selected topics and individual patients. The resident will prepare for the meeting to sufficient depth of knowledge to be able to lead the discussion of the topic. Goals and s During the learning experience the resident will focus on the goals and objectives outlined below by performing the activities that are associated with each objective. The resident will gradually assume responsibility for all of the patients within the assigned unit. The PGY1 resident must devise efficient strategies for accomplishing the required activities in a limited time frame. Achievement of the goals of the residency is determined through assessment of ability to perform the associated objectives. The table below demonstrates the relationship between the activities and the goals/objectives assigned to the learning experience. Goals and s Activities Competency Area GOAL R1.1 R1.1.1 In collaboration with the health care team, provide safe and effective patient care to a diverse range of patients following a consistent patient (Applying) Interact effectively with health care teams to manage patients medication therapy. Attend daily multidisciplinary rounds during which the resident has the opportunity to directly communicate pertinent medication and disease related concerns with other team members and answer medication related questions from the team while professionally presenting supporting rationale for 2

3 R1.1.5 R1.1.6 GOAL R1.2 (Creating) Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans). (Applying) Ensure implementation of therapeutic regimens and monitoring plans (care plans) by taking appropriate followup actions. Ensure continuity of care during patient transitions between care settings. Review patients profiles daily prior to rounding including but not limited to the following information: lab results, culture data, postoperative immunosuppression regimen, maintenance immunosuppression, drug levels, and newly started or discontinued medications. Identify the indication, necessity, and appropriateness of each medication on a patient s profile. Assure appropriate medication dosing, Discuss patient s pertinent issues/complaints during rounds and assess medications screening for unwanted adverse effects. Assess drug levels for appropriate and design a plan for the regimen and the need for continued monitoring. R1.2.1 GOAL R3.1 (Applying) Manage transitions of care effectively. Demonstrate leadership skills. Complete medication histories for transplant recipients prior to surgery and reconcile medications post-transplant and prior to discharge. Communicate pertinent information regarding new admissions, pharmacokinetic monitoring, and discharge planning with other pharmacy staff as appropriate throughout the day in daily huddle. Actively engage in discharge preparation R3.1.1 GOAL R4.2 (Applying) Demonstrate personal, interpersonal, and teamwork skills critical for effective leadership. Effectively employs appropriate preceptors roles when engaged in teaching. Identify potential and real drug- and diseaserelated problems; assess the clinical significance of drug-related problems by prioritizing problems. 3

4 R4.2.1 R4.2.2 (Analyzing) When engaged in teaching, select a preceptors role that meets learners educational needs. (Applying) Effectively employ preceptor roles, as appropriate. Provide anticoagulant education, discharge education, and discuss daily medication management plan with the patients when appropriate at a level appropriate for the specific patient, their family members, and their condition at that time. Preceptor Interaction The resident is expected to touch base with the preceptor daily prior to rounding with the team to address any significant issues and/or concerns they would like to address during rounds. The preceptor will be present with the resident daily on rounds or will be accessible via phone, text, or pager for any acute questions the resident has when preceptor is not physically present. A meeting will be held each afternoon for the resident and preceptor to discuss patients, and assure all issues have been addressed from rounds and all orders and tasks are completed. A calendar outline of topic discussions will be provided to the resident at the beginning of the rotation with the expectation that adjustments and modifications will need to be made throughout the month due to the unpredictability of the service. Example: Daily: 7:30 9:00 Pre-round/discuss pertinent issues with resident 1:00 3:00 Preceptor available in office to reviewing progress notes, discuss patient updates, etc. 3:00 4:30 Meet for topic discussions when planned Communication: A. Daily scheduled meeting times: Residents to prioritize questions and problems to discuss during scheduled meeting times as listed above. B. Residents are expected to read s at the beginning, middle and end of each day at a minimum for ongoing communication. This is appropriate for routine, non-urgent questions and problems. C. Office extension/cell phone text: Appropriate for urgent questions pertaining to patient care. D. Cell phone text/pager: Residents to page preceptor for urgent/emergency situations pertaining to patient care Expected progression of resident responsibility on this learning experience: Day 1: Preceptor to review learning activities and expectations with resident. Week 1: Resident to work up approximately 1/3-1/2 of the team s patients and present to preceptor daily. Preceptor to attend and participate in team rounds with resident, modeling pharmacist s role on the health care team. Week 2: Resident to work up approximately half of the team s patients and discuss problems with preceptor daily. Preceptor to attend team rounds with resident, coaching the resident to take on more responsibilities as the pharmacist on the team. 4

5 Weeks 3-4: Each week the resident is expected to take over the responsibility of working up more of the team s patients, continuing to discuss identified problems with preceptor daily. Once the resident is able to take responsibility for all patients assigned to the team, the preceptor will no longer attend team rounds, but will continue to facilitate the resident as the pharmacist on the team. 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 Who When Summative Preceptor End of week 4 Preceptor/Learning Experience Evaluation Resident End of week 4 5