Mayo Clinic College of Medicine Pharmacy Services. Rotation Summary

Transcription

1 Mayo Clinic College of Medicine Pharmacy Services Rotation Summary Rotation Title: PGY-2 Pediatric Hematology-Oncology Rotation Length: 3-6 weeks Primary Preceptor Name: Amanda Kuper, PharmD, BPCS, Ron Sieve, RPh Phone: Hours: General Description: The Mayo Eugenio Litta Children s Hospital is a Hospital within a Hospital based at the Saint Mary s campus in Rochester. The Children s Hospital is a 130-bed hospital that includes a General Care Area, Pediatric Intensive Care Unit, Neonatal Intensive Care Unit (level II and level III), Pediatric Transplant Unit, and a Pediatric Infusion Therapy Center. The Pediatric Hematology-Oncology Service is the admitting service for pediatric patients requiring bone marrow transplantation and for those patients with any diagnosed or suspected hematological or oncologic disease. Depending on the disease and level of care required, they will admit patients to the Pediatric Transplant Unit, Pediatric Intensive Care Unit, or Pediatric General Care area. At any given time, approximately 50% of the patients on the service are hospitalized for complications of their treatment regimens and 50% are hospitalized for chemotherapy administration. The Pediatric Hematology-Oncology group is a member of the Children s Oncology Group and does enroll patients in a variety of investigational protocols. Topic Discussions: As a specialty resident in hematology and oncology, it is expected that the resident will already have a good working knowledge of chemotherapy medication and chemotherapy rescue agents, allowing the rotation discussions to instead focus on blood disorders, cancers, and pediatric considerations of treatment-related supportive care issues. The resident will be responsible for developing a knowledge base pertaining to the following pediatric hematology and oncology disease states and potential treatment complications. This knowledge base should include, but will not be limited to etiology, epidemiology, pathogenesis, clinical presentation, diagnostic criteria, prognosis, common treatment regimens, therapeutic goals, and pharmaceutical care monitoring parameters associated with each disease and treatment. Fluid and electrolytes Acute lymphoblastic leukemia Pharmacokinetic considerations Acute myelogenous leukemia Fever and neutropenia Ewing sarcoma Pain management Hepatoblastoma Nutritional support Hodgkin lymphoma Chemotherapy induced nausea and vomiting Non-Hodgkin lymphoma Tumor lysis syndrome Medulloblastoma Sickle cell disease Neuroblastoma Hemophilias/von Willebrand disease Osteogenic sarcoma Aplastic anemia Rhabdomyosarcoma Hemophagocytic lymphohistiocytosis Wilms tumor Pediatric considerations in BMT Down syndrome implications in cancer

2 Goals Selected: Goal R1.2 Provide concise, applicable, comprehensive, and timely responses to requests for drug information pertaining to the care of individuals with cancer. OBJ R1.2.1 (Analysis) Discriminate between the requester s stated drug information question and the appropriate drug information need(s) by investigating the clinical situation and obtaining appropriate additional information. OBJ R1.2.2 (Synthesis) Formulate a systematic, efficient, and thorough procedure for retrieving drug information. OBJ R1.2.3 (Analysis) Determine from all retrieved biomedical literature the appropriate information to evaluate. OBJ R1.2.4 (Evaluation) Evaluate the usefulness of biomedical literature gathered. OBJ R1.2.5 (Evaluation) Determine whether a study's conclusions are supported by the study results. OBJ R1.2.6 (Synthesis) Formulate responses to drug information requests based on analysis of the literature. OBJ R1.2.7 (Synthesis) Provide appropriate responses to drug information questions that require the pharmacist to draw upon his or her knowledge base. OBJ R1.2.8 (Evaluation) Assess the effectiveness of drug information recommendations. Goal R1.5 Establish oneself as an organizational expert for oncology pharmacy-related information and resources. OBJ R1.5.1 (Synthesis) Develop a strategy for earning credibility within the organization to be an authoritative resource on the pharmaceutical care of individuals with cancer. Goal R2.1 Establish collaborative professional relationships with members of the oncology health care team. OBJ R2.1.1 (Synthesis) Implement a strategy that effectively establishes cooperative, collaborative, and communicative working relationships with members of the interdisciplinary oncology health care team. Goal R2.2 Prioritize the delivery of care to individuals with cancer. OBJ R2.2.1 (Synthesis) Devise a plan for deciding which individuals with cancer to focus on if given limited time and multiple patient care responsibilities. Goal R2.3 Establish collaborative pharmacist-patient-caregiver relationships. OBJ R2.3.1 (Synthesis) Formulate a strategy that effectively establishes a patient-centered pharmacist-patient-caregiver relationship. Goal Collect and analyze patient information. OBJ.1 (Analysis) Collect and organize all patient-specific information needed by the oncology pharmacist to anticipate, prevent, detect, and/or resolve medication-related problems and to make appropriate evidence-based, patient-centered medication therapy recommendations as part of the oncology interdisciplinary team. OBJ.2 (Analysis) Determine the presence of any of the following medication therapy problems in the current medication therapy of an individual with cancer: 1. Medication used with no medical indication 2. Patient has medical conditions for which there is no medication prescribed 3. Medication prescribed inappropriately for a particular medical condition 4. Immunization regimen is incomplete 5. Current medication therapy regimen contains something inappropriate (dose, dosage form, duration, schedule, route of administration, method of administration) 6. There is therapeutic duplication 7. Medication to which the patient is allergic has been prescribed 8. There are adverse drug or device-related events or potential for such events 9. There are clinically significant drug-drug, drug-disease, drug-nutrient, or drug-laboratory test interactions or potential for such interactions 10. Medical therapy has been interfered with by social, recreational, nonprescription, complementary, or alternative drug use by the patient or others 11. Patient not receiving full benefit of prescribed medication therapy 12. There are problems arising from the financial impact of medication therapy on the patient 13. Patient lacks understanding of medication therapy 14. Patient not adhering to medication regimen OBJ.3 (Analysis) Using an organized collection of patient-specific information, summarize the health care needs of individuals with cancer. Goal Design evidence-based therapeutic regimens for individuals with cancer. OBJ.1 (Synthesis) Specify therapeutic goals for an individual with cancer, incorporating the principles of evidence-based medicine that integrate patient-specific data, disease and

3 medication-specific information, ethics, and quality-of-life considerations. OBJ.2 (Synthesis) Design a patient-centered regimen that meets the evidence-based therapeutic goals established for an individual with cancer; integrates patient-specific information, disease and drug information, ethical issues and quality-of-life issues; and considers pharmacoeconomic principles. Goal Design evidence-based monitoring plans for individuals with cancer. OBJ.1 (Synthesis) Design a patient-centered, evidenced-based monitoring plan for a therapeutic regimen that effectively evaluates achievement of individual with cancer-specific goals. Goal R2.8 Recommend or communicate regimens and monitoring plans for individuals with cancer. OBJ R2.8.1 (Application) Recommend or communicate a patient-centered, evidence-based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and individual with cancer in a way that is systematic, logical, accurate, timely, sensitive, and secures consensus from the team and patient. Goal R2.9 Implement regimens and monitoring plans. OBJ R2.9.1 (Application) When appropriate, initiate the patient-centered, evidence-based therapeutic regimen and monitoring plan for an individual with cancer according to the organization's policies and procedures. OBJ R2.9.2 (Application) When necessary, contribute to the work of the team that secures reimbursement for drugs used in a regimen for an individual with cancer. OBJ R2.9.3 (Application) Use effective patient education techniques to provide counseling to individuals with cancer and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, storage, and medication administration. Goal R2.10 Evaluate the progress of individuals with cancer and redesign regimens and monitoring plans. OBJ R (Evaluation) Accurately assess the progress toward the therapeutic goal(s) of an individual with cancer. OBJ R (Synthesis) Redesign the regimen and monitoring plan of an individual with cancer as necessary based on evaluation of monitoring data and therapeutic outcomes. Goal R2.11 Communicate ongoing patient information. OBJ R (Application) Ensure that accurate and timely medication-specific information regarding a specific individual with cancer reaches those who need it at the appropriate time. OBJ R (Application) When given an individual with cancer who is transitioning from one health care setting to another, communicate pertinent pharmacotherapeutic information to the receiving health care professionals. Goal R2.12 Document direct patient care activities appropriately. OBJ R (Analysis) Appropriately select direct patient-care activities for individuals with cancer for documentation. OBJ R (Application) Use effective communication practices when documenting a direct patient-care activity for an individual with cancer. Goal R4.1 Provide effective education and/or training to health care professionals and health care professionals in training. OBJ R4.1.1 (Application) Use effective educational techniques in the design of all educational/training activities. OBJ R4.1.2 (Synthesis) Design an assessment strategy that appropriately measures the specified objectives for education or training and fits the learning situation. OBJ R4.1.3 (Application) Use skill in the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching, and facilitation) 1. OBJ R4.1.4 (Application) Use skill in case-based teaching. OBJ R4.1.5 (Application) Use public speaking skills to speak effectively in large and small group situations.

4 Activities: Perform admission medication reconciliation and review all patients histories upon admission to the Pediatric Hematology-Oncology Service. Particular attention is paid to the medication/ allergy history. If indicated, the resident interviews the patient (or parents) concerning medication and/or allergy history. Identify and prioritize significant current and past medical history. Distinguish which of the problems identified require drug therapy. Current medications and dosing regimens. History of past drug allergies or adverse drug reactions. Past medications used to treat condition. Pertinent normal and abnormal laboratory values. Complete P-CARE section for CC-HPI-PMH (chief complaint, history of present illness, and past medical history) for each patient admission. Evaluate initial medication therapy regimen for appropriateness. Assess drug selection given the patient s medical problem list, gestational age, contraindications, and drug interactions. Evaluate dose given the patient s organ function, age, gestational age, weight, and potential drug interactions. Determine if route and method of administration is optimal for patient s needs. Evaluate regimen for therapeutic duplications or omissions. Develop a drug therapy-monitoring plan. Determine parameters (objective and subjective) to monitor for efficacy and/or toxicity. Determine how often each monitoring parameter should be reviewed. Define acceptable endpoints for therapy. Evaluate the outcomes of implementing the pharmacotherapeutic regimen and modify as needed based on continuous evaluation of data. Know the pharmacology of each drug used. Know the indication for each drug used. Assess drug selection given the patient s disease state, allergy history, age, weight, contraindications, and potential for drug interactions. Assess appropriateness of dosing for each drug used based on height, weight, and any organ dysfunction that may be present. Assess appropriateness of the route of administration for each medication. Evaluate regimen for therapeutic duplicates Ensure home maintenance medications are ordered appropriately if indicated. Assess and monitor fluid, electrolyte, and parenteral nutrition therapy. Determine appropriate volume intake, electrolyte requirements, and nutritional needs when applicable. Evaluate parenteral nutrition therapy for physical incompatibilities, appropriate fluid intake, caloric intake, and daily intake of electrolytes, vitamins, trace elements, fat, and protein. Provide pharmacokinetic consultation on any medications which may require monitoring by the drawing of drug levels. Document activities, daily patient progress notes, interventions, and required daily monitors in P- Care. Participate in the pharmacist s work up of chemotherapy regimens. Verify chemotherapy orders for completeness and accuracy against the protocol. Review CDM for complete and appropriate documentation. Review and assure laboratory values are appropriate for chemotherapy administration. Complete Pharmacy Chemotherapy Record. Profile orders on the patient s electronic record. Acquire extensive knowledge of the most commonly utilized chemotherapy COG protocols, with particular focus on background, treatment plan, drug information, and supportive care guidelines. Provide medication discharge counseling to the patient/family as requested by the preceptor, nursing or the Pediatric Hematology-Oncology team. Attend Heme-Onc service rounds daily. Contribute to drug therapy decisions, bring forth medication-related issues, provide drug information, and provide informal medication education as the need arises or is requested. Attend Friday morning Pediatric Grand Rounds. Goals/ Objective: R2.10 R2.12 R6.1 R2.9 R1.5 R2.3 R1.2 R1.5 R2.2 R2.8

5 Preceptor Interaction: Meet with preceptor on a regular basis to review Hematology-Oncology patients. Review past medical history, history present illness, and pertinent laboratory data as it relates to disease state and therapeutic drug monitoring, evaluate initial drug therapy, identify potential medication related issues, develop monitoring plan for medication therapy, report on parameters being following in monitoring plan, discuss potential modification of therapy base on results of monitoring, identify medication therapy endpoints and patient progress towards reaching the endpoints. Also, participate in assigned disease state and drug specific topic discussions with the preceptor. Present at least one 30 minutes inservice to the pharmacy staff or Pediatric Hematology-Oncology Service. As an alternative, may develop a specific pharmacy/medication project that pertains to the Pediatric Hematology-Oncology Service and their patients. Meet with the preceptor at the midpoint of the rotation for a verbal evaluation and near the end of the rotation for a written evaluation utilizing Resitrak. Evaluation Strategy: ResiTrak will be used for documentation of formal evaluations. For evaluations, resident and preceptor will complete the evaluations separately. Prior to signing the evaluation, the preceptor and the resident will compare and discuss the evaluations. This discussion will provide feedback for both the resident and preceptor on their performance. What type of evaluation Who When Verbal Preceptor, Resident Mid-Rotation Summative Preceptor, Resident End of learning experience Summative Self-evaluation Resident End of learning experience Preceptor, Learning Experience Evaluation Resident End of learning experience