Preceptor Training

Lutheran Hospital, Fort Wayne, Indiana

Geriatrics Rotation

Preceptor:  Jacqueline Clouse, PharmD 

Primary Objective

Pharmacy students will be able to strengthen their knowledge base and obtain clinical experience critical for success in geriatric pharmacotherapy and gerontology.

Goals

The overall goal of this rotation is to further develop clinical knowledge and skills in:

·        Senior care/geriatric pharmacy

·        Prevention and management of disability in older adults

·        Collaboration with other health and social services disciplines

·        Communication with and advocacy for older adults in one or more setting across the continuum to improve health outcomes

Objectives

1. Apply knowledge of aging and geriatric pharmacotherapy to care for older patients and make professional recommendations regarding appropriate, effective, and safe medication therapy.

Suggested student activities:

·        Required-Cite evidence from the geriatric literature to support therapeutic decisions while cases are being presented to preceptor.

·        Required-Participate in therapeutic drug monitoring and application of pharmacokinetic and/or pharmacodynamic principles in medication dosing in the geriatric population.

·        Complete formal write-up of geriatric-related drug information question.

2. Provide on-going medication therapy monitoring, assessments and recommendations for individual patients.

Suggested student activities:

·        Required-Follow eight geriatric patients over the rotation period (4 at Generations and 4 at Lutheran).

·        Required-Complete a pharmaceutical care plan for four patients.

·        Required-Provide eight written consultations based on actual or potential medication-related problems from the geriatric patients monitored.

3. Identify seniors who may be at high risk for medication-related problems and formulate potential solutions to identify, resolve, and prevent medication-related problems.

Suggested student activities:

·        Review and interpret patient information to identify active problems, (e.g., past medical history, pertinent physical examination findings, nutritional status, and laboratory results.

·        Describe common clinical manifestations of disease and adverse drug events that are unique to older individuals.

·        Required-Identify, resolve, or prevent actual or potential medication-related problems and provide documentation of the problem and interventions for eight geriatric patients.

·        Report and assess adverse events in the facility, including use of a national or regional adverse drug reaction-reporting program.

4. Participate in and demonstrate skill in communication with older patients by obtaining detailed medication histories, interviewing for potential medication-related problems, and ongoing counseling of patients regarding their medication regimens and their health.

Suggested student activities:

·        Meet with and monitor selected patients on a frequent basis until discharged from facility or service (e.g., chart reviews, consultation with professional staff, patient interview and assessment, and maintenance of concise but sufficiently complete records, including copies of written consultations and outcomes and appropriate notations in the patient charts).

·        Required-Review medication histories on selected newly admitted patients and those patients identified to be managed longitudinally.

·        Assess appropriateness, safety, and effectiveness of all drug therapies (prescription and over-the-counter), formulate optimal pharmacotherapy plans, and make corresponding interventions as appropriate for a predetermined number of patients.

5. Engage in collaboration with other health/social service disciplines and non-health professionals, including caregivers, in planning and providing care for older adults; appreciate the unique contributions of each member to the interdisciplinary team and the expanded role of the pharmacist on the team.

Suggested student activities:

·        Required-Assignment to Generations patient cares area and interface with that service as applicable.

·        Required-Participate in rounds with the Dr Rosanwo a geriatric specialist and attend patient care plan team meetings

·        Interact with other health care personnel in a manner consistent with the philosophy and policies of the institution.

·        Include interdisciplinary activities or other ongoing programs that occur onsite (e.g., accompany patient to physician’s office observe physical or occupational therapy, participate in nutritional educational sessions, attend support group meeting, collaborate on research initiatives).

6. Engage and demonstrate skill in verbal and written communications with other health professionals by making medication therapy recommendations and in-service presentations and by providing medication information to nurses and physicians on a frequent, informal basis.

Suggested student activities:

·        Required-Write up and present one patient for a formal case presentation and lead a discussion.

·        Interview the resident/patient or caregiver to obtain a medication history and assessments when appropriate.

·        Communicate therapeutic recommendations to other health professionals and patients and their caregivers.

·        Required-Present articles for the pharmacy from geriatric journal sources.

7. Demonstrate sensitivity to the social and psychological aspects of the aging process and understand how they impact medication use.

Suggested student activities:

·        Required-Provide patient counseling to self-medicating patients or patients being discharged, taking into account the special needs of the older adult patient in regard to vision, hearing and functional disabilities.

·        Required-Record anticipated goals for the rotations and perceptions about older adults and the setting of care throughout the duration of the rotation,, which can be utilized to discuss with the preceptor what the student has learned about him/herself, it goals were attained, and why or who not; note any changes in perceptions throughout the process

8. Observe, understand, and appreciate the medication use process in different settings of care and the scope of pharmacy services (administrative and clinical) needed by patients and facilities and have firsthand familiarity with methods of providing such services.

Suggested student activities:

·        Required-Observe and/or participate in the day-to-day operations of the internal dispensing pharmacy for distribution of medications from the pharmacy to the facilities in a timely manner.

·        Observe and participate in the procedures for medication order, medication acquisition, medication security, storage and control procedures, quality assurance procedures, and stat order procedures in skilled nursing and assisted living facilities and how these must conform to stat and federal regulations.

·        Describe the role of computerization in the drug distribution system and medication order processing.

9. Describe the economic and financial aspects of providing pharmacy services for individual older adults while considering the issues of access and culture/language for this growing segment of the population.

Suggested student activities:

·        Required-Price the medications on a monthly basis for the patients followed and research Medicare Part D plans

·        Observe application of national, state, regional, local and corporate financial procedures and resources when delivering pharmaceutical care to seniors.

·        Conduct a needs assessment for patients and caregivers.

·        Describe the role of payment for medications and for consultant pharmacy services.

·        Discuss with patients the issues of access, such as transportation, physical ability, and language barriers, as they relate to attaining pharmacy services.

10. Identify geriatric focused professional organizations and resources within those organizations.

Suggested student activities:

·        Utilize library and other resources within setting of care for assignments throughout the rotation period.

·        Required-Research and access the Web sites of geriatric focused professional organizations.

·        Discuss the benefits of joining geriatric focused professional associations with the preceptor.

Special Projects

It is required that at least one major project or activity be undertaken by the student. The project or activity should address a specific need of the pharmacy or the targeted patient population unique to each student and permit the student to make an important contribution to that need.

Suggested student activities:

Guidelines obtained from the ASCP Foundation/Eli Lilly and Company Senior Care Pharmacy Student Rotations.

About Lutheran Health Network:

Lutheran Health Network is a network of ten hospitals in the Fort Wayne, Indiana area. Lutheran Hospital of Indiana is 435-bed community hospital. The Lutheran Musculoskeletal Center is a 40-bed orthopedics joint-venture hospital adjacent to Lutheran Hospital.  St. Joseph Hospital is a 150-bed community hospital. The Rehabilitation Hospital of Ft. Wayne is a 35-bed rehabilitation hospital. Dupont Hospital is aa 135-bed community hospital.  Lutheran Health Network also encompasses Kosciusko Community Hospital in Warsaw, Indiana, Dukes Memorial Hospital in Peru, Indiana, Bluffton Regional Medical Center in Bluffton, Indiana and Porter Hospital in Valparaiso, Indiana.  Lutheran Health Network also provides pharmacy services to Community Memorial Hospital in Hicksville, Ohio.  Community Health Systems of Franklin, Tennessee owns all of the hospitals.  

Lutheran Hospital, St. Joseph Hospital, Dupont Hospital and the Rehabilitation Hospital serve northeast Indiana, northwest Ohio, and southern Michigan.  

Lutheran Hospital offers a wide variety of specialty services for neonatal to geriatric patient populations. Lutheran is the only hospital in N.E. Indiana that performs heart transplants and kidney transplants. There are four intensive care units to take care of patients with coronary, cardiovascular, medical/surgical, and pediatric needs. The hospital also has a Children’s Hospital within the hospital.  That area includes a 10 bed critical care unit and a 25 bed neonatal unit. A foundation has been laid to classify the hospital as a Level II trauma center, which will soon be implemented.  Other major product lines for Lutheran Hospital include cardiac care, oncology, orthopedics and neurological services.

St. Joseph Hospital has a nationally known regional Burn Center that is accredited by the American Bum Association. St. Joseph offers a wide variety of specialty services, including cardiology, cardiac surgery, pulmonology, critical care, infectious disease, nephrology, and rehabilitation services. The hospital also operates a regional wound care/hyperbaric clinic, and a transition care unit or skilled care facility.  

The Pharmacy departments are fully computerized operations offering complete unit dose and IV admixture services.  The computerized distributive and informatics services include paperless FAX-imaging order processing, generation of nursing medication administrative records, drug allergy and interaction checks, access to Lab and medical information, clinical intervention documentation and use of computerized drug information systems.

The pharmacies are highly automated.  The robot provides medication cart fill assistance for all hospitals of Lutheran Health Network.   Decentralized automated drug distribution cabinets are on patient care areas for distribution of PRN medications and first doses.  Bedside drug administration verification assisted by bar code technology has been implemented at two facilities and is planned for implementation at all facilities.  Computerized Patient Order Entry has been implemented at two facilities and is planned for implementation at all facilities.

Specialized clinical pharmacy services include a well-established pharmacokinetic dosing service, anticoagulation service, TPN dosing service, pain management service, Xigris evaluations, renal dosing service and erythropoietic growth factor dosing service with pharmacy responsible for the complete dosing and monitoring of patients. Pharmacists counsel patients as part of a medication discharge program, and provide inpatient and outpatient classroom teaching as a member of the diabetic and cardiac rehab programs.  The Anticoagulation Clinic is a pharmacy-run clinic with nursing participation.  The pharmacists are all ACLS certified and are members of the code blue team assisting in the preparation and administration of code medications, and documentation of code process and outcomes. The pharmacy is also involved in the weekly burn unit rounds. Other services include targeted drug therapy monitoring, drug usage evaluation, family practice resident rounds, and continuing education programs for pharmacists and nurses, consulting services for transitional care unit, community involvement, and medical committee participation (including Pharmacy & Therapeutics, Institutional Review Board, Medical Ethics, and Infection Control).  

PharmD clerkship rotations are designed to provide a unique practical learning experience. The student will be expected to actively participate in all facets of pharmaceutical care services that apply to their particular rotation. Depending on the rotation, students may spend some time at each facility. Work responsibilities will primarily be Monday through Friday.