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Hematology/Oncology Clinical Director Rotation IU Simon Cancer Center 1030 West Michigan Street Indianapolis, IN 46202 Preceptor: Christopher Fausel, Pharm.D. BCPS BCOP Office: 278-6866 Pager: 312-6356 Email: cfausel@iupui.edu Introduction The IU Simon Cancer Center is one of the largest facilities with inpatient units and an ambulatory oncology infusion clinic that treats patients with cancer in the Midwestern United States. It is the only cancer center in the state of Indiana designated as such by the National Cancer Institute. This one-month rotation is designed to develop the student’s knowledge and skills in the development and maintenance of pharmaceutical care of patients with the diagnosis of cancer. Furthermore, the student will gain exposure to the program development and financial oversight required to maintain a state of the art cancer center. Students will participate in the daily functioning of the ambulatory oncology infusion area and in the leadership meetings that focus on daily decision making and long-term strategy development. Clinical skills centering on problem identification and solving, interaction with multidisciplinary healthcare team members, communications skills, patient interaction, documentation of consultations, and provision of drug information are emphasized. Students will interact with the members of the leadership of the cancer center and the IU School of Medicine involved with the oversight of the ambulatory infusion program. Objectives In caring for the adult cancer patient, the student shall demonstrate the ability to: 1. Assess the financial viability of implementation of clinical pharmacy services in the context of a large medical school led cancer center. 2. Collaborative work with medical oncologists to develop best practice treatment standards for anticancer therapy. 3. Identify potential and real drug- and disease-related problems in cancer patients; 4. Assess the clinical significance of drug-related problems by prioritizing problems; 5. Select appropriate goals for resolution of the identified problems considering etiology, severity, pharmacotherapy, prevention of problem progression, prevention of complications of treatment, and prevention of problem recurrence; 6. Develop a plan and appropriate monitoring parameters to meet each of the stated goals; 7. Initiate appropriate interventions for each of the stated problems; Activities and Responsibilities 1. Work with clinical director to facilitate program development which includes the following activities: a. Participation with the Chemotherapy Infusion Center Oversight Committee on a weekly basis and follow-up with issues discussed. b. Participation in meetings with the finance department of the Indiana University School of Medicine to track infusion center pharmacy performance. c. Working with physician groups to develop standard practices for disease specific chemotherapy regimens and associated supportive care measures. 2. Participate in the daily functioning of the ambulatory infusion area which includes the following activities: a. Verifying chemotherapy orders The student is responsible for the evaluating and verifying the correctness of chemotherapy orders for patients. The student is responsible for calculating the patient body surface area, calculating the doses of the individual antineoplastic agents, critically analyzing the antiemetic regimen, and ensuring that all appropriate supportive measures have been ordered correctly. This includes, but is not limited to IV fluids, rescue medications (e.g. mesna, leucovorin, etc.) and laboratory values. All chemotherapy orders must be staffed with the preceptor. b. Maintain a current patient profile A patient profile (derived from progress notes, Careweb, and the Medication Administration Record) will be maintained for each assigned patient. This profile must be kept current so that ready reference can be made to demographic information, pertinent medical history, chemotherapy for the current cycle, drug list, and appropriate therapeutic and laboratory monitoring parameters. c. Medication Reconciliation The student will assist with interviewing patients to obtain a complete medication history, including currently home medications, herbals, supplements, and allergies. This information will be compared to the patient’s current chemotherapy regimen to assess for drug interactions and contraindications to treatment. d. Preceptor discussion Periodic discussions between the student and instructor will be held to discuss selected topics and individual patients. The student will prepare for the meeting to sufficient depth of knowledge to be able to lead the discussion of the topic. Topics include but are not limited to: · Supportive care in oncology including antiemetic support, oncologic emergencies (tumor lysis syndrome, superior vena cava syndrome, hypercalcemia of malignancy), pain management and use of colony stimulating factors · Disease-specific treatment modalities for hematologic malignancies (acute leukemia, chronic leukemias, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, multiple myeloma) and solid tumor malignancies (lung, colon, breast, prostate and others) · Pharmacology and toxicity profiles of antineoplastic agents · Regulatory issues and practice standards for chemotherapy compounding (safety measures, Chapter 797 compliance) · Reimbursement strategies for cancer treatment e. Patient chemotherapy education Students will begin by shadowing the preceptor pharmacist and nurses in counseling patients regarding what to expect after chemotherapy is administered. As competency is documented the pharmacy student may be asked to assist with chemotherapy patient counseling. f. Intravenous drug admixture Students will be exposed to the necessary safety precautions and good manufacturing procedures required of preparing intravenous medications, specifically antineoplastics.
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