Residency
BMT (Bone Marrow Transplant)
- Acute Care
Preceptors:
Kristen Vinik, PharmD
Mary Lampas, PharmD, BCOP
Stephanie Sanders, BS, PharmD, BCOP
Site Description:
The inpatient BMT unit at the University of Utah is a 12-bed inpatient hospital unit serving patients receiving stem cell transplants and acutely ill stem cell transplant recipients not currently receiving stem cell transplant. While the inpatient BMT unit has 12 beds, the pharmacists are responsible for managing pharmacotherapy for all patients admitted to the inpatient BMT service, regardless of physical location, including patients admitted to other areas of the hospital such as intensive care units. The acuity is very high and it is not unusual for patients to stay greater than 30 days.
Rotation Description:
The clinical pharmacists working with the inpatient BMT service are responsible for ensuring the clinical appropriateness and safety of all medications prescribed for admitted patients, verifying the accuracy and appropriate dispensing of chemotherapy orders, performing medication reconciliation at admission and discharge, and educating patients on their medications every time they are discharged from the inpatient BMT service. The pharmacists function in a decentralized capacity and work directly with BMT attending physicians, hospitalists, oncology fellows, physician assistants, nurse practitioners, nurses, medical assistants, as well as centralized pharmacists and pharmacy technicians to optimize pharmaceutical care of inpatient BMT patients. The pharmacist also works with the entire BMT program on updating standards of practice for all aspects of the BMT service, ensuring that standing orders for chemotherapy regimens are appropriate, and attending numerous multidisciplinary meetings including a weekly intake meeting where patients who will be admitted to the inpatient BMT service are discussed and planned for. The pharmacists also participate in pharmacy department educational activities and meetings as much as time allows based on the needs of the inpatient BMT service.
RLS Goals:
R1.5: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients and health care providers.
R2.1: As appropriate, establish collaborative professional relationships with members of the health care team.
R2.2: Place practice priority on the delivery of patient-centered care to patients.
R2.3: As appropriate, establish collaborative professional pharmacist-patient relationships.
R2.4: Collect and analyze patient information.
R2.8: Recommend or communicate regimens and monitoring plans.
R2.10: Evaluate patients' progress and redesign regimens and monitoring plans.
R2.11: Communicate ongoing patient information.
R5.1: Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
Activities Evaluated:
| Rotation Activity | RLS Goal | Teaching Methods |
| Work up and/or follow a minimum of 5 of the admitted patients each day, depending on patient load and the resident's comfort level with BMT practices. | R2.2, R2.4 | IMCF |
| Attend and participate in daily inpatient rounds. | R2.1, R2.2, R2.4, R2.8, R2.10, R2.11 | IMCF |
| Interact daily with physicians, nurse practitioners, nurses, medical assistants, other pharmacy personnel, and patients to resolve medication-related problems for these patients. | R1.5, R2.1, R2.2, R2.4, R2.8, R2.10, R2.11 | IMCF |
| Attend any educational activities within the oncology pharmacy department or within the BMT program as schedule permits. | MF | |
| Lead presentations on medication-related topics of the inpatient BMT team's choosing (if applicable). | R1.5, R5.1 | CF |
| Lead 5 discussions with preceptors on a variety of BMT topics. | R1.5, R5.1 | CF |
| Give 5 formal and/or informal patient presentations to the preceptors. | R1.5, R2.11 | CF |
| Respond to drug information requests from the providers and nurses | R1.5, R2.1, R2.4, R5.1 | MCF |
| Verify and enter orders for 2 chemotherapy regimens (if patient load allows), which will be double-checked by the pharmacist preceptor and an additional pharmacist. | R2.4 | IMCF |
| Assist in 5 patient's medication reconciliation at admission and discharge (if patient load allows), patient education at discharge, and maintaining accurate patient medication lists for the patients and BMT service providers. | R1.5, R2.2, R2.3, R2.4, R2.11, R5.1 | IMCF |
| The resident may complete one project while on rotation with the inpatient BMT service. The choice of project will depend on the interests of the resident and the needs of the BMT program. If the preceptor is working on a project of interest to the resident, they would be able to assist in that endeavor. | R1.5, R5.1 | CF |
Readings and Preparatory Work:
Residents are expected to read additional articles on each topic if the only suggested reading is a chapter from the HSCT - A Handbook for Clinicians textbook. This textbook has a large selection of appropriate readings listed at the back of each chapter. When more than one learner is on rotation at a given time, they will alternate leading the discussions but all involved should be capable of leading or taking over a discussion as much as possible.
Topics
- HSCT Basics
- Allo vs, Auto
- PB vs. BM vs UCB
- Conditioning Regimens
- Myeloablative vs. Nonmyeloablative
- Chemo dosing in obese patients
- Infection Prophylaxis
- Infections prior to engraftment
- GVHD
- Prophylaxis
- Calcineurin inhibitors
- Transplant Associated Microangiopathy
- Acute treatment
- Chronic treatment
- Steroid refractory GVHD
- Long term steroid side effects
- Drug Interactions
- Pulmonary Complications
Critical Care Considerations - Mobilization/apheresis
- Growth Factors
- Oral Complications/mucositis
- GI Complications
- VOD/SOS
- Infections
- Fungal
- Bacterial (NF)
- Viral (CMV)
Project/Presentation Description:
Residents may be asked to review literature for a given practice on this service and update our standards of practice. A brief presentation to the inpatient team is expected regarding a topic pertinent to the service at the time.
Typical Daily/Weekly/Monthly Activities:
Pharmacists start at 0700 by checking the daily cartfill for the inpatient BMT unit in central pharmacy. Residents will be trained on how to do this, but will not be expected to do this every day. Residents should arrive around 0700 to work up patients before rounds at 0930. Rounds typically last 2 to 4 hours, depending on the patient census and attending physician. Time after rounds is occupied by patient discharge and counseling, following up on planned interventions discussed in rounds, attending educational activities and meetings, entering chemotherapy orders, and topic discussions.
Evaluations:
Residents will receive daily feedback from the unit pharmacist regarding their knowledge, skills and abilities. A short summative evaluation will be recorded in ResiTrak at the midpoint of the rotation and a complete evaluation will be recorded in ResiTrak on the final day of rotation.
