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Home Residency Rotations Blood & Marrow Transplant (BMT) Clinic (outpatient)

Residency

Blood & Marrow Transplant (BMT) Clinic (outpatient)

 
Rotation Preceptors

Stephanie Sanders BS, PharmD, BCOP
Kristen Vinik, PharmD
Mary Lampas, PharmD, BCOP

 
Site Description

The BMT clinic at the Huntsman Cancer Hospital is made up of a 10 chair, 4 bed infusion rooms, as well as numerous exam rooms. The clinic receives 10,000 patient visits per year serving patients receiving both autologous and allogeneic stem cell transplants. In 2007 the bone marrow transplant clinic also became home to a nationally recognized team of Multiple Myeloma physicians who are completing research in tandem autologous transplants.

The clinical pharmacists working with the BMT Clinic are responsible for ensuring the clinical appropriateness and safety of all medications prescribed for clinic patients, verifying the accuracy and appropriate dispensing of chemotherapy orders, performing medication reconciliation at clinic visits, educating patients on their medications as necessary. The pharmacists function in a decentralized capacity and work directly with BMT attending physicians, oncology fellows, physician assistants, nurse practitioners, nurses, medical assistants, as well as centralized pharmacists and pharmacy technicians to optimize pharmaceutical care of BMT clinic patients. In clinic pharmacists also work with transplant coordinators, a financial authorization team, and a prior authorization technician to ensure reimbursement for medications administered in clinic as well as outpatient prescriptions. 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' upcoming transplants are discussed and planned for. The pharmacists also participate in pharmacy department educational activities and meetings as much as time allows.

 
Rotation Description and Evaluated Activities

Typical expectations of residents include the following:

  • Interact daily with physicians, nurse practitioners, nurses, medical assistants, other pharmacy personnel, and patients to resolve medication-related problems for these patient (R2.1)
  • Evaluate a minimum of 3 patients coming into clinic each day, depending on patient load and the resident's comfort level with BMT practices (R2.2, R2.4, R2.6, R2.7, E7.4)
  • Sit in on provider patient clinic visits and discuss patient treatment plans with physicians (R2.1, R2.4)
  • Assist in the management of supportive care issues (nausea/vomiting, diarrhea, constipation, febrile neutropenia) (R1.5, R2.8, R2.9, R2.10, R5.1)
  • Provide patient education to at least one patient prior to a new phase of treatment and as necessary (R2.11, R5.1)
  • Maintain accurate patient medication lists for the patients and BMT service providers (R2.11)
  • Attend any educational activities within the oncology pharmacy department or within the BMT program as schedule permits (R2.1, R5.1)
  • Lead 5 discussions with preceptors on a variety of BMT topics (R2's)
  • Present at least 5 formal and/or informal patient presentations to the preceptors (R2's)
  • Respond to drug information requests from the medical staff (R1.5, R2.1)
  • Complete a practice improvement project if a need is identified that can be resolved within the 4 weeks of this rotation (eg. review and update a medication specific SOP) (R1.1)
  • Verify and enter a minimum of 2 orders for chemotherapy and 1 mobilization regimen, which will be double-checked by the pharmacist preceptor (R1.1, 1.3)
  • Typically, all 5 days per week are spent in direct patient care, with portions of time scattered through each day to complete educational activities and other expectations of the rotation.

 
RLS Goals & Objectives Evaluated

R1.1 Identify opportunities for improvement of the organization's medication-use system.
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.
R2.6 Design evidence-based therapeutic regimens.
R2.8 Recommend or communicate regimens and monitoring plans.
R2.9 Implement 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.

 
Discussion Topics

Hematopoietic stem cell transplantation (HSCT)

  1. Why it’s done
  2. How it’s done: autologous vs allogeneic, PBSCT vs BM vs UCB, DLI
  3. Preparative regimens
  4. Expected outcomes
  5. Timeline of immune system recovery
  6. Graft failure

Infectious risks associated with HSCT and prophylactic strategies

  1. Bacterial infections
  2. Fungal infections
  3. Viral infections
  4. PCP infection
  5. Immunizations

Graft-versus-host disease

  1. Acute vs chronic (mild, moderate, severe)
  2. Prevention
  3. Treatment
  4. Outcomes
  5. Calcineurin inhibitors

Pulmonary complications of HSCT

Transplant specific drug interactions

 
Typical Schedule

Pharmacists start at 0800 by checking the daily medications/infusions for the BMT clinic 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 0800 to work up patients before clinic appointments start at 8:30. Patient visits occur throughout the entire day, with the patient load varying from day to day. Time around seeing patients is occupied by patient counseling, following up on planned interventions (including lab values and drug levels), attending educational activities and meetings, entering chemotherapy orders, and topic discussions.

 
Evaluation

The resident will receive formative evaluation of their daily patient care plans and preparation for topic discussions. They will receive a brief summative evaluation at midpoint and a full summative evaluation on the last day of rotation.