Residency
Burn -Trauma Intensive Care Unit PGY1
Preceptors:
Hsin Lin, PharmD
Maureen Ghanem, PharmD
Site Description:
Burn Trauma ICU is a tertiary referral center that receives burn patients from the Intermountain area (including Utah, Wyoming, Idaho, Colorado, Nevada, and Arizona). The BTICU is a unique experience in that these patients range in age from newborns to geriatrics with medical acuity ranging from intensive care to rehabilitation. The unit consists of 12 ICU beds, self-contained OR suite, and an outpatient clinic.
The majority of patients cared for in the BTICU have suffered some sort of thermal injury whether from flame, scald, electrical, or chemical source. In addition the BTICU cares for other types of wound related problems including Stevens-Johnson syndrome, toxic epidermal necrolysis, frostbite, necrotizing fasciitis, gangrene and other skin disorders which require surgical management.
BTICU is truly a multidisciplinary team consisting of an attending physician, one resident, two interns, occasionally a medical student, nursing, pharmacy, dietary, physical therapy, respiratory therapy, social work, and child life who rounds daily on each patient.
Rotation Description:
The pharmacy resident is responsible for the following activities: working up all 12 critically ill patients daily, interacting with attending physicians, surgical, orthopedic residents, medical students, clinical nurses, registered dietitians during rounds. Providing comprehensive pharmaceutical care, resolving medication- related problems for these patients, documenting all patient care activities on the daily monitoring sheet, and precepting pharmacy students also on rotation. The primary focus of this rotation is patient care and for the resident to become the primary pharmacy contact for the burn team. The resident is expected to attend daily medical rounds with the burn team.
Specific emphasis will be placed on infectious disease issues, altered pharmacokinetics of medication, and metabolic abnormalities that occur in burn patients. Other critical care issues encountered by the resident will also be addressed depending on the resident's experiences prior to this rotation.
RLS Goals:
R2.1 - As appropriate, establish collaborative professional relationships with members of the health care team.
R2.4 - Collect and analyze patient information
R2.6 - Design evidence-based therapeutic regimens
R2.7 - Design evidence-based monitoring plans
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
Activites Evaluated:
| Rotation Activity | RLS Goal | Teaching Methods |
| Collect relevant clinical information to be able to make clinical decisions and recommendations on up to 13 patients a day. | R2.4 | Modeling Coaching Facilitation |
| Formulate and design patient specific therapeutic regimens - including monitoring plans - based on collected data and evidence from quality sources on up to 13 patients daily. | R2.4, R2.6, R2.7 | Coaching Facilitation |
| Participate actively in rounds, answer all questions posed to the pharmacist, clarify all pharmacotherapy plans, become the team's primary source of information for pharmacotherapy issues. Continually update patients' therapeutic plans for the duration of patient stay or duration of rotation, whichever ends first. | R2.1, R2.8, R2.9, R2.10 | Modeling Coaching Facilitation |
| Patient presentations to preceptor daily - organized by organ system with plans supported by evidence-based medicine. | R2.6, R2.7, R2.8, R2.9, R2.10 | Coaching Facilitation |
| Nursing in-service (1 per rotation see description below) | R2.1, R2.6, R2.8 | Facilitation |
| Formal journal club (1 per rotation see description below) | R2.6, R2.9 | Facilitation |
| Topic discussions (2-3 per week all based on literature regarding burn patients and issues as seen while resident is on rotation) | R2.6, R2.9 | Facilitation |
Readings and Preparatory Work:
Will be provided during rotation
Topic discussions three times weekly
Project Description:
The resident maybe required to complete one project/presentation while on rotation with BTICU. The choice of project will depend on the interests of the resident and the needs of the multidisciplinary team.
Examples of project:
1. Assist with current QI/QA projects
2. Analyze trends on drug utilization
3. Journal club
- The article must be related to burn/trauma
- Must be approved by preceptor by Monday of the 2nd week of rotation
- Likely to have impact on patient care
4. Nursing-in-service
- Topic selected by recommendations from nursing staff in BTICU
- Will be given on 3rd or 4th week of rotation
- Will have direct impact on patient care
- Must include handout or PowerPoint presentation
Typical Daily/Weekly/Monthly Activities:
The resident is expected to be punctual and to prioritize daily activities. A typical day will be at least 8 hours (0700 to 1530), but additional time is expected to complete daily responsibilities and ensure best outcomes for the patient.
0730 - 1100 Daily - Pre-rounding (+ 0730 Surgical grand rounds Wednesdays ; 0730 teaching rounds/nursing in-service Fridays)
1000 - 1100 Daily - Brief patient discussions with preceptor
1000 - +1500 Daily - Rounding with multidisciplinary team
1300 - 1600 Daily - Patient discussions, Patient work-up and follow-up, core topic discussions, presentations
1400 - 1500 Daily - (+ Pharmacy grand rounds on Tuesdays)
1600 + Daily - The resident is expected to complete all pertinent patient care activities prior to leaving for the day. Outside reading and projects will also be expected.
**optional to see an OR case
Evaluation:
The preceptor will start the rotation rounding with the resident and provide feedback on their daily improvement. They will have a formal summative evaluation at the end of the rotation which will also be recorded in ResiTrak.
