Residency
Emergency Medicine
Preceptors:
- Jeannie Rollo, PharmD
- Amy Scott, PharmD
- Erin Lingenfelter, PharmD
- Sarah Dehoney, PharmD, BCPS
Site Description:
The University of Utah Emergency Department is a Level I Trauma Center containing 33 ED beds and 10 Extended Care Unit beds and serves approximately 40,000 patient visits annually. During this rotation a resident will: perform medication history reconciliations, perform prospective reviews of medications administered in the ED, identify potential drug-related problems and communicate these to other health care providers, participate in trauma/cardiac/brain attack codes, participate in topic/article discussions, present patients to a preceptor, be a resource to the ED staff in the areas of pharmacotherapy, pharmacokinetics, drug interactions, adverse effects, and side effects of commonly administered medications, and may complete a project to improve pharmacy services in the area.
The Emergency Medicine rotation is held primarily in the University of Utah Hospital Emergency Department (ED) and the Emergency Department Extended Care Unit (ECU). The ED clinical team includes pharmacists, physicians, physician's assistants, nurses, EMTs, social workers, and case managers.
Rotation Description:
The resident will:
- Complete the Rotation Orientation Checklist with the preceptor during the first week
- Perform medication history intakes/reconciliation for a minimum of 20 patients
- Perform prospective review of medications administered in the ER, identify potential drug-related problems, formulate a pharmaceutical plan, and communicate this with the caregiver and/or the patient for a minimum of 2 patients per day
- Actively participate in at least 90% of cardiac arrest codes, trauma resuscitation, and brain attack evaluations during the resident's shifts
- Participate in bi-weekly topic presentations/article reviews
- Present 5 patients to preceptor daily in SOAP format
- Participate in board rounds with ED team when present (0700, 1600, 2400)
- Identify rational evidence-based drug therapy choices for common medical conditions treated in the ED
- Collaborate with other health professionals to assist in meeting the health care needs of patients in the ED
- Act as an easily-accessible resource to ED staff, residents and students regarding the pharmacology, pharmacokinetics, drug interactions, compatibility, adverse effects, toxic effects, and any other aspect of medications commonly administered in the ED setting
- Provide disease state education and patient-specific medication counseling in areas including anticoagulation and diabetes management for at least 2 patients during the rotation. Document this education in the electronic medical record
- Perform microbial culture follow-up daily which includes obtaining culture results, reviewing antimicrobial changes needed, and documenting interventions in the electronic medical record
- Identify opportunities for improvement of the organization's medication-use system by monitoring for medication errors and documenting via Patient Safety Net
- Complete an optional project to be determined by preceptor/resident to improve pharmacy services in the area
RLS Goals
R1.1 — Identify opportunities for improvement of the organization's medication-use system
R1.3 — Prepare and dispense medications following existing standards of practice and the organization's policies and procedures
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
R2.6 — Design evidence-based therapeutic regimens
R2.8 — Recommend or communicate regimens and monitoring plans
R2.9 — Implement regimens and monitoring plans
R2.12 — Document direct patient care activities appropriately
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 |
| Participate in cardiac arrest codes, trauma resuscitation, and brain attack evaluations | R1.3 | Direct Instruction Modeling Coaching |
| Be a resource to ED staff, residents, and students regarding the pharmacology, pharmacokinetics, drug interactions, compatibility, adverse effects, toxic effects, and any other aspect of medications commonly administered in the ED setting | R1.5 | Modeling Coaching Facilitating |
| Collaborate with other health professionals to assist in meeting the health care needs of patients in the ED | R2.1 | Coaching Facilitating |
| Identify potential drug-related problems, formulate a pharmaceutical plan, and communicate this with the caregiver and/or the patient Perform microbial culture follow-up which includes obtaining culture results, reviewing antimicrobial changes needed, and documenting interventions in the electronic medical record |
R2.6 R2.8 R2.9 R2.12 |
Direct Instruction Modeling Coaching Facilitating |
| Provide disease state education and patient-specific medication counseling in areas including anticoagulation and diabetes management | 5.1 | Coaching Facilitating |
Readings and Preparatory Work:**
Preparatory Work:
- Why ED Pharmacy?
- Rapid Sequence Intubation
Selected standard reading list topics (Bold are required):
- Rapid Sequence Intubation
- Toxicology
- ACS/unstable angina/MI/thrombolysis/anticoagulation
- CVA/TIA
- DKA/HONK
- Hypertensive emergency/urgency/HTN out of control
- Seizures
- DVT/PE
- Dysrhythmias
- CHF
- Infectious disease issues- pneumonia, UTI, meningitis, abdominal infections, SSTI, rectal abscess
- Asthma/COPD guidelines for ED management
**Reading file can be accessed through "Group" drive, clinical pharmacist, ED Readings
Optional Project/Inservice Description:
This will be determined at the beginning of each rotation
Past projects have included:
- Integrilin for ACS calculation sheet
- Rapid Sequence Intubation Inservice lecture for University Airmed team
- Medication Inservice lectures at ER Nurses Skills Day
- Educational Inservice on Cyanide Antidote Kit
Typical Daily/Weekly/Monthly Activities:
Rotations are typically 4 weeks of day shift (0700-1530) or 4 weeks of swing shift (1500-2330) as determined by the preceptors.
Attend Trauma Grand Rounds, Toxicology Case Conference as schedule permits
The ED can be a hectic environment. Having flexibility and good multi-tasking skills are helpful during the rotation.
Evaluations:
The resident will receive daily oral feedback regarding their ongoing performance and improvement. At the midpoint, a summary evaluation will be posted in Resitrak and a full summative evaluation will be documented after a face-to-face discussion of the resident's performance.
