Residency

Neonatology Rotation

Preceptors:

Ruth Ruble, RPh
Franklin "Chip" Huggins, PharmD, BCPS
Susan Oddou, PharmD

Site Description:

The Neonatology rotation is in a 48 bed level IIIb newborn intensive care unit caring for VLBW and ELBW infants drawn from a diverse urban/rural population of approximately 2 million covering 5 states. Pharmacy services include pharmacokinetic dosing, parenteral nutrition, medication utilization review, medication decision making, patient counseling and education of pharmacy students, pharmacy residents and pediatrics residents.

Rotation Description:

This rotation provides an initial post-doctoral experience in the newborn intensive care unit. Upon completion the resident will be qualified as a beginning practitioner in the NBICU. During the rotation, the resident will provide pharmaceutical care to approximately 25 preterm neonates at various stages of development from very low birth weight infants to term infants with complications requiring intensive care. Disease states include newborn respiratory distress, sepsis and other infectious diseases, cardiovascular diseases, seizures and drug withdrawal. The experience consists of daily interdisciplinary patient rounds, daily drug utilization review and monitoring, providing drug information and consultation to the NBICU team, 1-2 in-services, a written drug information article for the unit newsletter, and participation in administrative and quality improvement activities. Specific skills emphasized during the rotation include pharmacokinetic drug dosing, infectious disease management, newborn resuscitation, sedation and analgesia, and management of parenteral nutrition.

RLS Goals:

R1.4 Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the 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.
R2.4 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.
R3.1 Exhibit essential personal skills of a practice leader.
R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.
E7.1 Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues.
E7.2 Communicate effectively.
E7.3 Balance obligations to oneself, relationships, and work in a way that minimizes stress.
E7.4 Manage time effectively to fulfill practice responsibilities.
E7.5 Make effective use of available software and information systems.

Activities Evaluated:

Rotation Activity	RLS Goal	Teaching Method
Round with medical team daily after working each assigned patient up. (Up to 25 patients per day on the primary rounding team.) The following items will be done for each patient daily: • Collect patients' information on the unit form • Write a daily therapeutic care plan for each neonate based on best current evidence in the notes • Make recommendations to the physician team daily to insure best medications, doses, schedules, or routes are used for each neonate problem identified by the resident and reviewed with the preceptor before and after rounds • Follow a resident-determined monitoring plan for each neonate daily to ensure appropriate effects of therapy - recommending adjustments to he medical team for both regimens and monitoring plans as needed • Check weight-based dosing regularly for each neonate as they grow • Ensure recommendations are made prior to leaving each day for assigned patients, and verify/double check orders entered by MD in CPOE and verified by pharmacists in central pharmacy • Attend and support newborn resuscitations	R1.4, R1.5, R2.1, R2.2, R2.4, R2.6, R2.7, R2.8, R2.9, R2.11, R3.1, R6.1, R7.1, R7.2,E7.4, E7.5	C,M,F
Provide discharge counseling for at least one patient's family during the rotation, instructing on medication use and administration.	R5.1, E7.1, E7.2
Present a formal, written patient case to preceptor weekly using best evidence for recommendations	R2.4, R2.6, R2.7	I
Give 2 presentations to medical team using current and relevant literature	R5.1, E6.1, E7.1, E7.2	C,M,F
Review and present the following topics with preceptor over the course of the rotation: a-Basic patient issues in our NBICU b-Infectious Disease c-Total Parenteral Nutrition d-Cardiac Circulation e-Patent Ductus Arteriosus f-Pharmacokinetics in Neonates g-Medications commonly used in the NBICU h-Hypertension and Hypotension i-Respiratory Distress j-General Obstetrics	R2.6, R2.7, R2.8E6.1, E7.5	I,F
Elective topics to be reviewed based on resident interest and patients in the unit at the time of the rotation: 1-Pulmonary Hypertension 2-Interventricular Hemorrhage and neurologic outcomes 3-Maternal Pregnancy Induced Hypertension 4-Necrotizing Enterocolitis 5-Neonatal Seizures 6-Poor Cardiac Function 7-Medications & Breastfeeding 8-Basic Patient Exam 9-Perinatal Substance Abuse 10-Placental Function 11-Resuscitation at Delivery 12-Neonatal Pain Management 13-Bronchopulmonary Dysplasia	R2.6, R2.7, R2.8E6.1, E7.5	I,F

Teaching Methods include: I=direct instruction, C=coaching, M=modeling, and F=facilitation

Readings and Preparatory Work:

Avery’s Diseases of the Newborn, 8th Edition

Bacterial Sepsis and Meningitis, pp. 551-577
Parenteral Nutrition, pp. 1061-1071
Acid-base, Fluid and Electrolyte Management, pp. 372-397
Patent Ductus Arteriosus in the Premature Infant, pp. 816-826
Bronchopulmonary Dysplasia, pp. 723-736
Surfactant Treatment of Respiratory Disorders, pp. 670-686
Pharmacologic Principles and Practicalities, pp. 427-437
Renal Vascular Disease in the Newborn (Hypertension in the Newborn), pp. 1326-1331

Essentials of Obstetrics and Gynecology, 3rd Edition

Preterm Labor and Premature Rupture of Membrances, pp. 312-323
Antepartum Hemorrhage, pp. 187-195

Readings from the literature as assigned

Project/Presentation Description:

The resident will prepare the monthly pharmacy article for the unit newsletter.

Typical Daily/Weekly/Monthly Activities:

Perform pharmacist review/monitoring of NBICU patients
Participate in multidisciplinary rounds and therapeutic decision making
Provide drug information to providers
Review/correct total parenteral nutrition orders
Provide pharmacy support to neonatal resuscitation
Collaborate with attending physicians, resident physicians, neonatal nurse practitioners, nurses, dietitians and respiratory therapists to ensure positive medication use outcomes
Instruct/mentor resident physicians in neonatal pharmacotherapy

Evaluation:

The resident will be evaluated regularly by the preceptor based on daily observation and follow-up with the medical team. The resident will receive formative evaluation (feedback) on their recommendations, presentations and article. A snapshot will be completed at three weeks for R2.9.2. A final summative evaluation will be provided at the end of the rotation in ResiTrak.

Pharmacy Services