Residency
Critical Care - Neurosurgery and Neurology Rotation
Preceptors:
Gary Davis, PharmD
Benson Sederholm, PharmD, BCPS
Chad Condie, PharmD
Site Description:
The Neuro Critical Care Unit (NCCU) located on the third floor of University of Utah Hospital is a 23-bed critical care and step-down unit including neurology, neurosurgery, and medicine patients.
Rotation Description:
The pharmacist functions as part of a multidisciplinary team comprised of a Neurointensivist , neurology and neurosurgery residents, nurse practitioner, medical students, clinical dietician and neuroscience nurses. Pharmacists in the NCCU are expected to round daily on all patients, provide drug information, counsel patients, and facilitate medication delivery. Didactic and experiential training includes a focus in the following areas: ischemic and hemorrhagic stroke, meningitis, closed head injury, spinal cord injury, seizure prophylaxis, status epilepticus, brain tumors, myasthenia gravis, epilepsy, Guillain-Barre syndrome, anticoagulation management, and other medical and neurological disorders. In addition, training will include DVT prophylaxis, stress ulcer prophylaxis, nutritional support, antibiotic therapy, increased intracranial pressure monitoring, cerebral physiology, neuromuscular blockade, etc.
RLS Goals:
R1.4 — Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the med-use system
R2.1 — As appropriate, establish collaborative professional relationships with members of the health care team.
R2.4 — Collect and analyze patient information
R2.8 — Recommend regimens and monitoring plans for critically ill patients.
R2.12 — Document direct patient care activities appropriately.
R2.6 & 2.7 — Design evidence-based therapeutic regimens and monitoring plans.
R2.10 — Evaluate patients' progress and redesign regimens and monitoring plans.
Activities Evaluated:
| Rotation Activity | RLS Goal | Teaching Method |
| Effectively participate in Neurocritical care interdisciplinary team rounds daily in order to establish collaborative professional relationships. | R2.1 | C, M, F |
| Follow and evaluate all patient information in medical chart, including data from PowerChart , Pharmnet and / or from patient or family discussions. This information to be collected before or during morning interdisciplinary rounds using appropriate monitoring forms for assessments and recommendations. | R2.4 | I, C, F |
| Independently recommend an evidence-based therapeutic regimen and corresponding monitoring plan in a way that is systematic, logical, accurate, timely, and secures consensus from the critical care interdisciplinary team. With the eventual goal to assess all patients on the Neurocritical care service. | R2.6, R2.7, R2.8 | C, F |
| Appropriately select direct patient care activities for documentation using patient specific monitoring forms, kinetic programs, as well as medication reconciliation documented in the medical record for all assigned patients. | R2.12 | I, C, F |
| Interpret and assess the appropriateness of a critically ill patient's medication order following existing standards of practice and the organization's policies and procedures -specifically looking to prevent therapeutic duplication, prn meds for specific indications, adherence to formulary agents and approved formulary policies and guidelines, as well as ways to reduce costs by changing to oral medications when appropriate or recommending to discontinue unnecessary medications. | R1.4 | C, F |
Readings and Preparatory Work:
Readings will include relevant clinical studies which impact patient care as well as available clinical guidelines for stroke, epilepsy, meningitis, and other conditions. Other readings include: disease state reviews found within the medical and neurocritical care literature, chapters from Pharmacotherapy, as well as PSAP modules of interest.
Project/Presentation Description:
The trainee will present patient cases daily, inservicies as needed, and conduct one journal club in which an article relevant to clinical practice is discussed and reviewed.
Typical Daily/Weekly/Monthly Activities:
Include following patients admitted to the Neurocritical Care service, participating in daily patient care rounds, outlining a pharmacotherapy care plan for a given disease states, patient medication education, and drug monitoring. The trainee will discuss patient cases daily and present one in-service and one journal club article.
Evaluations:
The resident will be assessed on their preparation for rounds and their use of the literature to develop recommendations. The preceptor will be available daily to observe the resident and will also receive feedback from the NCCU team. The resident will receive regular verbal feedback and a midpoint and final written evaluation.
