Residency
Oncology Infusion
(Huntsman Cancer Institute) Rotation
Preceptors:
Daniel Sageser, PharmD (primary preceptor)
Lisa Cox, PharmD
Site Description:
The Huntsman Cancer Institute Infusion room pharmacy services 21 chairs, 3 beds and one private room. The HCI infusion room provides admixture and dispensing services to 50 to 75 patient visits per weekday as well as about 10 visits on Saturdays. The Infusion pharmacy is also the main location for all outpatient clinic needs including outpatient infusion treatments given in clinic, clinic injections, and drug information questions when the clinic pharmacist is unavailable. Another outpatient unit using our chemotherapy expertise is Moran Eye Institute. Technicians in this area are proficient in PhaSeal®, inventory management, and engaged in double check processes for safety. Pharmacists ensure safety and appropriateness of chemotherapy regimens, educate patients about chemotherapy, train residents and students, and participate in process improvements including but not limited to Order Template Committee, clinic injections flow, and turn-around time advances.
Rotation Description:
The pharmacists work with oncology nurse practitioners, physician assistants, oncologists, and hematologists to optimize pharmaceutical care of hematology and oncology patients. The resident's purpose is to develop the knowledge and skills needed to achieve competency in the provision of patient care and practice management in an outpatient hematology/oncology infusion center.
Rotation Goals:
- Demonstrate the ability to evaluate a patient from the clinic/pharmacy chart, laboratory information, and radiology information.
- Counsel a patient about chemotherapy and supportive care (nausea, vomiting, pain control, constipation, diarrhea, stomatitis, neutropenia, alopecia, anorexia.).
- Demonstrate knowledge of third party reimbursement issues which impact patient's access to care (i.e., prescription drug coverage/patient assistance programs).
- Demonstrate an understanding of the pharmacology, pharmacokinetics, adverse effects, pharmaceutical characteristics, spectrum of activity, and economic issues for each antineoplastic and supportive care drug dispensed to ambulatory oncology patients. Be familiar with proper handling procedures of chemotherapy agents.
- Be able to recognize and follow the different parts of an investigational protocol. Know how to log out and inventory investigational drugs. Be able to discuss ethical issues of placing a patient on an investigational protocol.
RLS Goals:
Goal R1.3: Prepare and dispense medications following existing standards of practice and the organization's policies and procedures.
Goal R1.5: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients and health care providers.
Goal R2.1: As appropriate, establish collaborative professional relationships with members of the health care team.
Goal R2.3: As appropriate, establish collaborative professional pharmacist-patient relationships.
Goal R2.4: Collect and analyze patient information.
Goal R2.9: Implement regimens and monitoring plans.
Goal E6.1: Identify a core library, including electronic media, appropriate for a specific practice setting.
| Rotation Activity | RLS Goal | Teaching Method |
| Attend tumor board a minimum of two times. Discussion of cases will follow meeting | R2.4 | I, M |
| Attend Fellow's conference as time and space allows | R2.4 | I, M |
| Counsel/Provide information for 15 patients. These may include medication histories, new medication counseling, monitoring of side effects. | R1.5 R2.3 R2.4 |
C, M, F |
| Work-up and presentation of patients to preceptor on daily or weekly basis. This includes brief description of reason for visit, primary disease history, medication therapy history, current therapy, and a patient centered problem list with medication therapy and monitoring associated with each. | R2.4 | C, M |
| Processing new chemotherapy orders. This includes evaluating laboratory values, organ function, dosage calculations, verifying orders, maintaining appropriate paperwork, etc. | R1.3 | C, M, F |
| Verifying chemotherapy admixtures. This includes evaluating schedule, dosage calculations, verifying admixture calculations, stability, and concentration dependence for appropriate medications. | R1.3 E6.1 |
C, M, F |
| Work with other healthcare professionals in the Infusion setting. This includes providing Drug information, verification/reconciliation of discrepancies in medication records, facilitation/triage of patient and medication needs. | R2.1 R2.4 R2.9 E6.1 |
C, M, F |
| Attend/ participate in pharmacology discussions of major chemotherapeutic classes of medication. | E6.1 R1.5 |
I, M, F |
Readings and Preparatory Work:
- Cancer Chemotherapy Manual sections on:
- chemotherapy orders
- extravasation policies
- safe handling and spill procedures.
- Know the more common chemotherapy vesicants.
- Educational Strategies to Promote Clinical Diagnostic Reasoning. Boen, JL. N Engl J Med 2006;355:2217-25.
- Others assigned/coached to find as needs arise.
Project/Presentation Description:
- One project to be completed by the conclusion of rotation to be determined by resident and service needs.
Typical Daily/Weekly/Monthly Activities:
Daily activities include verification and processing of chemotherapy orders for patients receiving therapy on that day, verification of chemotherapy admixtures, participation in pharmacology or disease state didactic discussions, counseling patients, and providing drug information for callers as well as nurses and other professionals in the infusion suite. Weekly activities include attendance at a tumor board, Fellows' conference, Residency conference, and PGY-2 Oncology Pharmacy Conference on Mondays. Monthly activities include completion of project.
Evaluations:
The resident will receive daily monitoring and feedback from infusion pharmacists and technicians. They will receive oral formative evaluation at least every other day from the rotation preceptor. The resident will sit down with the preceptor for a brief summative evaluation at midpoint (recorded in ResiTrak) and a complete summative evaluation at the end of the rotation (also recorded in ResiTrak).
