Residency
Hematology & Oncology
Preceptors:
Tricia Jeppson, PharmD, BCOP
Thu Tran, PharmD
Jeffrey A. Gilreath, PharmD, BCOP
Daniel Sageser, PharmD
Site Description:
The Huntsman Cancer Hospital has 50 inpatient beds which are covered by Hematology, Oncology, and varying surgical services. Pharmacists on these services:
- Participate on Hematology or Oncology interdisciplinary medical teams
- Ensure safety & appropriateness of chemotherapy regimens
- Educate pharmacy residents, pharmacy students, and other members of the medical team
The clinical pharmacists work with either the hematology or oncology team to optimize pharmaceutical care of inpatients on these services. Each team may consist of oncology nurse practitioners, physician assistants, medicine residents, and hematology/oncology fellows and attending physicians. Responsibilities include rounding with the team, medication management, admission and discharge medication reconciliation, and patient counseling. In addition, pharmacists perform chemotherapy order entry and participate in a double check system for every chemotherapeutic agent ordered. A significant part of the pharmacist's time is dedicated to rounding, entering chemotherapy, counseling patients on chemotherapy and counseling patients about their medications at discharge.
Rotation Description
Typical expectations of residents include the following: working up approximately 8-15 hematology or oncology patients each day, interacting with the medical interns, medical residents, medical students, nurse practitioners, physician assistants, nurses, case managers, and attending physicians to resolve medication-related problems for these patients. The resident will attend rounds every morning, hold discussions with the preceptors on a variety of hematology/oncology topics, perform formal patient presentations to the preceptor, attend weekly oncology pharmacy resident "killer sessions", attend pharmacy grand rounds when schedule permits, respond to drug information requests from the providers, and precept pharmacy students also on rotation with the hematology/oncology program. In addition, the resident will have the opportunity to create a chemotherapy counseling poster and counsel patients on their chemotherapy regimen. One formal presentation on a hematology/oncology topic of choice will be formally presented to either the hematology or oncology team during the rotation. The presentation should be between 20 - 30 minutes in duration on the topic of the residents' choosing.
RLS Goals:
R1.1 Identify opportunities for improvement of the organization's medication-use system.
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.
R2.12 Document direct patient care activities appropriately.
R5.1 Provide effective medication and practice-related education, training or counseling.
R6.1 Use information technology to make decisions and reduce error.
E6.1 Identify a core library, including electronic media, appropriate for a specific practice setting.
Activities Evaluated
| Rotation Activity | RLS Goal | Teaching Methods |
| Work up approximately 8-15 hematology or oncology patients each day, Independently design evidence-based therapeutic and monitoring plans. | R2.4, R2.6, R2.7, R2.12 | Direct Instruction Modeling Coaching Facilitating |
| Interact with nurse practitioners, physician assistants, nurses, and physicians to resolve medication-related problems for these patients prior to leaving each day. | R2.1, R2.2, R1.1 | Modeling Coaching Facilitating |
| Attend rounds every morning. Make clear and appropriate recommendations to the rounding team. | All selected goals | Direct Instruction Modeling Coaching Facilitating |
| Participate in discussions with preceptor on a variety of hematology/oncology topics and attend weekly oncology pharmacy resident "killer sessions." | R1.1, E6.1, R2.8 | Coaching Facilitating |
| The resident will present all assigned patients to the preceptor daily and include a daily note in the online documentation tool used by the inpatient clinical pharmacy staff. Pharmacy residents will also provide documentation for home medications and vaccine status in PowerChart. | R2.4, R2.6, R2.7, R2.8, R2.12 | Coaching Facilitating |
| Attend pharmacy grand rounds when schedule permits. | R5.1, R1.1 | Facilitating |
| Respond to drug information requests from providers as they arise each day. Responses must be accurate and timely. | R2.1, R2.2 | Facilitating |
| Precept pharmacy students also on rotation with the hematology/oncology program. Provide clear and concise discharge counseling for assigned patients. | R5.1 | Coaching Facilitating |
| One formal presentation on a hematology/oncology topic of choice will be formally presented to either the hematology or oncology team during the rotation. The presentation should be between 20 - 30 minutes in duration. | E6.1, R5.1 | Facilitating |
| Complete one formal drug information question while on rotation with the hematology/oncology program. The choice of question will depend on the interests of the resident and the needs of the hematology/oncology pharmacists. The question will be prepared in the traditional "PICO" format (Patient, Intervention, Comparison, Outcome). | R2.6, R2.7, E6.1, R5.1 | Facilitating |
Reading and Preparatory Work:
- IDSA Febrile neutropenia guidelines 2002
- Oncologic emergencies: Diagnosis and Treatment Mayo Clin Proc. 2006;81(6):835-848
- Adult Acute Myeloid leukemia. Mayo Clin Proc. 2006;81(2):247-260
- Medical Progress: Acute Myeloid Leukemia NEJM 1999; 341(14):1051-1062
- Walczak JR, Carducci MA. A Practical Approach to Management of Recurrent Disease. Mayo Clin Proc. 2007;82:243-249.
- Jabbour EJ, Faderl S, Kantarjian HM. Adult acute lymphoblastic leukemia. Mayo Clin Proc. 2005;80:1517-1527.
- Jabbour EJ, Estey E, Kantarjian HM. Adult Acute Myeloid Leukemia. Mayo Clin Proc. 2006;81:247-260.
- ASHP Guidelines on Preventing Medication Errors with Antineoplastic Agents. Am J Health-Syst Pharm. 2002;59:1648-1668.
Topics to be reviewed:
- Oncologic emergencies
- Neutropenic fever
- Interpreting a CBC with differential
- Acute Myeloid Leukemia
- Others, based upon patient cases that the resident will encounter on rounds
Typical Schedule
Typical hours are 7AM until 5PM.
Monday: Overview of patients, Patient care rounds. Killer Session
Tuesday: Overview of patients, Patient care rounds
Wednesday: Overview of patients, Patient care rounds
Thursday: Internal Medicine Grand Rounds 8AM, Overview of patients, Patient care rounds, topic discussion
Friday: Overview of patients, Patient care rounds, topic discussion, patient presentations
Evaluation:
The resident will be evaluated daily during patient presentations and weekly during topic discussions with preceptors . They will have feedback regarding their ability to be effective on rounds and for each required activity or presentation listed above. The midpoint evaluation will review the resident's strengths and weaknesses and focus on areas of improvement for the resident to work on during the final two weeks of the rotation. The final evaluation will be a summative evaluation of all selected goals and will occur on the final day of the rotation.
