Residency
Psychiatric Medicine (UNI) Rotation
Preceptors:
Russ Spence, RPh, MS
Mary Lou Hamill, PharmD
Site Description:
The University of Utah Neuropsychiatric Institute (UNI) at University of Utah Hospitals and Clinics is a 90 bed acute care psychiatric hospital located at 501 Chipeta Way in Research Park south of UUHSC. UNI is currently expanding and has started construction of an 80 bed addition that is scheduled for completion in the fall of 2011. Our mission is to optimize the quality of life of the people we serve by providing excellent, compassionate, and integrated health services throughout the lifespan. We are committed to provide excellence in behavioral and mental health care to the Intermountain West Community.
The University Neuropsychiatric Institute (UNI) is a full-service, psychiatric hospital providing mental health and substance abuse treatment. Our services include inpatient hospitalization, day treatment, intensive outpatient and outpatient services for children, adolescents and adults. We provide services to children and adults including primary care, psychiatric evaluations, medication management, counseling services, behavior support, and case management. UNI is a tertiary care facility for acutely ill psychiatric patients.
UNI patients are referred from emergency rooms, physiciand, law enforcement, and self referrals from Utah and many of the surrounding intermountain states of Idaho, Wyoming, and Nevada. UNI admits approximately 3200 inpatients per year. Most of UNI's patients are referred due to treatment resistance, severity of illness, or exacerbation of illness that can not be controlled by the referring physician. UNI contracts with Valley Mental Health for their patients requiring inpatient treatment, in addition Cirque Lodge( a private drug rehabilitation facility) sends their patients to UNI for a medical detoxification prior to admission to their facility at Sundance, Utah.
UNI has its own P&T Committee for managing the special needs of psychiatric patients. Medication education groups are offered weekly to both patients and family of patients. In depth monitoring of inpatients is needed to provide safe and effective medication use for these difficult to treat patients...
Rotation Description:
The usual 4 week rotation at UNI includes one week rotations with an attending team in each of the listed areas. Rounds for most UNI teams tend to be longer than many other services and may last 2-4 hours.
- Depression and bipolar
- Schizophrenia
- Inpatient detoxification and substance abuse
- Children’s disorders
Other mental illness may be seen depending upon patient admissions. These might include:
- Obsessive-compulsive disorder
- Personality disorders
- Generalized anxiety disorders
- Phobias
- Sleep disorders
- Eating disorders
- Developmental disorders
- Alzheimers
- Parkinsonism
- Delirium/dementia
- Sexual disorders
- Attention deficit disorders
- Tourettes
- Impulse control
- Movement disorders
Attendance and/or participation in treatment options to medications including the following:
- Electroconvulsive treatment
- Psychotherapy
- Music therapy
- Art therapy
- Stress reduction
- Opportunities are also available to participate in clinics caring for developmental disorders or autism
Routine drug information questions are received from most practitioners and usually involve one to two hours a day. Participation and leading the Wednesday patient medication education groups are required of all residents. Weekly case presentations to the pharmacy staff are utilized to demonstrate the residents’ knowledge of the major psychiatric illnesses. Residents must complete medication reconciliations for each of the areas they are assigned to. Attendance and participation at the following meetings is required:
- Pharmacy and Therapeutics Committee
- Patient Safety Committee
- Quality Committee
- Falls Committee
- Medication Error Committee
These activities help the resident develop their communication and literature evaluation skills as well as become proficient in the use of psychiatric medications in the acute hospitalized patient setting. Medication education of psychiatric patients is a key element of the rotation. Working daily with the team’s Physician, Nurse, and Social Worker is vital in providing the best possible after care for each patient. Processes may include providing assistance in obtaining patient medications, insuring the patient is placed in a setting that assists in patient compliance with medications, and educating the patient on problem solving for medication management.
RLS Goals
R1.1 - Identify opportunities for improvement of the organization's medication-use system
R2.4 - Collect and analyze patient information
R2.6 - Designing or modifying evidence-based therapeutic regimens
R2.10- Evaluate patients' progress and monitoring plans
R5.1 - Provide appropriate effective medication education counseling specific to psychiatric patients and their caregivers.
R6.1 Use information technology to make decisions and reduce error.
Activities Evaluated:
| Rotation Activity | RLS Goal | Teaching Methods |
| Use inpatient and outpatient electronic systems and patient paper charts to collect and analyze patient-specific medication, history and lab data each day of rotation for all assigned patients. | R 2.4 | Direct Instruction Modeling Coaching Facilitation |
| Design and modify both psychiatric and general medicine regimens for assigned patients based on the most current literature. Consider both therapeutic efficacy and safety related to the recommended therapeutic regimens. | R 2.6 | Coaching Facilitation |
| For each assigned patient, the resident must design a monitoring plan to evaluate the patient's daily progress for the duration of the patient's stay or the duration of the rotation - whichever is longer. As each assigned patient's psychiatric status changes, the plan must be revised and reviewed with the preceptor. | R 2.10 | Direct Instruction Modeling Coaching Facilitation |
| Maintain confidentiality of patient information. Understand added patient confidentiality issues of psychiatric patients and describe this added level of confidentiality to the preceptor. | R6.1 | Direct Instruction Modeling Coaching Facilitation |
| Provide appropriate effective medication education counseling specific to psychiatric patients and their caregivers at least 4 times during the rotation. | R5.1 | Modeling Facilitation |
| Participate in ADR reporting and trending using the Patient Safety Net system. The resident will observe the medication use system at UNI to identify opportunities for improvement in the pharmacy systems. | R1.1 | Direct Instruction Modeling Coaching Facilitation |
Readings and Preparatory Work:
Be familiar with basic medication treatment options for major psychiatric disorders prior to beginning of rotation. Examine the UNI shared file for medication information - http://healthcare.utah.edu/
Typical Daily/Weekly/Monthly Activities:
Standard time of attendance 7:00 - 4:30, Monday through Friday
- Preparation for rounds 7AM-8AM Monday through Friday
- Team Rounds 8-2 Monday through Friday (times vary by rotation) Follow-up for team rounds 12-3PM (this includes both patient and team F/U) Monday through Friday
- Attend P&T Committee meeting (3rd Monday of the odd numbered months, 12 - 1)
- Attend ECT during week 2 (Wed 5AM-8AM)
- Attend/lead patient medication education group Wed 3:45-5:30
- Attend/Lead family medication education group Wed 6-7PM
- Attend Art Therapy (second week of rotation TBA)
- Attend Music Therapy (second week of rotation TBA)
- Attend Psychotherapy (second week of rotation TBA)
- Attend Stress Relation (second week of rotation)
- Weekly case presentation (Friday time TBA)
- Weekly nursing in-service (TBA)
Evaluation:
The resident will receive regular feedback from the preceptors and pharmacist staff members at UNI. A midpoint summative evaluation will be discussed and posted in ResiTrak. A summative evaluation will be reviewed with the resident on the last day of rotation in ResiTrak.
