IPPE/APPE Rotation Pearls

Lainie Linafelter & Gina LuchenPharmD Candidates 2017

University of Kansas School of Pharmacy

Objectives• Discuss tips for preparing for your

rotation• Introduce tools and tips that may be

useful during rotation• Review proper techniques for

responding to drug information questions, completing journal clubs, and preparing presentations

Before the RotationPrepare as much as possibleAsk what you can review:

Guidelines Institution/Location-Specific

PoliciesAsk what you need to bring:

LaptopsNotesReferences

Ask where and when to meet on the 1st day:BE EARLY…especially if on a unit

with rounding services

Ask about the dress code: Scrubs vs business casual vs

business professionalPrepare personal goals for each

rotationRead description of rotation site

on RxPreceptor.

Topics to Review Prior to RotationAnticoagulants

WarfarinEnoxaparin (Lovenox)Rivaroxaban, Apixaban, Dabigatran

Common disease statesHeart FailureHypertensionHyperlipidemiaCAP / HAP / VAPCOPD/Asthma Infectious disease notes susceptibility charts for antibioticsRelevant guidelines based on your specific unit / rotation

During the beginning/middle of your rotation, ensure you are following and completing relevant field encounters… don’t leave all of them for the spring!

Useful Items for Your White Coat PocketAntibiotic coverage charts or pocket guides (Sanford Guide)Useful usernames and passwords for KU-SOP DI resourcesCalculator (don’t rely on your phone)Pharmacy / preceptor phone numbersMini pocket notebookBLACK pens

Relevant Equations to Keep in MindCreatinine Clearance (CrCl)Ideal Body Weight (IBW)Adjusted Body Weight (AdjBW)Volume of Distribution (Vd)Metric conversionsInches centimetersPounds kilograms

Corrected Calcium

What to Ask as You Begin Your RotationWhat is within the pharmacists’ responsibilities?

Dosing adjustments?Home med to formulary conversions? IV to PO switches?Medication discontinuation?Medication histories / discharge counseling?

What can students do?Medication/discharge counseling?Medication reconciliation?Access to specific aspects of the patient chart?Progress notes / acuities or task lists / education documentation?Special projects?

Hospital protocols on antibiotic / anticoagulant dosing or monitoring?

Useful ToolsGlobalRPhLexiCompLexiCalculator

Clinical PharmacologyMicromedexGoodRx practical for

medication price estimates UptoDate good start for

disease state information

CredibleMeds QTcprolongation guideRxPreceptor Mobile AppFRAX Score CalculatorASCVD Risk CalculatorePSS Preventative Screenings

App

How to Process ChartsRefer to your preceptor for individual styles and pointers on

your unitIf no specific instructions provided make sure to look at:Notes H & P / Admission noteLabs BMP and CBC w/ differentialVitals BP, HR, RR, Temp, Height, WeightInputs and Outputs (I’s & O’s)Microbiology results / pending culturesMedication List

Drug Information QuestionsConfirmation from two sourcesDon’t rely solely on class notesInclude up-to-date guideline proofDon’t forget print-form books available in the hospital/pharmacyUtilize the primary resources cited within tertiary resourcesTake advantage of the institution/hospital libraryMedical librarians often can provide very useful primary resources

Guidelines

Other ResourcesUse references at the end of your class notes to guide your

searchEnsure the information you are using is the most recent/up to

dateConsult your preceptor on appropriate guidelines useHospital specific policies/protocolsLearn how to access themLearn how they differ from clinical guidelines

Rx Preceptor templates Journal ClubNew Drug Evaluation

Journal ClubsArticle title Study purposeLiterature JustificationEndpoints: Primary and

SecondaryStudy DesignType of studySubjects and randomizationQuestionnaire or study structure

MonitoringInclusions/ExclusionsSample of population

EthicsAnalysis and dataOutcomesTolerability / SafetyConclusionLimitationsClinical ImportanceCurrent guidelinesPlace in therapyFinancial and safety considerations

Journal Club App$6.99 appProvides great, up-to-date

landmark medical trialsBreaks down key pointsSuggests specific points that

should be included in journal club summariesQuick, easy access to

trials/studies

PresentationsPatient CaseSubjectiveObjective

Relevant labs NOT all labsAssessmentPlanPresent the facts as they

happenedEvaluate the plan based on

guidelines NOT opinionsLiterature ReviewSimilar to a journal club

Topic PresentationsUse visuals when explain

pathophysiologyFocus on medicationsKnow alternative therapies and

relevant literatureTopic DiscussionsFormal or informalDiscussions with or without

handouts

Presentations Continued…Clarify length, time, structure and expectations with preceptorThe content, tone, audience and detail may vary by the site

Specify if a rough draft needs to be submitted ahead of the presentationALWAYS save your work with your name on each page as a

PDFPrint ahead of time (a day prior if possible)Specify printing preferences with preceptor

References to UseUnless otherwise specified use AMA format:Author, et al. Title of article. Journal Name [using National Library of

Medicine Abbreviations]. Year, vol (issue no): pages. doi:###.####.

NEVER cite:Tertiary resources (LexiComp, UptoDate, Micromedex)Non-scientific resourcesNewspaper articles or opinion based literature