Oncology
Overview
The purpose of the rotation is to provide an opportunity for the resident to
provide pharmacist patient care to oncology patients (inpatients and outpatients)
at Unity Hospital. Residents on this rotation will be active members of the
oncology team. The resident learning focuses on patient-related problems, and
includes chemotherapy, neutropenia, antiemetics, pain management, supportive
care, and palliative care.
Preceptor
Leo Paquette, R.Ph.
Pharmacist
Contact information
Phone 763-236-4123
Fax 763-236-4143
E-mail leo.paquette@allina.com
Rotation location
Unity Hospital
Hours
Monday - Friday
(Approximate) 0730-1600
Goals
Goal S1: Take personal responsibility for attaining excellence in one’s own
ability to provide pharmaceutical care.
Goal S2: Demonstrate ethical conduct in all job-related activities.
Goal S3:Demonstrate the characteristics of a professional.
Goal S5: Appreciate the need to adapt direct patient care to meet the needs of diversity.
Goal S6: Use an organized system for staying current with pertinent literature.
Goal S7: Communicate clearly when speaking or writing.
Goal S9: Solve practice problems efficiently.
Goal S10: Function effectively as a member of the health care team.
Goal S15: Understand direct patient care delivery systems in multiple practice settings.
Goal S19: Manage time effectively to fulfill practice responsibilities.
Goal P2: Design, recommend, monitor, and evaluate patient-specific therapeutic regimens that incorporate the principles of evidence-based medicine
Goal P3: Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients, health care providers, and the public.
Goal P4: Document direct patient-care activities appropriately
Goal P5: Provide inservice education to physicians, nurses, and other practitioners.
Goal P8: Prepare and dispense medications following existing standards of practice and the health system's policies and procedures.
Goal M2: Prepare and disseminate written drug information.
Goal M16: Utilize pharmacy technical and clerical personnel effectively.
Goal M18: Provide instruction to pharmacy technicians, pharmacy students, pharmacy residents, and pharmacists.
Daily rotation activities
1. Monitoring, evaluating and optimizing drug therapy for each assigned patient daily. Review appropriateness of therapy/specific antineoplastic selected. Provide dosage calculations and adjust doses based on patient’s specific parameters. Identify appropriate laboratory tests and clinical assessments used to monitor for drug toxicity and tumor response. Collect clinical and laboratory information on assigned patients from the medical record, flow sheet and the nursing team. Monitor for adverse drug reactions and drug-related illness. Assess supportive care. Determine therapeutic plans, discuss with the pharmacist and make therapeutic recommendations.
2. Provide consultation for the prescribing of Total Parenteral Nutrition solutions. The resident should complete the TPN monitoring form, evaluate the patient and provide appropriate recommendations for TPN. Patients are followed daily and changes to the formulation are made according to the needs of the patient.
3. Perform pharmacokinetic assessments whenever serum drug levels are obtained. Common drugs include (but are not limited to) aminoglycosides, vancomycin, phenytoin, valproic acid and digoxin. The drug level(s) are to be evaluated using methods appropriate to the drug. Following evaluation, recommendations regarding dosage regimen adjustments are made to the appropriate physician. Documentation of the levels, pharmacokinetic analysis (as appropriate) and reasons for dose modification should be made in the patient’s medical chart. Documentation is also made on the pharmacy flow sheet.
4. Perform pain management assessment for assigned patients. Following evaluation and discussion with the pharmacist and pain team nurse, make recommendations on medication therapy to the appropriate physician. Documentation of the pain assessment should be made in the patient’s medical chart in collaboration with the pain nurse.
5. Participate in pharmacy department initiatives, such as I.V. to oral switch, automatic substitution of non-formulary drugs, automatic renal dosing program, and antimicrobial restriction policy.
6. Obtain pertinent medical literature to answer drug information questions and copy for team members, using appropriate reference sources.
7. Respond to questions from the nursing staff. In particular, questions about the compatibility of intravenous medications are problematic and require immediate attention.
8. Participate in patient education, as requested.
9. Provide nursing inservices on selected topics, as necessary.
10. Completion of DUE data collection, as assigned.
11. Discussion of oncology readings with the preceptor.
12. Identify, review and present two journal articles on an oncology-related topic to pharmacy staff. Prepare and present a case presentation for pharmacists.
13. Identification of adverse drug reaction.
Interaction with health care providers
The resident will work closely with the pharmacist and the oncology care team.
The resident will interact with the oncologists, nurses and other health care
providers. The resident will interact with patients and their families.
Meeting attendance
The resident will set up a meeting weekly with the preceptor for 30 minutes.
These meetings will allow time for the preceptor to review rotation activities
from the previous week and provide feedback on performance. The resident will
also set up a meeting on the last day of the rotation to review the preceptor
and resident evaluation. Additional meetings include discussion of oncology
topics three times weekly with preceptor. The resident will participate in care
improvement or service line meetings held during the rotation. The resident
will attend staff meetings at the rotation site.
Potential topics/disease states for discussion
- Chemotherapy for selected diseases: Leukemia, lymphoma, myeloma, breast
cancer, ovarian/endometrial cancer, lung cancer
- Protocols
- Investigational review board (IRB)
- Investigational drug policies
- Chemotherapy
- Colony stimulating factors
- Hypercalcemia malignancy
- Tumor lysis syndrome
- Extravasation management
- Neutropenia (focus on antibiotics and growth factors)
- Nausea and vomiting
- Pain management
- Supportive care
- Palliative care, death and dying
- Mouth care
- Nutrition management
- Transfusion care
- Handling cytotoxic and hazardous medications
- Resources for chemotherapy
Orientation to the rotation - the preceptor will:
- Provide the resident the goals and objectives for the learning experience
- List the activities the resident will be engaged in during the month to
accomplish the goals and objectives (see step 7 of the RLS process)
- Describe how the preceptor will evaluate the resident (e.g., objective data,
criteria based checklist)
- Provide the resident with self evaluation forms (e.g., rotation evaluation
from, criteria based checklist), and
- Communicate how will the resident evaluate the preceptor
- Establish routine meetings during the month to provide feedback and allow
time for clarifying expectations. Monitor the growth and development of the
resident during this time.
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