2020-2021 STUDENT MANUAL

AMBULATORY CARE ROTATION

ROTATION DESCRIPTION

PRIMARY PRECEPTOR: Faria Chaudhry, Pharm D

PGY1 Ambulatory Care Pharmacist Resident
Email: faria.chaudhry@sjrmc.com phone (574) 335-6567

SITE DESCRIPTION :
Saint Joseph Health System (SJHS) is a member of the Trinity Health Network, a not-for--profit Catholic health system. It is one
of the largest multi-institutional Catholic health care delivery systems in the nation. Trinity health mission focuses on serving
together in the spirit of the Gospel as a compassionate and transforming healing presence within the community. Saint Joseph
consists of two acute care hospitals, one rehabilitation institute, independent/assisted/skilled-nursing/rehabilitation centers, and
clinics located throughout North Central Indiana. The Family Medical Center (FMC) and the Family Medicine Faculty
Physicians (FMFP) clinic are located on the fourth floor of the Medical Office Building (MOB), which is connected to Saint
Joseph Regional Medical Center (SJRMC). The Saint Joseph Family Medicine Residency consists of medical residents,
pharmacy residents, podiatry residents, medical directors, and pharmacy directors. These clinics are typically open Monday
through Friday 8 am – 5 pm.

The ambulatory care pharmacists at Saint Joseph Health Systems are responsible for a variety of patient care activities including

 Diabetes management appointments  Hypertension management

 Diabetes education classes  Asthma and COPD appointments
 Anti-coagulation clinic  Weight loss management
 Medication therapy management  Transitions of care
 Medicare annual wellness visits  Medication adherence
 Smoking cessation  Heart Failure Clinic

This rotation is designed to give learners the opportunity to refine their clinical and patient care skills by working collaboratively
with an interdisciplinary team and in pharmacist-driven clinics.

CLINICAL PHARMACY PRECEPTORS

Miranda MacFarlane, PharmD Chris Gildea, PharmD, BCACP, CDE

PGY-2 Pharmacy Resident Ambulatory Care Ambulatory Care Pharmacist
email: miranda.macfarlane@sjrmc.com phone: (574)-335-6490 email: christopher.gildea@sjrmc.com phone: (574)-335-4679

Stephanie McAfee, PharmD Carolynn Horn, PharmD, BCPS, BCACP

PGY-2 Pharmacy Resident Ambulatory Care Ambulatory Care Pharmacist
email: stephanie.mcafee@sjrmc.com phone: (574)-335-6493 email: carolynn.horn@sjrmc.com phone: (574)-335-5070

Molly Corder, PharmD Katie Clark, PharmD, BCPS

PGY-1 Pharmacy Resident Ambulatory Care Ambulatory Care Pharmacist
email: molly.corder001@sjrmc.com phone: (574)-335-6566 email: katherine.clark@sjrmc.com phone: (574)-335-7074

Jason Isch, PharmD, BCACP, CTTS Ed Sheridan, PharmD, BCPS, BCACP

Assistant Professor of Pharmacy Practice Manchester University
email: jish@manchester.edu phone: (574)-335-6520
Lauren McNace, PharmD, BCPS, BCACP
Ambulatory Care Pharmacist
email: lauren.mcnace@sjrmc.com phone: (574)-335-6563
Diana Mechelay, PharmD, BCPS, BCACP, CTTS
Ambulatory Care Pharmacist
email: diana.mechelay@sjrmc.com phone: (574)-335-6491
Director, Graduate Pharmacy Education and Ambulatory
Pharmacy Services
email: sheridane@sjrmc.com phone: (574)-335-6514
Ed Battjes, PharmD, BCACP, BC-ADM, CDE
Ambulatory Care Pharmacy Residency Program Associate
Director/Ambulatory Pharmacy Services Manager
email: battjese@sjrmc.com phone: (574)-335-6513
Brittany Oliver, PharmD, BCPS
Ambulatory Care Pharmacist
Email : brittany.oliver@sjrmc.com phone : (574) 335-6524
ROTATION OBJECTIVES:
By the end of the rotation the student should be able to:

1. Critique evidence-based guidelines, primary literature and laboratory results to make appropriate therapeutic
recommendations.
2. Appropriately provide written documentation and communication for treatment recommendations, progress and
interventions.
3. Participate and communicate appropriately in an interdisciplinary team to provide patient care.
4. Effectively communicate, interview and counsel patients using motivational interviewing.
5. Demonstrate an understanding of the pathophysiology, treatment, and monitoring of chronic disease states.
6. Illustrate skills finding, evaluating and applying primary literature to assess patient cases, journal clubs, topic
discussion or other projects.

ROTATION EXPECTATIONS
1. General expectations
 Prior to arriving on the first day of the rotation:
o Read the rotation manual
o Read the CaoguChek Monitrong Manual and complete associated quiz. Send quiz results to primary
preceptor. (Save file name as : CoaguChek INR_Student Name_Year)
o Register and complete the OutcomesMTM online training
o Sign confidentiality agreement and send to primary preceptor (Save as: Confidentiality
agreement_Student Name_Year)
o Notify the primary preceptor if there are any expected conflicts for the upcoming rotation
o Email the following to the primary preceptor:
 Documentation of Current CPR (or BLS) at the time of the student's rotation (Save as:
CPR.BLS_Student Name_Year)
 Documentation of a recent 8 panel drug screen (within 12 months from the student's rotation)
(Save as: Drug Screen_Student Name_Year)
 Documentation of a criminal background check (Save as: BackgroundCheck_Student
Name_Year)
 Documentation of vaccination status including Rubella, Chicken pox, and Hepatitis B (Save
as: Vaccines_Student Name_Year)
 Documentation of a recent PPD (within 12 months from the student's rotation) (Save as: PPD
Testing_Student Name_Year)
 Documentation of a current season influenza vaccine (Save as: Flu Vaccine_Student
Name_Year)
 CoaguChek INR Monitoring Quiz Result (Save as: CoaguChek INR_Student Name_Year)
 Confidentiality agreement (Save as: Confidentiality agreement_Student Name_Year)
 General expectations
o Participate in rotational activities for a minimum of 40 hours per week
o Arrive to rotation in a timely manner. Clinics typically occur Monday through Friday between 8 AM
and 5 PM, with an hour for lunch.
o May have an additional experience to work in community pharmacy opportunities on one or more
Saturdays between the hours of 8 AM and 1 PM
2. Professionalism
 Learner should adhere to professional dress code
 Learner should adhere to the policies and procedures of Saint Joseph Health System, including patient
confidentiality
 Learner should address any conflicts or request time off within the rotation at least 2 weeks before the first day of
rotation
 Learner should display respect and proper mannerism with patients, healthcare team and fellow peers
3. Ambulatory Care Pharmacy Clinic
  The student will have the opportunity to work in various ambulatory care pharmacy clinic experiences; however,
the preparation for and role within each clinic should be universal. As such, the student is expected to complete
the following actions before or after attending a clinic:
o Reach out to clinic preceptor 48 hours prior to scheduled clinic to get list of patients to work up and
schedule to discuss and present patients.
o Use appropriate monitoring form to evaluate assigned patients and develop plans.
o Arrive to patient discussions with appropriate materials: patient’s medication list, copy of completed
patient workup form, and assigned laptop.
o During clinic, if the student is not actively leading the interaction, the student should be documenting the
interaction for both subjective and objective information.
o After the clinic, the student should take direction from the clinic preceptor as to which patient
interactions to document. The student should take initiative to set a follow up time with the clinic
preceptor to review the completed documentation.
o At the end of the pharmacy rotation, the student should be able to successfully lead, either partly or
fully, an entire patient interaction.
4. Medical resident clinic
The student will potentially have the opportunity to work alongside the family medicine residents during one-half of
their clinic day.

Prior to attend clinic, the student is expected to complete the following:

 Using the appropriate monitoring form, evaluate all patients assigned to that clinic half day (except well-child
visits and well-women visits).
 Print out all of the patient's medications list.
 Set up time to discuss patients evaluated with pharmacy preceptor (please reach out to preceptor at least 48 hours
before scheduled medical resident clinic time). During this time, the student and preceptor will develop a list of
potential recommendations for each patient during the half-day of clinic.

During this experience, the student is expected to:

 Complete medication reconciliation using paper printout of the patient's medication list and inform medical
resident and nursing team members of results to update the patient's chart in the electronic health record.
 (If applicable), provide medication counseling and education to patients utilizing appropriate patient literature or
demonstration devices
 (If applicable), answer drug information questions. Depending on the significance of the question, provide the
answer to the individual who asked AFTER reviewing the answer with the pharmacy preceptor.
 Discuss pre-approved (already discussed with pharmacy preceptor) recommendations with medical resident.

5. Outcomes MTM clinic

At Saint Joseph Health System we provide medication therapy management (MTM) services for all patients in the
network using OutcomesMTM. Alongside a preceptor, the student will have the opportunity to utilize this platform
throughout their rotational experience to provide targeted interventions (TIPS) or comprehensive medication reviews
(CMR).
 Providing MTM Services – TIPS
o Identify eligible patients on OutcomesMTM platform
o Record the patient on Excel Tracking Sheet
o Analyze patient information and determine course of action
o Review evaluation and action times with preceptor
o Contact patient/prescriber to discuss TIPs
o Complete necessary documentation on Outcomes MTM and the Excel Tracking
 Sheet Providing MTM Services – CMR
o Identify eligible patients on OutcomesMTM platform
o Record the patient on Excel Tracking Sheet
o InContact patient to evaluate interest in CMR services
o Schedule patient to receive CMR o Analyze patient information and determine course of action
o If providing CMR over the phone or in clinic, provide CMR Service
o Complete necessary documentation on Outcomes MTM and the Excel Tracking Sheet
ASSIGNED PROJECTS AND TASKS
Informal Topic Discussion (1-4)
 15-30 minute presentation
 Student lead discussion
 May be asked to create an organized and
succinct handout with summary
 Use credible sources and guidelines to prepare
for discussion
Clinical Trial Presentation (1)
 20-25 minute presentation, 5-10 minutes for
questions
 Formally evaluable 3-4 reputable clinical trials
focused on one disease state
 Complete provided table (in Google drive) to
give overview on key points from trials
 Provide an interactive component
 Present to ambulatory care team
Formal Patient Case Presentation (1)
 Identify one patient case by second week of
rotation
 Briefly cover patient and clinical decision
 Review disease state and guideline driven
pharmacotherapy, include at least 2 clinical
trials
 Cite all references utilized (class notes are not
appropriate reference)
 Engage audience with possible interactive
portion
Journal Club (1)
 15 minutes
 Create a 1-page handout front and back
 Student will be asked to complete one journal
club or clinical trial presentation during the
rotation
 Learned will be a assigned a journal article. If
they are not assigned one, learner should send
three possible journal articles related to
ambulatory care, published within the last 12
months.
 Leaner must submit journal articles by the first
Thursday of their rotation. The preceptor will
assign the student the journal they will be
reviewing < 1 week.
Examples of completed presentation and handouts are available on the Google Drive (Student Examples folder)
Formal Topic Discussion (1)
 20-25 minute presentation with 5-10 minutes
for questions
 May create handout or PowerPoint
 Develop educational resource with an
interactive component
Diabetes Class
 Classes depend on the availability of the
classes. May be in person or virtual
 Present portion of diabetes classes, 3-5 slides
 Provide slides, handouts, and possibly an
interactive component
Oral examination (2)
 Learner will be given 30 minutes to work up a
mock patient case. Learner may use drug
information resources if needed
 Prior to presentation, may ask up to 3
questions to guide clinical decision
 Orally present patient case to pharmacy team
for evaluation
 This will be completed twice: once at the
beginning of the block and once at the end.
Patient Care and Drug Information Questions
 Students will be asked questions periodically
throughout the rotation
 If the student does not know the answer, it is
their responsibility to come back to the
preceptor with the answer within 24-48 hours.
If they will not be seeing the preceptor within
the time frame, they may email the preceptor
and their primary preceptor with the answer.
INITIAL QUESTIONNAIRE

1. What are your future careers plans or area of pharmacy you hope to practice in?

2. What rotations have you completed so far?

3. What are your goals for this rotation?

4. What are your strengths and why?

5. Why are some areas or skills you would like to improve?

6. What is your ideal way to learn and receive feedback?

7. What other pertinent information does your preceptor know in order to help you have a successful
rotation?
ORIENTATION CHECKLIST
 Introduction of instructor(s), preceptor(s), and other staff members
 Facility tour, student work spaces
 Collect, review and upload student rotation requirements
o Confidentiality Agreement
o Health Stream online training email confirmation
o Current CPR/BLS documentation
o Documentation of immunizations (rubella, varicella, hepatitis B, influenza)
o Documentation of recent PPD within 12 months from start of rotations
o Criminal background check
o 8 panel drug screen within 12 months from start of rotation
o CoaguChek INR Monitoring Quiz Results
 Review student initial questionnaire
 Review rotation goals, objectives, and expectations
 Discuss dress code and professionalism
 Discuss duty hours and time commitment
 Discuss process for requesting absences
 Review rotation schedule
 Review requirements for presentations
o Oral beginning/end of block
o Clinical trial evaluation
o Patient case presentation
o STEPS/formal disease state presentation
 Review expectations for experiences
 Discuss evaluation process
 Discuss computer access and resources
 Discuss how to review a chart
 Progress note training

APPE Student:__________________________________ Date _____________

Primary Preceptor: ______________________________ Date ______________