Heart Failure/Transplant APPE

The Heart Failure/Transplant (HF/TXP) rotation involves the provision of pharmaceutical care for those patients with advanced heart failure, including the provision of care for those advanced HF patients who have mechanical circulatory support (MCS) devices including, but not limited to ventricular assist devices (VADs), or those who have received a heart transplant. The complete spectrum of pharmaceutical care is experienced during the rotation, including:

• Medication order review, clarification, and validation
• Interaction with nurses regarding medication administration issues/questions
• Monitoring and assessing drug therapy
• Rounding with the healthcare team
• Providing patient/family education including, but not limited to anticoagulant education, transplant medication education, dofetilide, and sotalol education.

Interactions with other members of the health care team include staff physicians, residents and fellows, medical students, pharmacy residents, nurse practitioners, transplant coordinators, social workers, nurses, and dietitians.

Core Content 

Core content we will cover via actual patient care experiences, discussions, reading materials, and/or case presentations includes a review of the following:

• Cardiac Transplant
  • Overview
  • Induction therapy
  • Immunosuppressive therapy
  • Complications of immunosuppressive therapy
  • Associated medical problems
  • Drug-drug interactions
  • Rejection-monitoring and treatment
• Heart Failure
  • Acute decompensated
  • Chronic
  • Ventricular assist devices

We will emphasize designing, monitoring, and evaluating patient-specific pharmacotherapy. The preceptor serves as a role model and a learning resource for the student, but also provides the opportunity for independent practice as appropriate. The student is encouraged to take initiative in assisting the direction of the learning experience during the rotation to optimize his or her personal development.

Daily Activities

• Patient care rounds with the HF/TXP Services.
• Targeted drug therapy and TPN monitoring.
• Medication profile review and drug interaction screening for patients on the HF/TXP service.
• Adverse drug reaction and medication error reporting.
• Patient education as it relates to target medication teaching and other medications.
• Nursing education and participation in teaching opportunities with nursing staff.
• Drug information searches and responses.

Other Activities throughout the rotation 

• Students may have the opportunity to assist with care, profile review, and medication questions for the heart failure and transplant clinics.
• Students will be required to present a case presentation or journal club.
• Students may have the opportunity to present a Power Point presentation (approximately 30 minutes) at the end of the rotation on a topic to be determined by the student and preceptor.
• Students may have the opportunity to have another project (ex. write an article for the heart failure newsletter or complete a project for clinic, etc.) throughout the rotation.

Assessment

Assessment of student performance will be done using the respective School of Pharmacy evaluation form. The student and preceptor will meet prior to/at the beginning of the rotation to identify any additional goals/objectives/projects to be accomplished during the course of the rotation and negotiate appropriate timelines. Development of a rotation calendar is strongly encouraged. A formal verbal assessment will be done at the midpoint of the rotation using the evaluation form as a platform. The student will do a formal written self-assessment and preceptor will provide a formal written evaluation within one week of the completion of the rotation.

Preceptors

Kedra Blunck, PharmD, BCPS-AQ Cardiology

• School of pharmacy: University of Wisconsin-Madison
• Residency training: PGY1—Carl T. Hayden Veterans Affairs Medical Center
• Specialty interests: Cardiology Critical Care, Heart Failure, Transplant, Pulmonary Hypertension
• Health system, hospital, pharmacy, and residency committee involvement: Saint Luke’s Hospital Cardiac Transplant Team, Saint Luke’s Hospital Mechanical Circulatory Support Team, Saint Luke’s Pharmacy Residency Research Oversight Committee
• Professional involvement: American College of Clinical Pharmacy (ACCP), Cardiology and Transplant PRN, American College of Cardiology (ACC)
• Pharmacy awards, accolades: 2012 Missouri Society of Health-System Pharmacists Best Student Poster Award; 2012-2013 Saint Luke’s Hospital Pharmacy PGY1 Preceptor of the Year; 2015 Greater Kansas City Society of Health-System Pharmacists Pharmacist of the Year

Julie Welge, PharmD, BCPS

• School of pharmacy: University of Kansas
• Residency training: PGY1—Saint Luke’s Hospital of Kansas City
• Specialty interests: Cardiothoracic Surgery, Cardiovascular Intensive Care, Heart Failure and Cardiac Transplant, Mechanical Circulatory Support
• Professional involvement: Society of Critical Care Medicine (SCCM)
• Health system, hospital, pharmacy, and residency committee involvement: Saint Luke’s Health System Pharmacy Clinical User Group; Cardiac Transplant and Mechanical Circulatory Support

Leah Sanchez, PharmD, BCCCP    

• School of pharmacy: University of Missouri-Kansas City
• Residency training: PGY1—Houston Methodist Hospital; PGY2 Critical Care—Houston Methodist Hospital
• Specialty interests: Cardiology, Critical Care, Advanced Heart Failure, Cardiac Transplant
• Health system, hospital, pharmacy, and residency committee involvement: Anesthesia Evidence-Based Practice Team (EPT), Cardiac Transplant Selection Committee, Research Oversight Committee, Residency Advisory Committee

Preceptors are available via Voalte messaging system during working hours or via email.