Pharmacy Student Rotation Cardiac Surgery

Preceptor:
Khalid A. Alburikan, PharmD, BCPS
Format:
Five-week rotation emphasizing the understanding and management of
medication problems specifically focused on the patient undergoing cardiac
surgery. The patient population will predominantly be cardiac surgery (CICU
service) patients, but may include 21A and 31A patients if workflow needs or
unique learning opportunities arise. Both the identification of medicationrelated problems and the application of therapeutic management will be
stressed. The pharmacy student will assist the preceptor and any KSUMC
pharmacy residents in the delivery of care to this patient population.
When physically not present, the preceptor will be available by pager 0836 or
his designee will be available for assistance.
Rotation Materials:
This clerkship outline will be distributed the first day of the rotation. The
outline specifies rotational expectations. The pharmacologic management of
CICU patients will be the main focus. Required and supplemental reading
materials will be available through the KSU Cardiology Learning POD website
(http://cardiology-ksu.weebly.com/).
Rotation expectations:
Attendance
1. The Cardiac Surgery Rotation is conducted Sunday through Thursday,
excepting holidays, unless circumstances dictate a need for student
weekend attendance.
2. The student will attend all AM patient-care rounds in the
Cardiothoracic Intensive Care Unit (CICU) and acute care units
(21A/31A):
i. AM patient care rounds are conducted from 8:00 AM, Sunday
through Thursday.
ii. The preceptor (or a KSUMC pharmacy resident acting in his
stead) will be present with the student for AM patient care
rounds. Based on student performance and/or patient acuity,
the student may be given the opportunity to attend patient care
rounds without the preceptor later in the rotation month.
3. The student will attend all Critical Care Learning POD group learning
sessions, Journal Club, unless excused by the preceptor in advance.
Other responsibilities (patient care responsibilities, learning
opportunities, project work, etc.) should be attended to at other times
during the day. Notable exceptions will be urgent/emergent patient
care situations.
4. The student will optionally attend certain Cardiac team meetings
(monthly journal club, monthly M&M meeting, weekly surgery

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King Saud
University College of Pharmacy

5.

6.
7.

conference) if patient care responsibilities and/or other learning

opportunities do not preclude it.
The student will optionally attend KSUMC Department of
Pharmacy meetings with the preceptor if patient care responsibilities
and/or other learning opportunities do not preclude it. The preceptor
will identify meetings that would be more advantageous for the
student to attend and may encourage the students attendance.
The standard rotation day will conclude at 4:00-4:30 PM, but may last
longer if unique learning opportunities or patient-care requirements
arise.
The student may miss 2 days of the rotational experience due to
absence. These absences should be cleared with the preceptor in
advance, if possible. If more than 2 days are missed, the student and
preceptor will meet discuss alternative student learning opportunities
to complete the rotational experience.

Patient care Clinical Activities

Patients in the CICU are critically ill patients status post coronary artery
bypass grafting (CABG), aortic and/or mitral valve replacement or repair,
heart transplant, and/or ventricular assist device (VAD) placement. The
student will be expected to:
1. Collect, organize, and understand information from patients electronic
and paper medical records, laboratory data, medication administration
records (MARs) and from patient care rounds daily.
2. Assess the appropriateness of medication regimens and make
medication recommendations to members of the health care team.
Areas of emphasis include (but are not limited to):
a. Assess peri-operative hemodynamic monitoring and ensuring
appropriate medication treatment.
i. Understand the structure of and data acquired from a SwanGanz central venous catheter.
b. Ensure appropriate application of evidence-based medications to
cardiac surgery patients.
c. Use pharmacokinetic principles and knowledge of renal and
hepatic medication clearance to calculate initial doses and make
adjustments to doses of medications, where applicable.
d. Recognize and manage drug-drug and drug-disease interactions.
e. Ensure appropriate deep vein thrombosis, stress ulcer, and
infection prophylaxis.
f. Assist the surgical team in selection and dosing of pain control,
sedation, and paralytic medications (when applicable).
g. Ensure conversion to and titration of oral antihypertensive
medications.
h. Recommend treatments for atrial fibrillation and other
dysrhythmias.
i. Respond to Adult Coronary Life Support (ACLS) events.
j. Ensure appropriate use of pulmonary medications for patients in
need of respiratory support.
k. Assess and recommend electrolyte replacement.
l. Monitor immunosuppressive medications.
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King Saud
University College of Pharmacy

m. Monitor anticoagulation medications (heparin, enoxaparin,

warfarin, dabigatran).
Patient care Counseling activities
1. Conduct anticoagulation patient counseling according to UNC

Hospitals Department of Pharmacy standards

a. All patients on the CICU services will be counseled prior to
discharge if they are to continue on the following
anticoagulant medications after discharge:
i. Warfarin
ii. Enoxaparin
iii. Fondaparinux
iv. Dabigatran
v. Rivaroxaban
2. Conduct complete medication discharge counseling on all patients
according to KSUMC Hospital standards.
Process improvement project
During the rotation month, the student will identify and complete a
cardiac surgery (CICU) service-based process improvement project. This
project is intended to systematically improve the pharmacy-related care
of patients on these services. Appropriate projects will ideally require 510 hours of dedicated student time to complete. If the student is unable
to identify a suitable project, they may choose from a running list that the
preceptor will maintain.
Downtime activities
If the student has a period of time during the rotation day that is not
directly accounted for with patient care activities, scheduled learning
activities, and/or meetings, the student should use that time to:
1. Read literature pertinent to the cardiac surgery/cardiology/critical
care patient population.
2. Work on process improvement project.
3. Pursue learning opportunities involving watching medical
procedures.
4. Speak with or observe non-pharmacy members of the healthcare
team.
5. Attend non-pharmacy organized learning sessions
6. Attend to other UNC pharmacy student administrative
responsibilities.
Evaluation
A midpoint evaluation will be held (at or near the 2-week mark) to assess the
students progress, acknowledge successes, and address any weaknesses.
This evaluation time will be open to entertain any further goals or interests
the student has for the rotation. At any time during the rotation the student
should make the preceptor aware if the structure of the rotation day, the
teaching style of the preceptor, or other factors are precluding the student

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King Saud
University College of Pharmacy

from having an optimal learning experience. The preceptor will endeavor to

restructure or improve the rotational experience accordingly.
The final evaluation will be comprised of preceptors assessment of rotational
expectations (patient care - clinical, patient care - operational, patient care
counseling, process improvement project performance evaluations and
downtime utilization); however knowledge base, other written work, and/or
verbal communication with the preceptor and healthcare team will be
weighed accordingly. A formal report, project, or test may be required at the
end of the rotation.

2015-2016

King Saud
University College of Pharmacy