Questions
1) Assess laboratory parameters and determine how this impacts care of the patient. Please describe 1 example .
Every morning when I visit the patients in a routine roundup, I review their records of laboratory parameters that include liver function and renal function. This review enables me to determine that the parameters are below normal. Therefore, I immediately make recommendations for the patients based on this information. For example, I saw a patient with INR of 1.6 taking 3mg. of Warfarin. I recommended increasing the dose of Warfarin to reach the therapeutic level of 2-3.
For now, I meet the skills required to assess the laboratory parameter. To improve my skills, I will undergo a keen observation every time I make a round visit to the patients. I will also make recommendations about the things that I see, and ask my preceptor for any clarification.
2) Demonstrate appropriate technique for obtaining patient vital signs (e.g., blood pressure, heart rate).
I have no chance measuring vital signs yet, but I’m comfortable applying this skill. I can demonstrate my capability in ambulatory care rotation.
Plan for improvement
1. I was able to determine that my patient was not in a complete heart failure regimen. Therefore, I recommended adding a beta blocker because of its mortality benefit per AHA/ACC guidelines.
2. I found out that my patient was only taking Hydralazine for her heart failure, so, I recommended adding Isosorbide Dinitrite per A-HeFT
3) Detect drug-related problems and develop a plan to solve these problems.
Plan for improvement
I will continue making medication reconciliation, and apply the necessary adjustment with the preceptor’s approval.
4) Create patient-specific therapeutic plans including therapeutic goals.
Plan for improvement
Review the patient’s disease status, make an accurate medication list, look for any lab trending, and create a specific plan for the patients.
5) Effectively present patient cases to a pharmacist, physician, or other healthcare professional in a concise manner.
Presentation:
I had a case presentation a week ago where I presented a summary about the history of present illness in a concise manner. During this presentation, I showed the pertinent lab value and relevant information for each state of specific disease.
Constant practice and the preceptor’s feedback help to improve this skill.
6) Accurate medication histories: examples
First, I asked the patient about her intake of medications and assessed her adherence. Then, as I looked at the patient’s medical chart, I realized that she has an allergy to Lisinopril without any documentation about the type of reaction. So, I decided to return and clarified my findings with the patient.
Second, I asked my patient about her medication list and assessed her adherence. As I looked deeply at the patient’s medication list from the pharmacy, I came to know that she has been taking inhaler. So, I immediately went back to the patient and asked her if she is taking inhaler for COPD.
Plans for improvement:
I aim to develop a system that would enable me to remember all the questions that I should ask the patient in an organized way.
7) Describe the patient’s education session you found most rewarding in counseling.
My most rewarding session was counseling a 73 years old male for NSTEMI. I provided the patient with a list of medications and counseled him about it. I informed him about the proper application of these medications, including the name, dose, routine intake, frequency, and indication for each medicine. In addition, I reviewed with the patient about the side effects of the medications and instructed him about the dose changes.
Plan for improvement
I usually have a checklist with me during the roundup and anticipate the questions of my patients so that I could answer them thoroughly. However, I think that having a casual conversation with the patients and interacting with them instead of focusing on the checklist will have more benefits to the patients.
8) Prioritize responsibilities for successful completion of patient care. Example
Last Tuesday, 3 patients were admitted overnight and planned to be discharged the next morning. I reviewed their medication list, interviewed them, and completed their medication histories before the rounds. In the afternoon, I prepared the medication list for the patients who will be discharged for home. I gathered relevant medication information, and I was able to counsel them on time.
Plans for improvement:
I will focus on the most important tasks for the patients.
9) Describe a task that has been an especially useful learning activity.
My preceptor asked me about some relevant questions and encouraged me to have an interactive conversation with the medical residents.
Plans for improvement:
I need to review the diseases that I commonly encounter in my rotation, and have an interactive conversation with the residents about patient care.
10) Evaluate drug information questions posed by a patient or healthcare provider
The first question came from my preceptor about the Famotidine dose in renal impairment patient CrCl<50 mL/minute. The answer is: Administer 50% of dose or increase the dosing interval to every 24 hours.
The second question was about the use of Felcanide in PVC, and according to CAST trial, it should be used.
Plans for improvement:
I am more confident identifying and applying evidence to the care of my patients.
