Abdominal Transplant Outpatient Clinic APPE

Saint Luke's Hospital Abdominal Transplant Clinic Advanced Pharmacy Practice Experience (APPE) Rotation involves the provision of pharmaceutical care for patients under the kidney and liver transplant teams. The area of practice is primarily in the transplant clinic in Medical Plaza 1 on the Saint Luke’s Hospital campus. Patients seen in this clinic include those in the pre-transplant evaluation and the post-transplant follow-up phases of care. 

This rotation allows students to experience working as a part of the multidisciplinary team, including nurse coordinators, nephrologists, hepatologists, surgeons, and other members of the transplant team.

Acceptable attire includes solid color scrubs (matching top/bottom without logos) or business casual. 

Potential Topics/Content

Specific topics which the student will learn through readings, topic discussions, and patient care shall include:

• Renal and liver transplantation and immunosuppressive therapy.
• Pharmacotherapy of complications associated with renal and liver transplantation.
• Management of chronic diseases in transplant recipients.
• Antimicrobial management including post-transplant prophylaxis, screening and management of opportunistic infections, and review of culture data.
• Assessing medication adherence/compliance.
• Smoking cessation counseling.

Activities

• Evaluate candidate for absolute/relative contraindications to transplant (EPA III).
  • Workflow: Review medical record, review immunization history, interview patient/care partner, read literature on pharmacological contraindications to transplant, develop a recommendation for candidacy, including therapeutic interventions to improve status.
• Review patients’ medications and allergies (EPA IV).
  • Workflow: Complete medication reconciliation (interview patient, review dispense histories, review outside records, call pharmacy if needed, pay special attention to medications of concern).
• Provide medication education to patients.
• Optimize medication therapy for post-transplant patients. 
  • Workflow: Review labs, culture results, drug levels, screen for drug-drug interactions and appropriate prophylactic therapies (dose and duration), ensure appropriate guideline directed medication therapies onboard.
• Screen and report adverse drug events or reactions. 
  • Workflow: Review common side effects for medications, interview patient to assess tolerance, document ADRs in risk management reporting system.
• Adjust medication doses based on renal function (EPA IV).
  • Workflow: Identify medications that require dose adjustment based on CrCl or liver function, make recommendations to transplant team.
• Participate in selection meetings by communicating medication-related concerns.
  • Liver Transplant selection meeting: Tuesdays at 15:30.
  • Kidney Transplant selection meeting: Wednesdays at 14:30.
• Education team members on medication therapies.

Other Activities

Attend noon conferences (PGY1, PGY2, APPE student presentations) as clinic schedule allows. 

Assessment of Performance

You will have a team of preceptors, including your assigned primary preceptor, who will provide frequent informal feedback on your performance. Your primary preceptor will complete formal evaluations with input from the team. Assessment of performance will be done using the respective school of pharmacy evaluation form, based on the entrustable professional activities domains (EPAs). The goal is for the student to be able to perform all patient care activities at a minimum level III (reactive supervision) or greater (IV intermittent supervision, V independently). 

The student and preceptor will meet at the beginning of the rotation to identify any additional goals/objectives/projects to be accomplished during the rotation and negotiate appropriate timeliness. Student development of a rotation calendar is strongly encouraged within the first or second day of rotation. A formal verbal assessment will be done at the midpoint of the rotation using the evaluation form as a platform. The student will also provide a formal written self-assessment at mid-point of the rotation. The preceptor will provide formal written and verbal evaluations within one week of the rotation’s completion.

Preceptors

Breanna Clark, PharmD, BCTxP

• School of pharmacy: University of Kansas
• Residency training: PGY1—University of Utah; PGY2 Solid Organ Transplant—University of Utah
• Specialty interests: Transplant, Infectious Diseases
• Professional involvement: American Society of Transplantation

Lindsey DeZotell, PharmD, BCPS

• School of pharmacy: South Dakota State University
• Residency training: PGY1 Saint Luke’s Hospital of Kansas City
• Professional involvement: Abdominal Transplant Selection Committee, Saint Luke’s Health System (SLHS) CRRT subcommittee, Kidney Transplant Outcomes Committee, SLHS Scheduling Committee
• Health system, hospital, pharmacy, and residency committee involvement: American College of Clinical Pharmacy (ACCP)
• Pharmacy awards, accolades: 2020 Missouri Society of Health-System Pharmacists Platform Presentation Research Recognition—Preceptor

Lauren Rice, PharmD, BCTXP

• School of pharmacy: South Dakota State University
• Residency training: PGY1—Methodist University Hospital; PGY2 Solid Organ Transplant —Nebraska Medicine
• Specialty interests: abdominal solid organ transplant, ambulatory care, medication adherence
• Professional involvement: American Society of Transplantation, Missouri Society of Health-System Pharmacists

Jill T. Robke, PharmD, BCPS, FASHP

• School of pharmacy: University of Kansas
• Specialty interests: Abdominal Transplant, Immunization, Work-life Balance, Preceptor Development
• Health system, hospital, pharmacy, and residency committee involvement: Co-chair System Pharmacy Education Team (SPET)
• Professional involvement: American Society of Health-System Pharmacists (ASHP), Kansas Council of Health-System Pharmacy (KCHP)
• Pharmacy awards, accolades: 2008 Preceptor of the Year, University of Kansas School of Pharmacy; 2009 ASHP Fellow; 2004 Missouri Society of Health-System Pharmacists (MSHP) Pharmacist of the Year; 2003 ASHP Best Practices in Health-System Pharmacy Award—Improving Immunization Rates in At-risk Patients; 2002 Drug Topics’ Pharmacist of the Year; 2000 MSHP Research Award; 1999 ASHP Foundation Asthma Patient Care Traineeship; ASHP 1999 Immunization Advocacy Grant; 1997 MSHP Research Award