Authors
- Robert J. Haight, PharmD, BCPP, FAAPP
- Jenna Roberts, PharmD, BCPP
Minnesota Direct Care and Treatment, Pharmacy Services offers a number of unique training opportunities at multiple clinical sites for psychiatric pharmacy residents and pharmacy students. Some of these learning experiences include acute care psychiatry, forensic services, nursing home, adolescent psychiatry, and an outpatient clinic. Precepting models at Southern Cities Clinic (SCC), Faribault, MN and Saint Peter Regional Treatment Center (SPRTC), Saint Peter, MN in forensic services will be highlighted.
Southern Cities Clinic
The learning experience at SCC focuses on the assessment, treatment, and monitoring of patients diagnosed with intellectual and developmental disabilities. The rotation is currently offered to PGY2 psychiatric pharmacy residents but will be available for pharmacy students in the future.
During the eight-week rotation, the resident works directly with the clinic pharmacist to complete new patient consults, answer drug information questions, and complete provider-requested consults. Completion of consults also includes scheduled interviews with patients and their caregivers. After shadowing the primary preceptor, residents are expected to complete consult interviews and notes independently. This allows the resident to gain first-hand experience communicating with a care team instead of an individual patient. Since many patients are non-verbal or have cognitive limitations due to their diagnoses, the resident relies on caregiver assessments and feedback regarding symptoms, targeted behaviors, potential side effects, and ongoing treatment monitoring. This can be challenging since the needs and goals of patients may not always be known to their caregivers. Residents must collaborate with the multidisciplinary team members to ensure patients’ medication treatment plans are safe, effective, and avoid worsening concurrent medical diagnoses.
The rotation also provides opportunities for residents to develop literature review and clinical thinking skills due to the limited research and approved medications for the diagnoses and symptoms experienced by patients with intellectual or developmental disabilities. This also allows the resident to gain experience providing education on potential treatment options to providers, patients, and caregivers. Residents have worked with patients diagnosed with rare disorders, including Prader-Willi Syndrome, Cornelia de Lange Syndrome, Angelman Syndrome, and multiple diagnoses associated with 22Q deletions.
Due to patient anxiety, potential for agitation, and mobility concerns, residents also gain experience with telehealth appointments and interviews. While these appointments have their limitations, they also provide homebound or rural residents with opportunities to interact with psychiatric specialists, including pharmacists.
Saint Peter Regional Treatment Center
The learning experience at SPRTC introduces trainees to the challenges of treating patients with severe mental illness. Advanced Pharmacy Practice Experience (APPE) students explore multiple units within forensic services, including acute psychiatric care, transitions services, and the forensic nursing home. The PGY2 psychiatric pharmacy resident is assigned three units at higher levels of care to increase exposure to pharmacist needs.
APPE students are always accompanied by a preceptor for safety purposes. Over the five-week rotation, they participate in multidisciplinary rounds, document on complex patient cases, and lead medication education groups. During rounds, students directly observe interactions between the patients, staff, and psychiatric professionals. Students are encouraged to work on observation skills to assess patients for medication side effects and symptoms of mental illness. Preceptors work with students to assess and differentiate these presentations, such as determining anxiety versus akathisia, and how these observations can be used to guide medication recommendations. Students are then guided on how to accurately represent these observations in documentation. Additional opportunities include observing electroconvulsive therapy (ECT), leading discharge medication counseling, and completing drug information questions and consults.
The PGY2 psychiatric pharmacy resident rotation is a 9-week experience. The resident is expected to attend multidisciplinary rounds independently and work directly with the psychiatric practitioners by the end of the rotation with indirect oversight from preceptors. Collaborating with the psychiatric practitioners requires an understanding of each patient’s legal situation, which can impact medication adjustment options. The resident will lead and document on medication groups, which may require creation of patient education materials or additional follow-up based on patient attendance and participation. They attend unit meetings, including the Weekly Clinical Review (WCR), a multidisciplinary meeting with clinical and support staff where all patients are reviewed. The resident is expected to provide feedback on their experiences with patients and assist with medication questions. These opportunities allow the resident to gain hands-on experience with collaborative decision-making, approaching complicated medication recommendations, and patient and staff education.