PGY1 Pharmacy Residency
Rotation Overviews
The Surgical - Trauma Intensive Care Unit (STICU) rotation is a five week surgery/critical care rotation for pharmacy residents. Pharmaceutical care is provided for those patients in the STICU, which is a 16 bed unit for critically ill general surgery, solid organ transplant, burn injury, and trauma patients. The pharmacy resident would make rounds with the STICU team which generally consists of an attending physician, 3 physician housestaff residents, respiratory therapists, and nurses. The resident must devise strategies for accomplishing the required activities in a limited time frame while also balancing the other resident responsibilities. The complete spectrum of pharmaceutical care services are experienced during the rotation including:
- Read and understand the required goals and objectives for this rotation.
- Patient profile review with identification and resolution of medication related problems
- Assistance with medication order entry, order review and order clarification
- Rounding with STICU team and primary surgery teams
- Providing pharmacokinetic and nutritional support consults
- Interaction with nurses, physicians, and nutritional support specialists
- Monitoring and reporting of adverse drug reactions
- Providing drug information to the STICU team
- Documenting clinical interventions
- Coordination of distribution problems not resolved by in-patient pharmacy
Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
- Post-operative infectious complications
- Venous thrombosis prophylaxis
- Gastrointestinal stress ulcer prophylaxis
- Glycemic control in the intensive care unit
- ICU analgesia, sedation, and neuromuscular blockade
- Cardiovascular monitoring parameters when using inotropes
- Sepsis and inflammatory response syndrome (SIRS)
- Shock and related syndromes
- Nutritional support for critically ill surgery patients
- Pharmacokinetics in critically ill patients
- Fluid balance and acid / base disorders
- Fistulas and Ileus
- Burns
- Anemia of critical illness
The five week Medical Intensive Care Unit (MICU) rotation allows for the provision of pharmaceutical care to complex critically ill adults with multiple medical problems. The MICU is a 16-bed unit, and the MICU service averages 16-24 critically ill medicine patients. The MICU team is comprised of one attending (double board certified in pulmonary and critical care medicine), one pulmonary/critical care physician fellow, four second or third year medical residents, four medical interns, medical students, clinical pharmacy, bedside nursing, a nursing outcomes manager, and a clinical nutritionist. Subdivided into groups, the medical residents and students are separated into four sub-teams each having one intern, one upper level medical resident, and zero to one medical students. Exposure to a variety of disease states and pharmacotherapy management experiences occurs during the rotation. The pharmacy practice resident begins by covering approximately 8-10 patients, and works to increase patient volume throughout the rotation. The resident must assume responsibility and accountability for all pharmacotherapy management issues for their assigned patients. Generally speaking, the resident must provide the following pharmaceutical care services: patient profile review with medication/therapy problem identification and resolution; assistance with medication order entry, order review and order clarification; rounding with MICU multidisciplinary team; pharmacokinetic and nutritional support consults; responses to drug information requests; good communication and interaction with nurses, physicians, and nutritional support specialists; and coordination of distribution problems not resolved by in-patient pharmacy.
Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
- Hemodynamic support using inotropic/vasoactive agents
- ICU analgesia, sedation, and neuromuscular blockade
- Pharmacokinetics in critically ill patients
- Sepsis/septic shock/systemic inflammatory response syndrome (SIRS)
- Multiple organ failure and oxygen delivery in critically ill patients
- Fluid and electrolyte balance/replacement in critically ill patients
- Acute renal failure/uremic bleeding/acid-base disturbances
- Disseminated intravascular coagulation (DIC)
- Variety of infectious diseases (a few examples- Catheter-Related Blood Stream Infections, Hospital and Ventilator Associated Pneumonia, Community-Acquired Pneumonia, etc.)
- Acute respiratory distress syndrome (ARDS)
- Acute alcohol withdrawal
- Diabetic ketoacidosis (DKA)
- Hypertensive emergency
- Acute gastrointestinal bleeding
- Acute COPD exacerbation
- Acute overdoses ( tricyclic antidepressants, acetaminophen, miscellaneous)
- ICU prophylaxis issues: Gastrointestinal stress ulcer prophylaxis, venous thrombosis prophylaxis
The Pediatric Intensive Care Unit (PICU) rotation is a five-week critical care rotation for pharmacy residents. The focus of this rotation is the provision of complete pharmaceutical care services to the PICU patient population. The PICU is a 12 bed medical/surgical tertiary care unit. The patients range in age from newborns to young adults. In addition to trauma and general medical cases, the most frequent post-operative admissions are for neurosurgical procedures, open heart surgery, orthopedic surgery, or solid organ transplantation. The PICU is also capable of providing many new and investigational therapies, including extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide. Residents will be required to provide the following services:
- Daily patient profile review with identification and resolution of patient medication problems
- Daily rounding with the PICU service
- Pharmacokinetic consultations
- Drug information services
- Coordination of pharmacy services
Core content to be addressed through patient case presentations and topic review sessions include:
- Fluid and electrolyte management in the critically ill child
- Sedation, analgesia, and neuromuscular blockade in the PICU
- Management of seizures and traumatic brain injury in children
- Management of shock in children
- Parenteral and enteral nutrition
- Therapeutic drug monitoring and pharmacokinetic differences in infants and children
- Post-operative management
The Neonatal Intensive Care Unit rotation is a five-week critical care rotation for pharmacy residents. The focus of this rotation is the provision of complete pharmaceutical care services to the NICU patient population. The NICU is a 45-bed unit. The patients include both premature infants and term babies with underlying disease. The NICU is involved in several investigational drug studies and is capable of providing many new therapies, including extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide. Residents will be required to provide the following services:
- Daily patient profile review with identification and resolution of patient medication problems
- Daily rounding with the NICU service
- Pharmacokinetic consultations
- Drug information services
- Coordination of medication ordering and distribution problems, working in conjunction with the inpatient pediatric pharmacy
- Participation with the NICU Interdisciplinary Clinical Council
Core content to be addressed through patient case presentations and topic review sessions include:
- Medication needs of the preterm infant
- Parenteral and enteral nutrition
- Therapeutic drug monitoring and pharmacokinetic differences in the neonate
- Fluid balance and electrolyte replacement
- Post-operative management in neonates
- Normal growth and development
The general pediatrics rotation is five-week acute care rotation for pharmacy residents. The focus of this rotation is the provision of complete pharmaceutical care services to the 7 West and 7 Central patient populations. These two units can house approximately 40 medical/surgical patients. The patients range in age from newborns to young adults. In addition to general medical cases, other admissions include transfers from the PICU and NICU and children receiving chemotherapy. Residents will be required to provide the following services:
- Daily patient profile review with identification and resolution of patient medication problems
- Daily rounding with the general pediatrics service
- Pharmacokinetic consultations
- Drug information services
- Coordination of medication ordering and distribution problems, working in conjunction with the inpatient pediatric pharmacy
- Documentation of activities through the MIS intervention pathway
Core content to be addressed through patient case presentations and topic review sessions include:
- Management of sepsis in young children
- Fluid and electrolyte replacement
- Therapeutic drug monitoring and pharmacokinetic differences in children
- Fluid balance and electrolyte replacement
- Normal growth and development
- Medication error prevention and the development of pediatric clinical services
The Transplant Surgery rotation is a five-week surgery/critical care rotation for pharmacy practice residents. This rotation provides pharmaceutical care for those patients in the SICU for immediate postoperative care and the transplant unit for preparation for discharge. The Transplant Surgery Service performs surgery and long term care for adult and pediatric liver, kidney and pancreas recipients. An extensive research program is associated with the Transplant Surgery Service to learn more of the pharmacology of transplant immunosuppression and to provide cost effective therapy to transplant recipients. The complete spectrum of pharmaceutical care services are experienced during the rotation including:
- Patient profile review with problem medication order identification and resolution
- Enforcement of transplant service policies to initiate / discontinue standard medical therapies
- Assistance with medication order entry, order review and order clarification
- Aid patient enrollment into and monitoring on investigational drug protocols
- Participation in patient education program and discharge planning process
- Rounding with Transplant Surgery team
- Provision of pharmacokinetic and nutritional support consults
- Interaction with nurses, physicians, and nutritional support specialists
- Coordination of distribution problems not resolved by in-patient pharmacy
Completion of core content will be achieved via patient experiences, discussions of reading materials, and/or case presentations to include:
- Surgical techniques of organ transplantation
- Medical and surgical complications of organ transplantation
- Techniques of immunosuppression
- Identification and treatment of rejection
- Post-operative infectious complications
- Nutritional support for critically ill transplant patients
- Pharmacokinetic analysis in unstable / dynamic patients
- Fluid balance and fluid replacement in surgical patients
The Women's Health rotation is a five-week acute care rotation for pharmacy residents. This rotation provides the provision of pharmaceutical care for patients on the Obstetric, Gynecologic, and Gynecologic-Oncology teams. Women's Health encompasses Labor and Delivery, with 10 LDRP beds and 2 ORs, 8C-OB, a 14-22 bed antepartum/ postpartum unit, 8C-GYN/GCRC-GYN, a total of 14 beds in the combined units for gynecology and gynecologic-oncology patients, and an active triage area servicing the obstetric patient population. Pharmaceutical care services experienced during the rotation will include:
- Identify pharmaceutical issues in the obstetric population, develop plans for resolution, and discuss those plans with the preceptor and team
- Round with the Obstetrics and GYN-Oncology teams and establish a collaborative practice
- Gather and organize pertinent patient data
- Using the patient profile, review current medications and identify potential problems
- Develop specific therapeutic goals for the patient, relying on knowledge of the patient's underlying disease state(s), current health status, and outcomes of previous therapies
- Provide one brief written project, such as a review of specific disease treatments or novel therapies, for either Obstetric or GYN-Oncology nurses
- Attend educational opportunities, such as Grand Rounds and Tumor Board
- Provide pharmacokinetic consults
- Participate in the transmission of information about patients being discharged to home health agencies, if appropriate
- Appropriately document clinical activities and interventions
Core content which will be covered via patient experiences, discussion of reading materials, and/or case presentations includes a review of:
- Chronic disease management during pregnancy
- Infections during pregnancy, labor, and postpartum
- Contraception
- Gynecologic infections
- Gynecologic disorders
- Venous thrombosis prophylaxis and treatment
- Gynecologic malignancies and chemotherapy
- Management of cancer pain
- Management of cancer complications
Thoracic Cardiovascular
Post Operative Unit
The Thoracic Cardiovascular Post Operative (TCVPO) Unit rotation is a five-week surgery/critical care rotation for pharmacy residents. This rotation provides pharmaceutical care for those patients in the TCVPO as well as those patients on 4 West (30-bed acute care/intermediate care surgical unit). TCVPO is a 12-bed postoperative unit. The patients include cardiac, thoracic, and vascular surgery patients. In addition, the TCV is involved in LVAD (left ventricular assist device) placement as well as heart and lung transplantation. The complete spectrums of pharmaceutical care services experienced during the rotation include:
- Patient profile review with identification and resolution of patient medication problems
- Assistance with medication order entry, order review, and order clarification
- Rounding with the cardiac, thoracic or vascular surgical team
- Providing drug information services to members of the healthcare team
- Providing pharmacokinetic consults
- Assistance with nutritional support recommendations
- Monitoring and reporting Adverse Drug Reactions
- Interaction with nurses, physicians, nutrition support specialists and other healthcare providers
- Coordination of medication ordering and distribution problems, working in conjunction with the inpatient pharmacy
Core content that will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
- Post-operative infectious complications and its management
- Post-operative management of atrial fibrillation
- Gastrointestinal stress ulcer prophylaxis
- ICU analgesia, sedation, and neuromuscular blockade
- Cardiovascular hemodynamic monitoring
- Nutritional support for the thoracic, vascular or cardiac surgery patients
- Pharmacokinetics in critically ill TCV surgery patients
- Fluid balance and replacement in the TCV surgery patient
- Post-operative nausea and vomiting
The Ambulatory Care rotation is a five-week rotation for pharmacy practice residents. This rotation provides provision of pharmaceutical care for patients seen in the University Medical Associates (UMA) clinic. The UMA clinic is an internal medicine clinic composed of medical residents and attendings, nurses, nurse practitioners, social workers, respiratory therapists, and pharmacists serving a dual purpose of providing patient care and offering an ideal setting for resident outpatient education and training. The Pharmacy clinic provides chronic disease management and patient/ caregiver education including initiation of therapy, drug therapy monitoring and medication adjustment for diagnosed and treated patients referred by their primary care physician. The pharmacy services that will be experienced during the rotation include the following:
- Therapeutic drug monitoring and medication adjustment utilizing subjective and objective data, including ordering of all pertinent labs, their follow up and appropriate documentation.
- Medication counseling and education - new prescriptions, medication compliance, inhaler technique teaching, glucometer technique, insulin teaching, pill box education.
- Medication reconciliation
- Follow-up of detected drug therapy problems by alteration in therapy, initiation of new therapy, health education, referral to other sources of care and follow up of referrals, or other appropriate measures
- Monitoring of serum drug concentrations providing appropriate recommendations
- Provide educational in-services to nursing staff
- Provide a presentation to medical staff during Morning Report - new drug therapy and/or optimal drug utilization, guideline changes, etc.
- Provide drug information to physicians, nurses, and other health care providers in UMA
Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
- Hypertension
- Diabetes Mellitus
- Hypercholesterolemia
- Tobacco abuse
- Motivational Interviewing/Assessment of Readiness To Learn
The Coronary Care Unit (CCU) is a 10-bed intensive care unit and a 29 bed acute cardiology step-down unit. This is a 5-week rotation that provides experience in the management of patients with ischemic cardiac disease, heart failure, arrhythmias, hyperlipidemia, and other cardiovascular related issues. The following is a list of activities that are representative of the resident's responsibilities during the rotation:
- Daily medical rounds with attending physicians, residents, nurses, and medical students
- Daily patient profile review and identification of and resolution of any medication related issues
- Daily review of laboratory data to monitor for appropriate dosing of drug therapy and evaluation of nutritional needs of the patient
- Evaluation of all medical regimens for appropriateness and cost-effectiveness
- Proactive involvement in selecting, modifying and monitoring drug therapy
- Provision of medication information to physicians, nurses, and patients
- Monitor for and report Adverse Drug Reactions
- Documentation of pharmacist interventions and activities
- Maintain an active presence in the unit throughout the day
Core content that will be covered by patient experiences, assigned readings, topic discussions, and/or case presentations includes but it not limited to the following:
- Ventricular and Atrial arrhythmias
- Acute Coronary Syndromes
- Acute Heart Failure
- Post PCI Management
- Hyperlipidemia
- Intra-aortic balloon pumps
- Left Ventricular Assist Devices
- Cardiac Transplantation Criteria
- Hypertensive Urgencies and Emergencies
The Drug Information Rotation is a required 5-week rotation in the PGY1 Pharmacy residency program. The DI Service is responsible for providing comprehensive, unbiased, evidenced-based medication information, coordination of the activities of the Pharmacy and Therapeutics (P&T) Committee, management of the inpatient and outpatient Formularies and non-Formulary requests, management of drug shortages, oversight of the pharmaceutical service representatives, and the medication use evaluation program. While on rotation, the resident participates in all components of the Drug Information Service. These components include:
- providing comprehensive, unbiased, scientifically supported drug information to UVa-affiliated healthcare providers
- evaluating appropriateness and cost-effectiveness of drug therapy
- providing Formulary management
- supporting the professional development of pharmacy students, pharmacists, and technicians.
Discussions will include:
- Pharmacy and Therapeutics Committee/Formulary management
- Drug Information resource selection
- Evaluation of biomedical literature
- Ethics in drug information practice
- Relations with pharmaceutical industry representatives
The acute care hematology/oncology (hem/onc) rotation is available to PGY1 residents as an elective rotation or as a required acute care rotation. Residents on rotation will have the opportunity to work with a multidisciplinary team to care for patients with hematologic disorders, oncologic emergencies, acute complications related to cancer, acute leukemia, aggressive lymphomas, and solid tumors requiring complicated or aggressive chemotherapy regimens.
The following activities represent the resident's responsibilities during the rotation:
- Attend and actively participate in daily multidisciplinary rounds
- Develop and maintain an active problem list and monitoring plan for all patients
- Discuss patients in a problem oriented format with preceptor daily
- Develop a discharge plan for all patients (this process begins upon admission) and inform discharge coordinator of high cost/high risk discharge prescriptions
- Proactively identify preadmissions for planned chemotherapy and review the relevant studies for the regimens
- Read all pertinent CareCast (Centricity) notes on admission
- Prioritize issues and interventions by level of importance to ensure prompt resolution of critical issues
- Provide evidence based pharmaceutical care and drug information using the following resources: primary hem/onc medical literature, tertiary hem/onc references, professional organization practice guidelines (IDSA, NCCN, ASCO, ASH), ASCO & ASH meeting abstracts, and institutional guidelines
- Read one clinical study or review article every 2 days while on rotation
- Be familiar with formulary restrictions of medications used on the service and communicate with drug information or AST when use of a restricted drug is required
- Document all clinical interventions in the electronic medical record (MIS system
- Utilize pharmacists notes to communicate pertinent clinical information to other pharmacists
- Attend hem/onc grand-rounds weekly
- Provide an in-service to health care professionals
- Obtain admitting medication histories and provide discharge teaching as requested
- Inform preceptor of all commitments and planned time off by the second day of the rotation
- Spend at least 1-2 hours per day on the patient care unit to be available for questions
Core content to be covered via patient experiences, discussion or reading materials, and/or case presentations include but are not limited to:
- Tumor lysis syndrome
- Neutropenic fever
- Acute leukemia
- Aggressive lymphomas
- Stem cell transplantation
- Hypercalcemia
- Spinal cord compression
- Other oncologic emergencies
Neurosciences Intensive Care Unit
The Nerancy Neuro Intensive Care Unit (NNICU) rotation provides a five-week experience in critical care of neurological and neurosurgical patients. The NNICU is a 12-bed unit which provides care for critically ill neurosurgical, neurology, and occasionally, otolaryngology/head & neck surgery patients. The following activities represent the resident's responsibilities:
- Read and understand the required goals and objectives for this rotation
- Attend medical rounds daily with attending physicians, residents, and medical students
- Review patient charts and medication profiles daily for the identification and resolution of medication-related problems
- Proactively be involved in selecting, modifying and monitoring medical therapy
- Evaluate all medical regimens for therapeutic appropriateness and cost-effectiveness in a timely manner
- Prioritize issues and interventions by level of importance to ensure critical issues are resolved promptly
- Provide medication information to physicians, nurses, and patients
- Provide formal in-service education to health care professionals
- Participate in the hospital adverse drug reaction monitoring and reporting program
- Document clinical interventions and other therapeutic activities
- Maintain presence on the unit throughout the workday
Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
- Cerebrovascular disorders
- Subarachnoid hemorrhage
- Central nervous system (CNS) infections
- Electrolyte disorders of CNS origin
- Myasthenia gravis and myasthenic crisis
- Guillian-Barre syndrome
- Death by neurologic criteria
- Spinal cord injury
- Traumatic brain injury
Infectious Diseases is a five-week rotation for pharmacy residents and consists of experiences on the Antimicrobial Stewardship Team (AST) and the Adult Inpatient Infectious Diseases (ID) Consultation Service at the University of Virginia Health System. Interested residents may also spend a morning in the clinical microbiology laboratory.
Activities on the Antimicrobial Stewardship Team may include:
- Daily review of all category A antimicrobials for approval and appropriateness
- Documentation of category A approvals in MIS
- Participating in daily assessment of inpatient antimicrobial regimens and communicating recommendations to the primary team. Interventions may involve consultation with one of three attending infectious diseases physicians
- Participation in monitoring and documentation of team interventions
- Evaluation of clinical outcomes of team interventions
- Participation in AST-related educational activities (e.g. inservices, development of guidelines and prescribing policies)
Adult Inpatient ID Consultation Service:
- Daily rounds with Adult Infectious Diseases Consultation Service. If formal rounds do not occur, ID progress notes should be reviewed to ensure knowledge and appropriateness of team recommendations
- Designing, and recommending appropriate antimicrobial therapy regimens and monitoring plans
- Redesigning regimens and corresponding monitoring plans based on evaluation of monitoring data
- Providing antimicrobial use education to medical staff
- Providing concise and timely responses to requests for drug information for patients and medical staff related to anti-infectives
- Monitoring and reporting Adverse Drug Reactions
- Attending weekly ID case/didactic conference and ID bimonthly journal club
Core content which will be covered via patient experiences, discussions of reading materials, ID didactic lectures, and/or case presentations includes a review of:
- Bacterial mechanisms of resistance
- Bone and joint infections
- Catheter-related bloodstream infections
- Endocarditis
- Fungal infections
- Infections in the immunocompromised host
- Intraabdominal infections
- Meningitis
- Microbiological methods/susceptibility testing
- Pneumonia (community-acquired, healthcare-associated, hospital-acquired, ventilator-associated)
- Skin and skin structure infections
The Internal Medicine rotation is a five week acute care rotation for pharmacy residents. This rotation allows the provision of pharmaceutical care to patients admitted to a General Medicine Service (GM). The focus of the rotation is the management of drug therapy in patients with multiple medical problems. The complete spectrum of pharmaceutical care services experienced during the rotation includes:
- Daily patient profile review with identification and resolution of patient medication problems
- Assistance with medication order entry, order review and order clarification
- Rounding with the General Medicine Physician Team
- Providing pharmacokinetic consults and participating in nutritional support consults
- Providing drug information services to members of the healthcare team
- Monitoring and reporting Adverse Drug Reactions
- Interaction with nurses, physicians, nutrition support specialists and other healthcare providers
- Coordination of distribution problems not resolved by in-patient pharmacy
Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
- Acute Kidney Injury
- Chronic Kidney Disease
- Chronic Obstructive Pulmonary Disease
- Community Acquired Pneumonia
- Electrolyte Abnormalities
- Endocarditis
- Hospital Acquired Pneumonia
- Hyperglycemic Crisis Management
- Osteomyelitis
- Skin and Soft Tissue Infections
- Thrombosis: Prevention and Treatment
- Renal Replacement Therapy