PGY1 Pharmacy Practice Residency
Rotation Overviews

Nutrition Support Rotation

The Surgical Nutrition Support rotation is a five-week elective rotation for pharmacy practice residents. This rotation provides provision of nutrition support for those patients in all surgery units. The complete spectrum of nutrition support services are experienced during the rotation including:

  • Patient profile review with nutritional assessment and identification of nutrition support needs
  • Assistance with nutrition support order entry, order review, and order clarification
  • Rounding with the surgery nutrition support team
  • Providing nutritional support consults
  • Interaction with nurses, physicians, and nutritional support specialists
  • 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:

  • Benefits of enteral over parenteral nutrition
  • Indications/contraindications for parenteral and enteral nutrition
  • Monitoring nutrition related laboratory values
  • Electrolyte management of parenterally and enterally fed patients
  • Assessing nutritional status
  • Nutrient substrates and physical characteristics of tube feeding products
  • Drug/tube feeding interactions
  • Drug/parenteral nutrition interactions
  • Immune-enhancing enteral nutrition

     Surgical - Trauma Intensive Care Unit

The Surgical - Trauma Intensive Care Unit (STICU) rotation is a five week surgery / critical care rotation for PGY-1 pharmacy residents.  Pharmaceutical care is provided for those patients in the STICU, which is a 16 bed unit for critically ill general surgery, 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:

  • 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
  • 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
  • ICU associated thrombocytopenia

 

Medical Intensive Care Unit

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

 

Pediatric Intensive Care Unit

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 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:

  • 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

 

Neonatal Intensive Care Unit

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
  • Documentation of activities through the MIS intervention pathway
  • 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

 

General Pediatrics

Learning Experience:

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 childrent
  • 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

 

Transplant Surgery Service

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

 

Women’s Health

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 bed antepartum/postpartum unit, 8C-GYN/GCRC-GYN, a total of 13 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
  • Drug information services
  • Providing pharmacokinetic consults
  • Assistance with nutritional support recommendations
  • 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
  • Post-operative atrial fibrillation
  • Gastrointestinal stress ulcer prophylaxis
  • ICU analgesia, sedation, and neuromuscular blockade
  • Cardiovascular hemodynamic monitoring
  • Nutritional support for the TCVPO surgery patients
  • Pharmacokinetics in critically ill TCV surgery patients
  • Fluid balance and replacement in the TCV surgery patient
  • Post-operative nausea and vomiting

 

Ambulatory Care

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 Therapeutic Drug Monitoring clinic provides 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
  • Medication counseling and education - new prescriptions, medication compliance, inhaler technique teaching, glucometer technique.
  • Follow-up of detected drug therapy problems by alteration in therapy, initiation of new therapy, health education, referral to other sources of care, or other appropriate measures
  • Monitoring of serum drug concentrations providing appropriate recommendations
  • Provide educational in-services to nursing staff
  • Provide presentations to medical staff at Afternoon report - new drug therapy and/or optimal drug utilization
  • 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

 

Acute Care Cardiology

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, and other cardiovascular diseases.  The following are 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.
  • Formal in-service education to health care professionals.
  • Active participation in the hospital adverse drug reaction monitoring and reporting program. 
  • 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

 

Drug Information Service

The Drug Information Rotation is a required 5-week rotation in the PGY1-pharmacy residency 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 healthcare providers, administrators, and researchers
  • evaluating appropriateness and cost-effectiveness of drug therapy
  • supporting the Pharmacy and Therapeutics Committee and its Work Groups
  • supporting the professional development of pharmacy students, pharmacists, and technicians

To meet the rotation goals, the resident will:

  • respond to drug information requests
  • prepare a drug monograph or class review for presentation at a Pharmacy and Therapeutics Committee or Work Group meeting
  • attend all Pharmacy and Therapeutics Committee and Work Group meetings
  • participate in Drug Information Services Quality Assurance
  • participate in Journal Club
  • participate in tertiary literature review
  • attend meetings with pharmaceutical sales representatives
  • prepare two written assignments (eg, institutional newsletter article, segment of annual formulary review)

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

 

Hematology / Oncology

The acute care hematology/oncology 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 daily multidisciplinary rounds
  • Proactively identify preadmissions for planned chemotherapy and review the relevant studies for the regimens
  • Develop and maintain an active problem list and monitoring plan for all patients
  • Prioritize issues and interventions by level of importance to ensure prompt resolution of critical issues
  • Document all clinical interventions
  • Attend hem/onc grand-rounds weekly
  • Provide an in-service to health care professionals
  • Perform admitting medication history and provide discharge teaching as requested

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
  • Hyper-calcemia
  • Spinal cord compression
  • Other oncologic emergencies
  • Acute leukemia
  • Aggressive lymphomas
  • Stem cell transplantation

 

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 responsibility:

  • 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

The Infections Diseases (ID) rotation provides a five-week experience in anti-infective pharmacotherapy within the context of the adult ID consultation service and the Antimicrobial Stewardship Team (AST). The consultation service includes the attending physician, an ID fellow, medical students, and medical housestaff, in addition to the clinical pharmacy specialist. AST is primarily a pharmacist-run service with consultation available upon request from one of five ID faculty members.

The following activities represent the resident's responsibility:

  • 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 anti-infective therapy.
  • Evaluate all antimicrobial regimens for therapeutic appropriateness, drug interactions, 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.
  • Attend medical grand rounds (when related to infectious diseases), pharmacy grand rounds, ID case conference, ID didactic conference, ID journal club, and other presentations as designated by the preceptor

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
Internal Medicine

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, specifically GM1.  The focus of the rotation is the management of drug therapy in patients with multiple medical problems.  The GM1 team is comprised of an attending physician (representing internal medicine and various subspecialties), two upper level residents, two interns, medical students, and a clinical pharmacist. This team is subdivided into two teams: one upper level resident, intern, and 1-2 medical students.  An average daily census for one of the teams is 8-10 patients (16-20 patients for both teams).  The pharmacy practice resident (clinical pharmacist) will assume responsibility for an entire GM1 team.  Specifically, the pharmacy practice resident will be responsible for the following: 

  • 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
  • Participation in Medication Use Evaluations
  • 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