Required learning experiences at The Christ Hospital
Preceptor: Molly Webster, PharmD, BCPS
The Ambulatory Care rotation is a required four-week rotation for pharmacy practice residents. This rotation provides provision of pharmaceutical care for patients seen in The Christ Hospital Outpatient Medicine Clinic. The internal medicine clinic is composed of medical residents, fellows, attending physicians, nurses, patient care assistants, and pharmacists serving a dual purpose of providing patient care and offering an ideal setting for resident outpatient education and training. Pharmacy plays a role by providing medication therapy management including initiation of therapy, drug therapy monitoring and medication adjustment for diagnosed and treated patients referred by their primary care physician. Pharmacy is also actively involved in providing education to patients, caregivers, nurses and physicians as needed.
Core content which will be covered through patient experiences, discussions of reading materials, and/or case presentations including, but not limited to a review of:
- Diabetes Mellitus
- Congestive Heart Failure
- Gastroesophageal Reflux Disease
- Chronic pain
- Chronic Obstructive Pulmonary Disease
Preceptor: Angela Haskell, PharmD, BCPS
This rotation will provide the resident with exposure to the Antimicrobial Stewardship Program at The Christ Hospital and may only be done after completion of the Infectious Disease core learning experience. This rotation can be either a 2 or 4 week rotation. Each day, the resident will utilize decision support software to assist with the review of all patients receiving antimicrobial therapy as well as bug-drug mismatches. The resident will also be responsible for a stewardship project (DUR, policy development, initiative implementation, etc.) and present findings/recommendations to the Antimicrobial Stewardship Committee meeting. The resident will participate in stewardship rounds with the Stewardship Team.
The resident will participate in various aspects of the stewardship program including program justification and various intervention strategies including but not limited to:
- Auditing and feedback
- Criteria for use
- Guideline implementation
- De-escalation and streamlining
- Dosage optimization
- Outcomes measurement
- Antibiogram development
- Medication usage evaluation
Cardiology: Heart Failure
Preceptor: Kathryn Weber, PharmD, BCPS
The Cardiology learning experience involves being an active interdisciplinary team member on the CHF service. The team consists of the heart failure cardiologist, 2-3 nurse practitioners, and the cardiology pharmacy specialist. Other team members may include medical residents, case managers, nurse practitioner students, and pharmacy students. Patients covered by the CHF service include heart failure patients, post-cardiac surgery patients and left ventricular assist device patients. There are daily patient rounds with the multidisciplinary team. The cardiology pharmacy specialist is responsible for identifying and resolving medication therapy issues for patients covered by the CHF service. The purpose of this learning experience is to provide the resident with an opportunity to expand his/her knowledge of cardiology in a varied cardiac patient population and to perform efficiently as a cardiology pharmacist.
Common disease states with which the resident will be expected to gain proficiency through literature review, topic discussion, and direct patient care experience include, but are not limited to: systolic heart failure, heart failure with preserved ejection fraction, hemodynamics, acute decompensated heart failure, left ventricular assist devices, acute coronary syndromes, stable angina, pulmonary hypertension, and atrial and ventricular arrhythmias. The resident is expected to understand the pharmacotherapy related to these disease states as well as other disease states encountered in this setting. Topic discussions and key articles will be used to help develop the resident’s patient care skills for common disease states or acquiring knowledge about diseases seen infrequently on the service.
Critical Care: Medical ICU
Preceptors: Abby Rhoades, PharmD and Shannon Gray, PharmD
The medical intensive care unit (MICU) critical care learning experience involves being an active member of the intensivist-managed MICU team. The MICU team is composed of the medical intensivist, medical residents/students, pharmacy, nursing, nutrition, social work and spiritual support. The resident is expected to assume all critical care pharmacist responsibilities including patient profile review, multi-disciplinary rounding, therapeutic drug monitoring as well as providing drug information/education to other health care professionals. Additionally, the resident will respond to all code blue emergencies throughout the hospital and lead advanced cardiovascular life support (ACLS) drug therapy.
Topics that will be covered via patient care experiences, discussions, readings and/or presentations include but are not limited to the following:
Continuous renal replacement therapy (CRRT) and other dialysis modalities
ACLS/targeted temperature management
Acute respiratory distress syndrome
Chronic obstructive pulmonary disease/asthma exacerbations
Acute deep vein thrombosis/pulmonary embolism
Drug Policy and Drug Information
Preceptor: Alissa Lee, PharmD, BCPS
The Drug Information (DI) rotation is a required one month rotation in the PGY1-Pharmacy residency program. On this rotation the resident will gain experience in providing comprehensive, unbiased, evidenced-based medication information. They will also be involved with coordination of the activities of the Pharmacy and Therapeutics (P&T) Committee as well as leading and presenting at a P&T meeting. The learning experience involves participation in ongoing quality improvement initiatives, management of the Formulary and non-Formulary requests, management of drug shortages, development of departmental/hospital policies/protocols to standardize practices and improve overall safety of the medication use process, education of staff regarding medication use policy guidelines and Formulary changes, and meetings with pharmaceutical industry representatives.
Education and Communication Longitudinal
Preceptor: Alissa Lee, Pharm.D., BCPS
This longitudinal experience will expose the resident to a variety of methods to disseminate drug and medical information and knowledge.
Activities will include:
- Two Pharmacy Grand Rounds presentations to pharmacy staff
- One Noon Conference presentation to internal medicine residents
- Editing and publishing at least one edition of the quarterly pharmacy newsletter
- Contribution of articles to the quarterly pharmacy newsletter
- Minutes and executive report preparation for the monthly P&T committee for at least two meetings
- Presentation of topic discussions to APPE students on rotation at the hospital
Preceptor: Jenny Foster, PharmD, BCPS
The Emergency Medicine (EM) learning experience involves stepping into the role of the EM pharmacist; this involves continual interaction with nursing, midlevel practitioners, medical residents and attending physicians on the care of Emergency Department (ED) patients. In addition, there are opportunities for education and counseling of ED patients as well as ED staff on a variety of issues. The ED at The Christ Hospital provides care to a wide variety of patient populations with varying acuities and medical problems; mostly with internal medicine disease states as TCH is not a trauma center. There are no formal “rounds” in the ED but the EM pharmacist will review patient charts assessing for potential drug therapy recommendations; any identified are discussed with the nurse or ED provider as appropriate. The EM pharmacist is also available to ED staff for drug therapy consultations, to answer questions, and to resolve pharmacy related issues. Also, the EM pharmacist is responsible for culture results on discharged ED patients and recommendations are discussed with mid-level practitioners on a daily basis. The EM pharmacist collaborates with the pharmacy intern on medication reconciliation in the evening. The purpose of this learning experience is to allow the resident to experience the practice of an EM pharmacist, to learn how to quickly and efficiently provide drug information, to assist in immediate medical care, and to expand his/her clinical knowledge of a wide variety of disease states and treatments.
Common disease states and procedures with which the resident will be expected to gain proficiency through literature review, topic discussion, and direct patient care experience include but are not limited to: acute management of tachycardia/bradycardia, rapid sequence intubation, toxicology/overdose, ACS, stroke, DKA, ID (community and health-care acquired pneumonia, urinary tract infection, CA-MRSA, sexually transmitted disease, bacteremia etc), and seizures/status epilepticus.
Internal Medicine: Family Medicine Inpatient Service
Preceptor: Matt Keeler, PharmD, BCPS
The PGY 1 resident will be expected to provide evidence-based patient-centered care to a variety of patients on the Family medicine inpatient service. Common disease states encountered include infectious, cardiovascular, renal, thromboembolic, fluid and electrolyte disturbances, gastrointestinal, neurologic, transplant, oncology and hepatology. The resident will be assigned to the medical team and expected to attend rounds, provide educational services (including in-services and drug information requests) and provide care for all patients on the resident service.
The provision of care will include the collection and analysis of patient information, the design of an evidence-based therapeutic regimen and monitoring plan, the communication of recommendations to the medical team and the implementation, documentation and follow up of recommendations. All recommendations will be made in light of the overall responsibility for the welfare of the patient.
The resident will be expected to participate in daily patient discussions, topic presentations and may assist in the precepting of advanced clerkship students.
- Provide evidence-based patient-centered care to an internal medicine population.
- Attend daily medicine rounds.
- Provide educational opportunities to the medical residents, pharmacy students and others present on the medical team.
- Participate in afternoon discussions with preceptor, sometimes as part of the student presentations.
- Appropriately document interventions and follow-up in the medical record.
- When applicable, assist in precepting pharmacy students on rotation, leading topic discussions, and daily patient presentation discussions.
- Several projects and presentations will be assigned throughout the month based on the needs of the medical team and the pharmacy department.
Pharmacy Practice Management
Preceptor: Justin Gamble, PharmD
Pharmacy Practice Management (PPM) is a year-long, longitudinal learning experience at The Christ Hospital designed to expose the resident to the diversity of roles and responsibilities that the department of pharmacy assumes to ensure safe and efficient utilization of medication therapy within the hospital. The learning experience will give the resident an overview of issues and tasks affecting overall pharmacy operations and specific current management initiatives. The resident will meet with the Director of Pharmacy and Clinical Coordinator to discuss theories on pharmacy administration, budget issues, technology advancements, and other global issues relating to the department and the profession. Clinical resource management, pharmacoeconomics, drug procurement, and quality improvement are among the topics covered. During this rotation, the resident will also gain an understanding of the role of each of the managers and management support staff members within the department. The resident is an active member of the P&T Committee, and will also attend other committee meetings throughout the hospital as required. Individual assignments will allow the resident to exercise leadership and practice management skills and identify opportunities to improve the medication use process.
Pharmacy Services Longitudinal
Preceptor: Nicole Yunker, Rph
The resident will complete a pharmacy practice component of the residency program commonly referred to as “staffing”. Staffing begins in August after successful completion of the pharmacy orientation period. The resident will staff 20 weekends which is approximately every other weekend starting in August with 3 weekends off.
To develop pharmacy practice skills and gain experience in distribution, department policies and procedures, drug procurement, medication safety and leadership opportunities.
- Core content of this learning experience includes:
- Order verification
- Formulary management
- Code blue participation
- IV room responsibilities
- Unit dose responsibilities
- Clinical initiatives as the year progresses
The resident is responsible for the completion of a residency project. The project may be in the form of original research or the development, enhancement, or evaluation of an aspect of pharmacy operations or patient care services. A list of potential projects ideas will be distributed to the resident for consideration. Alternately, the resident may independently develop a project idea. The resident will have a project preceptor who will function as project mentors and co-principal investigators and will work directly with the resident to oversee the initiation, development, and completion of the research project. The preceptor will collaborate on the research project itself and serve as a resource for the resident. The project will be considered complete when the stated objectives have been met: poster presentation at ASHP Midyear Clinical Meeting, Regional Resident Conference presentation, GCSHP poster presentation, and completed manuscript. A residency certificate will not be awarded until the project is completed.
Transition of Care Longitudinal
Preceptor: Molly Webster, PharmD, BCPS
The Transition of Care (TOC) rotation is a year-long, longitudinal learning experience at The Christ Hospital designed to provide the resident with an opportunity to identify and resolve medication related problems through direct patient care. The TOC clinic is intended to provide a timely, focused visit for Internal Medicine (IM) patients who have recently been discharged from the hospital. The pharmacy resident will be responsible for performing thorough medication reviews, providing drug information and identifying and resolving medication related problems. The goal is to ensure their health is continuing to improve post discharge, and all medication changes have been communicated and implemented effectively. This rotation involves being part of an interdisciplinary team which consists of an attending physician, medical residents, nurses, patient care assistants, secretaries and pharmacists. The pharmacy resident will work directly with patients during the TOC clinic and will need to be knowledgeable in a variety of chronic disease state processes and their respective management and monitoring strategies. The resident will expand upon this knowledge and further experience will be gained by working as part of a multidisciplinary team. Strategies for providing patient and caregiver education will be explored while discovering patient barriers to learning, social barriers to obtaining medications and failed hospital processes during the discharge process.