Description of Available Rotations

Orientation

Duration: 6 weeks

A 6-week rotation at the beginning of the residency year where residents will be introduced to the hospital and pharmacy department. Residents will gain familiarity with the hospital’s policies and procedures, pharmacy operations, and transition into the residency program. Pharmacy operations include computerized physician order entry (CPOE), oversight of dispensing, medication automation, etc. Throughout the rotation, residents will complete all requirements mandated by the hospital and pharmacy department.

Clinical Pharmacy Services (CPS)

Duration: 14 weeks

Comprised of 4 rotations: Infectious Diseases, Nutrition Support, Inpatient Anticoagulation, and Drug Monitoring. The goal of this rotation is for residents to develop their own clinical practice and manage patients in a safe, effective manner.

CPS: Infectious Diseases (ID)

Duration: 5 weeks

This rotation focuses on the management of all patients on antimicrobial agents. Residents will learn diverse and complex infectious disease states, while strengthening their understanding of the medications used to treat such conditions. This learning experience will focus on two main elements: dosing antibiotics such as vancomycin and aminoglycosides, and Antimicrobial Stewardship Program (ASP). Residents will work closely with all physicians but especially ID teams by staying in constant communication and attending ID rounds.

CPS: Nutrition Support

Duration: 5 weeks

Nutrition support encompasses our Basal Bolus Insulin Program (BBIP) and Total Parenteral Nutrition (TPN) management. Under pharmacy-driven protocol, BBIP provides a unique platform for residents to independently manage insulin regimens for patients enrolled in this service. Residents will gain a thorough understanding of glycemic management and work closely with nursing staff to ensure safe and effective therapy for patients. Residents will be taught to manage all adult TPN patients from initiation to discontinuation. Residents will work with registered dietitians, nurses, and physicians to provide collaborative care in the nutritional support of their patients.

CPS: Inpatient Anticoagulation

Duration: 1 week

This rotation provides training on a variety of anticoagulants that pharmacy has been tasked to monitor. These agents include warfarin, heparin, enoxaparin, and direct-oral anticoagulants. Using Vigilanz, residents will learn to optimize anticoagulants for hospitalized patients. Services include dosing and adjusting anticoagulant regimens, as well as recognizing when to initiate and discontinue anticoagulants.

CPS: Drug Monitoring

Duration: 1 week

Drug Monitoring week provides intense training on a variety of AHGL protocols. These protocols include renal dose adjustment, weight-based dosing, IV to PO conversion, drug level monitoring, high risk medication review, and pharmacotherapy consults. Residents will use Vigilanz to address and manage all these various alerts to ensure patient safety.

Critical Care

Duration: 6 weeks

Critical care, designated as ICU, focuses on the management of critically ill patients. AHGL has 3 critical care units: Intensive Care Unit (ICU), Cardiac ICU, and Surgical ICU. Each unit holds 10-12 patients with a typical census of 50-70%. Residents will be exposed to a diverse range of complex acute disease states commonly seen in critical care medicine.

Residents will learn to efficiently assess patients to provide comprehensive pharmacy support to the multidisciplinary team comprised of intensivists, nurses, dietitians, social workers, respiratory therapists, and other healthcare providers. Residents will engage in multidisciplinary rounds (MDR) daily. Using Vigilanz, residents are responsible for the complete care for all ICU patients through antimicrobial stewardship, anticoagulation monitoring, nutrition support, and drug monitoring. Due to the comprehensive nature of this rotation, residents will need to complete the Clinical Pharmacy Services rotation prior to the Critical Care rotation.

General Medicine

Duration: 4 weeks

Also known as Family Medicine Service (FMS), allows residents to work independently with our Family Medicine team which is comprised of a physician attending and medical residents. Residents will represent the pharmacy department and provide pharmacy support to the FMS team to optimize care for patients enrolled into their service. Residents will attend daily morning rounds with the team to review each patient before rounding on the patient floors. This rotation will be scheduled in the latter half of the residency to ensure residents have gained enough experience and confidence to work self-sufficiently. Residents will report to the clinical coordinator after rounds to discuss patients and interventions made.

Transition of Care (TOC)

Duration: 8 weeks

Comprised of 3 learning experiences: Emergency Medicine, Discharge Pharmacy, and Outpatient Pharmacy. Designed to expose and train residents in all facets of Transition of Care.

TOC: Emergency Medicine (1^st component)

Duration: 3 weeks

Residents will interview patients/caregivers or contact that patient’s outpatient pharmacy/long-term care facility in the Emergency Department (ED) to perform home medication reconciliation. If the patient/caregiver is not available, residents will learn to utilize other resources to gather the information. Residents will also learn to triage all direct and overnight admissions to ensure these patients’ home medication lists are accurate. Residents will also provide support to the ED staff which includes physicians, nurses, social workers, etc.

TOC: Discharge Pharmacy (2^nd component)

Duration: 3 weeks

Residents will work closely with our physicians and nurses to ensure patients being discharged on optimized drug regimens by conducting discharge medication reconciliations. Residents will learn to assess progress notes, review inpatient and discharge medications, and resolve any discrepancies. Residents will also play an active role in heart failure management by optimizing medication management for congestive heart failure (CHF), completing bedside consultations for CHF patients, and triaging CHF alerts on Vigilanz for patients with high risk for readmission. Residents will also evaluate for pharmacological intervention strategies in preventing falls in high-risk patients. Lastly residents will further reinforce medication reconciliation skills by conducting timely completion of long-term acute care (LTAC) admission medication histories for patients admitted to our Transitional Care and Rehabilitation Units.

TOC: Outpatient Pharmacy (3^rd component)

Duration: 2 weeks

Residents will gain various outpatient pharmacy experiences which includes filling and dispensing medications, order verification, bedside delivery and consultations, prescribing/refill authorizations under collaborative practice agreement, specialty pharmacy, and prior authorizations and appeals. Residents will also play a role in discharge care which includes phone calls to the patients as well as to their pharmacies to ensure continuity of care.

Intravenous and Sterile Compounding

Duration: 4 weeks

This rotation is designed to provide ample training in both the sterile and non-sterile compounding IV room. Residents will learn to manage the sterile IV compounding room and gain experience in parenteral medications utilized in the hospital, including chemotherapy, outpatient infusion center (OPIC), and neonatal intensive care unit (NICU) orders. Residents will gain experience in both compounding medications as well as conducting final checks of others’ work using BD IV preparations. Residents must demonstrate the ability to successfully compound 10 items during the rotation. Residents will also learn to manage tasks outside the IV room which includes working with pre-mix medications and oral syringes.

Anticoagulation Clinic

Duration: 4 weeks

Anticoagulation clinic (ACC) focuses on the management of anticoagulation in the ambulatory care setting. Residents will work closely with our ambulatory care pharmacists to manage warfarin and direct oral anticoagulants (DOACs). Residents will conduct patient interviews to gather information and optimize medication regimens. When managing warfarin, residents will interpret patients’ INR, extrapolate patient information, and coalesce this information to provide recommendations for a weekly warfarin regimen under pharmacy-driven protocol. Residents will also play an active role in the management of DOAC regimens by assessing patient information and evaluating appropriateness of medication (doses, lab values, etc.).

Elective Rotations

2 rotations (each 2 weeks in duration)

Residents will select 2 elective rotations by the midway point of residency. Because electives are paired with physician preceptor(s), these rotations are scheduled in the 2^nd half of the residency year after residents are licensed and have demonstrated competency in most of their Core Rotations. Residents will work directly with the physician or specialist but will be evaluated by the Residency Program Coordinator who facilitates all electives. The goal of the elective is to allow residents to pursue their area of interest.

Available Elective Rotations:

• Advanced Critical Care
• Advanced Infectious Diseases
• Nephrology
• Neurology
• Cardiology
• Oncology
• Behavioral Health
• Neonatal Intensive Care Unit (NICU)
• Repeat Rotation
• Create a Rotation