100 High Street
Buffalo, NY 14203
PGY1 at BGMC - Rotation Descriptions
Buffalo General Medical Center
The pharmacist-managed anticoagulation clinic has been actively seeing patients since 1994. The pharmacist, under the supervision of a physician director, is responsible for initiating, monitoring and adjusting anticoagulation therapy. The pharmacy resident is responsible for providing coverage, under the supervision of the anticoagulation pharmacist during their medicine rotation.
Anticoagulation Management Service
The Anticoagulation Management Service (AMS) operates as a pharmacist-driven consult service focused primarily on dosing warfarin (approximately 40-50 patients daily). The service’s responsibilities are divided between two pharmacists. Through a P&T approved protocol, the pharmacist monitors all patients on anticoagulants in the hospital.
The AMS pharmacist is responsible for writing initial consults, daily progress notes, daily orders for warfarin and necessary labs, and providing recommendations on “bridging therapy” and DVT prophylaxis. The pharmacist also provides a notice and recommendation for follow-up to the next provider after discharge. This pharmacist also serves as a liaison to the medical and nursing staff on other anticoagulant issues, especially, but not limited to, the treatment of heparin-induced thrombocytopenia (HIT).
Finally, with the assistance of pharmacy students/interns, the pharmacists provide face-to-face and written education to all inpatients on warfarin. The pharmacy resident would be responsible for providing coverage for this service during an elective four-week rotation.
The coronary care unit (CCU) at Buffalo General is focused on the management of critical cardiac patients. The service consists of an attending cardiologist, a cardiology fellow, two to three medical residents, several medical interns, and a pharmacist. The pharmacist is responsible for providing evidence-based recommendations for appropriate cardiac pharmacotherapy management in addition to day to day management of critically ill patients. The pharmacist manages drug therapies through verbal/written recommendations in compliance with Kaleida Health’s approved protocols. The pharmacist also reports any adverse drug reactions (ADR) and medication errors. The pharmacist may be called upon to discuss various pharmacotherapy topics with the medical team in small group sessions. There is opportunity for observation of invasive and non-invasive cardiac procedures. Finally, weekly therapeutics discussions and a formal evidenced based medicine topic presentation are requirements for successful completion of this rotation. This is a 4-week elective experience.
Buffalo General’s cardiac medical intensive care unit (CMICU) medical teaching team covers on average 12-16 patients. The team members rotate monthly and include an attending physician, a pulmonary/critical care fellow, a resident(s), 2-3 interns, +/-medical students and a clinical pharmacist. The clinical pharmacist provides educational sessions and materials, as well as drug information to all health-care professionals on the team. Drug therapy monitoring is provided to all CMICU patients. The clinical pharmacist has an integral role in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient’s concurrent diseases. Patient outcomes are also routinely assessed.
The clinical pharmacist is also responsible for ADR and Medication Error reporting involving team patients. Each Pharmacy Practice Resident is precepted by the clinical pharmacist for six weeks.
The cardiovascular surgical ICU (CVICU) at Buffalo General is for patients recovering from coronary artery bypass and valve replacement surgery. The team consists of an attending physician and nurse practitioners with clinical pharmacy oversight. The pharmacist provides antimicrobial stewardship, drug therapy monitoring and consultative services to the CVICU team. The resident will provide comprehensive pharmaceutical care by rounding independently with the mid-level practitioners with daily preceptor feedback and oversight. Participation in code blues is also required. A formal presentation on a topic pertinent to the patient population is required at the conclusion of the rotation. This is a four week elective experience.
The Surgical ICU (SICU) consists of patients who have experienced general surgery, orthopedics, cardiothoracic, and vascular services. The clinical pharmacist is responsible for rounding with the SICU team and the patients they are responsible for, but are expected to follow all patients in the ICU. Patients are cared for by the attending physician and Nurse Practitioners in addition to the nursing staff. The clinical pharmacist has an integral role in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient’s concurrent diseases. The pharmacist may also assist in medication reconciliation especially upon transfer out of the ICU. Patient outcomes are also routinely assessed.
The major goal of this rotation is to provide a clinical pharmacy practice environment for the resident to apply the clinical, communication and teaching skills necessary to interact in a multidisciplinary emergency medicine environment.
The rotation will consist of providing clinical pharmacy services to an emergency medicine service under the preceptorship of a clinical pharmacy specialist. The practice environment will require daily interactions with the medical attendings, house staff, and mid-level practitioners, nursing staff, pharmacy staff and other healthcare professionals as necessary to optimize pharmacotherapy for patients. In addition to monitoring and consulting on pharmacologic issues, the resident will also provide educational presentations to nursing, pharmacy and physician staff members.
The preceptor will be available on a daily basis to discuss patient care issues, facilitate interactions with other health care team members, provide guidance in preparation and presentation of educational programs, and evaluate resident performance.
The general medical teaching services at Buffalo General Medical Center are comprised of an attending physician, a resident, two interns, medical students and a clinical pharmacist. These teams cover approximately 15-20 patients each. The clinical pharmacist provides educational sessions and materials, as well as drug information to other health-care professionals on the team. Drug therapy monitoring is provided to all team patients. The clinical pharmacist has an integral role in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient’s concurrent diseases. Patient outcomes are also routinely assessed. All patients are educated regarding their drug therapy and counseled regarding discharge medications to optimize therapeutic outcomes. The clinical pharmacist is also responsible for ADR and Medication Error reporting involving team patients. The general medicine experience is eight weeks in duration, during which time the resident is precepted by the clinical pharmacist. In addition, Pharmacy students may join the team allowing the resident an opportunity to assist in the teaching process.
Infectious Disease Consult and Antibiotic Stewardship
These modules are divided into two four-week learning experiences. Residents will first complete the Antimicrobial Stewardship rotation at the beginning of the year. Stewardship principles and processes are introduced to the resident. The stewardship service covers all beds outside the critical care units, and typically follows 30-50 patients as a daily average. Patient antibiotic regimens are reviewed in light of the culture data and clinical data from the chart. All patients currently receiving vancomycin and or aminoglycosides will be followed by this service on a daily basis and provide dosing recommendations/therapeutic drug monitoring as appropriate. The resident will work closely with the antimicrobial stewardship pharmacist who is scheduled for the week. They will both meet 3-4 times a week with the ID attending to discuss complicated cases and interventions will be made either by the pharmacist or attending through direct phone call to the provider.
The second rotation that the resident will participate in is rounding with the Infectious Disease consult service. Residents will be responsible for following all patients on the ID consult list, usually 20-30 patients. The resident will work with the attending, assisting in patient monitoring, drug selection, and drug information. Residents will be responsible for providing the pharmacokinetic monitoring for patients on vancomycin or aminoglycosides. Rounds occur daily in the afternoon.
At the end of each four-week module, the resident will be expected to formally present a case or topic related to infectious disease with adequate literature evaluation. During the module, informal topic discussions will take place with the preceptor.
Neuroscience Intensive Care Unit (NSICU)
The Neuroscience Intensive Care Unit (NSICU) medical teaching team covers on average 8-12 patients. The team members rotate weekly to monthly and include an attending physician, 1-2 chief neurosurgical resident(s), 1-3 junior neurosurgical resident(s), +/- medical students and a clinical pharmacist. The clinical pharmacist provides educational sessions and materials, as well as drug information to all health-care professionals on the team. Drug therapy monitoring is provided to all NSICU patients. The clinical pharmacist has an integral role in medication selection utilizing knowledge of current literature to compare treatment options with respect to efficacy, pharmacokinetics, adverse effects, and pharmacoeconomics. Dosage adjustment and therapy duration recommendations are based on clinical/laboratory data, patient responses, and the patient’s concurrent diseases. Patient outcomes are also routinely assessed.
At Buffalo General, the pharmacy employs a registered dietitian (RD) to manage parenteral nutrition therapy. In addition, enteral nutrition regimens are managed on a consultative basis. During the nutrition rotation, the pharmacy resident will work with the RD to assess nutritional status, calculate nutritional requirements, design a parenteral nutrition regimen and monitoring plan and write the daily parenteral nutrition orders. The resident will also be required to write initial and follow-up notes. Exposure will also be given to the initiation and management of enteral nutrition, with a particular focus on drug nutrient interactions. Daily patient and topic discussion will be help with the preceptor and RD. This is a four week elective rotation.
Women & Children’s Hospital of Buffalo (WCHOB):
At Women & Children’s Hospital, clinical pharmacy services are dedicated to daily rounds for the Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit, Pediatric Collaborative Surgical Rounds, and the Hematology/Oncology service. The Pediatric Intensive Care Unit is a 20 bed unit with a typical census between 12 and 15. Two medical teams provide services for 50 patients, on average, in the Level III Neonatal Intensive Care Unit. Collaborative Surgical Rounds provide Family Centered Care for pediatric general surgery patients. In addition clinical pharmacists provide pharmaceutical care to patients admitted to hospitalist, community and specialty pediatric teams throughout the general pediatric floors.
The clinical pharmacist is a member of a team that includes the attending physician, fellow, medical residents or nurse practitioners, social worker, and nutritionist. In addition pharmacy interns and students intermittently join the team. Clinical pharmacists in these areas provide information and education regarding pediatric dosing & dosage forms, interactions, adverse effects, therapeutic drug monitoring & pharmacokinetics, appropriate antimicrobial selection, sedation and analgesia, narcotic withdrawal, discharge medication counseling for caregivers, and pharmacoeconomics.
During the pediatric rotation, pharmacy residents typically spend two weeks in the PICU and two weeks with either Collaborative Surgical Rounds and general pediatrics or Pediatric Hematology /Oncology. Residents also attend the Pediatric Pharmacy & Therapeutics Sub-Committee. Discussion topics between preceptors and residents are specific to patients admitted during the rotation and typically include meningitis, trauma, pain management, febrile neutropenia, sickle cell disease, hemophilia, and asthma. Given the short time duration of this rotation and the specific patient population, the resident receives instruction in neonatal pharmacotherapy, however, formalized rounding in the NICU is reserved for elective rotations. The resident is also required to complete a case presentation in pediatrics.
The Pharmacy Manager is responsible for the oversight of accurate, timely and cost effective pharmacy services to all inpatient and outpatient clinic settings throughout the hospital site. Each site’s Pharmacy Manager reports to the Kaleida Health System Director of Pharmacy. The Director of Pharmacy Services is responsible for the provision of accurate, timely and cost effective pharmacy services to all inpatient and outpatient clinic settings throughout the health-system. The Director is also responsible for working with each site’s manager to develop streamlined, efficient pharmacy services in both its distributive and clinical areas. Residents will be working with both the Director of Pharmacy and the Pharmacy Manager for the Practice Management component of their residency program.
Residents in the Kaleida Health Pharmacy Practice Residency are exposed to various projects related to the development and monitoring of new programs involving automation, utilization management, systemic patient safety issues, internal and external accreditation readiness and interdepartmental relationships. The Director for Pharmacy Services and the Pharmacy Manager works in conjunction with the President, Chief Nursing Officer (CNO), Director of Quality Improvement, Nurse Managers and other administrative leadership to ensure service and quality standards are met and to resolve pharmacy-related issues. Residents will become familiar with pharmacy benchmarking techniques including various ways to assess the productivity and cost-effectiveness of pharmacy activities by site. This includes program justification and various techniques used to present and gain approval for a new program.
The Director for Pharmacy Services and Pharmacy Manager works extensively with the medical staff leadership and other health professionals to assure appropriate use of pharmaceuticals within Kaleida Health. Residents gain experience with pharmacy and therapeutics functions, from a system-wide perspective. The Department of Pharmacy Services have a priority role in overseeing the provision of drug information and pharmaceutical care. Additionally, the Department of Pharmacy Services is an essential team member in the development of care maps, disease management protocols, etc.