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Pharmacy Residency Programs

PGY1 at Women & Children's Hospital of Buffalo - Rotation Descriptions

Buffalo General Medical Center

Administrative Practice Activities

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 setting. The Director is also responsible for the development of streamlined, efficient pharmacy services in both its distributive and clinical areas.

Residents in the Kaleida Health Pharmacy Practice Residency are exposed to various projects related to the development and monitoring of new programs involving automation as well as database maintenance. The Director for Pharmacy Services works in conjunction with the President and Chief Nursing Officer (CNO) to ensure service and quality standards are met and to resolve pharmacy-related issues. Residents will analyze processes for rental, leasing and purchase of supplies and equipment and will work with the system-wide pharmacy information system with Cerner and the IST staff of Kaleida Health. 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 works extensively with the medical staff 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. Pharmacy services has a priority role in overseeing the provision of drug information, pharmaceutical care, and is an essential team member in the development of care maps, disease management protocols, etc.

Ambulatory Care

Anticoagulation Clinic
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 the eight weeks of residency during their medical 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 and several pharmacy student/interns. 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, through the assistance of pharmacy students/interns, the pharmacists provide face-to-face and written education to all inpatients on warfarin. The pharmacy practice resident would be responsible for providing coverage for this service during an elective four-week rotation.

Cardiology

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.

Critical Care

ILCU
The ILCU is an intermediate-care unit designed to manage chronically critically-ill patients. The Clinical Pharmacist provides pharmaceutical care via rounding daily with a multidisciplinary team. Drug therapy monitoring is provided to all ILCU patients. Medication reconciliation is an important aspect of the clinical pharmacists’ role for these patients as they transition from the intensive care unit.

CMICU
Buffalo General’s cardiac medical intensive care unit (CMICU) medical teaching team covers on average 8-12 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 eight weeks.

SICU/CVICU
The Surgical ICU (SICU) and Cardiovascular ICU (CVICU) 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.

Emergency Medicine

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.

General Medicine

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.

Geriatrics

DeGraff Skilled Nursing Facility:
The resident’s geriatric clinical training involves improving drug therapy in elderly patients in ambulatory, acute and long-term care settings. The rotation focuses on pharmacokinetic/dynamic differences associated with aging, and appropriate interventions are targeted to reduce inappropriate medication use in elderly.

The resident participates in consultant pharmacist activities at DeGraff Skilled Nursing Facility, a 70-bed long term care facility located adjacent to the DeGraff Memorial Hospital (DMH). These activities include performing mandatory comprehensive drug regimen reviews, psychotherapeutic drug monitoring, drug level monitoring, and drug regimen streamlining (i.e. elimination of unnecessary medications). Recommendations for improving drug therapy are formally written and given to SNF staff for physician approval. The ambulatory experience involves patient counseling and education, adherence assessment, and optimization of the patient's medication regimen with regard to safety and efficacy. The resident is also required to give weekly presentations to pharmacy staff on topics related to geriatric pharmacotherapy.

Infectious Disease/Antibiotic Stewardship

This is an eight week module involving rounds with the private infectious disease attending and antimicrobial stewardship. The resident will work with the attending, assisting in patient monitoring, drug selection, and drug information. Additionally, antimicrobial 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 routinely 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. Pharmacist interventions are given to the prescriber either verbally or by written note placed in the chart.

Once weekly, the infectious disease attending will meet with the pharmacy stewardship team to discuss certain patients deemed necessary (i.e. broad spectrum therapy without culture data for > 72 hours.)

At the end of the eight 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.

Neurosurgical Intensive Care Unit (NSICU)

The Neurosurgical 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.

Nutrition

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.

Pain Management

This is a one month elective rotation at Buffalo General Medical Center. The pharmacy resident will participate in daily rounds with the pain management team attending and nurse practitioner. The team typically provides service to 15-20 patients (this includes patients admitted to the Hospice unit). The resident will be involved in patient monitoring and drug selection decisions based on patients response to current therapy. In addition, the resident is often called upon to assist the team in providing drug information. The pharmacy resident is also responsible for ADR and medication error reporting involving team patients. The resident is required to complete a pain medication-related research project during the rotation.

Pediatrics

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.