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Pharmacy Residency Programs

PGY2 Critical Care Pharmacy Practice - Rotation Summary

Cardiology

The coronary care unit (CCU) at Buffalo General is focused on the management of critically-ill cardiac patients. The service consists of an attending cardiologist, a cardiology fellow, two medical residents, several medical interns, and a pharmacist. The pharmacist/resident is responsible for providing evidence-based recommendations on the management of a variety of pharmacotherapeutic issues, including, but not limited to cardiology, general medicine and infectious diseases. They are also responsible for managing drug therapies through verbal/written recommendations along with hospital approved protocols and reporting adverse drug reaction (ADR) and medication errors. The pharmacist may be called upon to discuss different drug therapies with the medical team in small group sessions. Opportunity is given 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. 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.

Critical Care

Buffalo General – CVICU
The cardiovascular surgical ICU (CVICU)  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 PGY2 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.

Buffalo General – ILCU
The intermediate-care unit (ILCU) is designed to manage chronically critically-ill patients. The clinical pharmacist provides pharmaceutical care via daily rounds with a multidisciplinary team. That includes an attending physician, nurse practitioners, social work, respiratory therapy and a medical student. Drug therapy monitoring is provided to all ILCU patients. Infectious disease/antimicrobial stewardship, palliative care and medication reconciliation are important aspects of the clinical pharmacists’ role for these patients. In addition, the pharmacist is called upon to assist in maintaining continuity of the patient’s pharmaceutical care, as they are often the most consistent health care professional present on the team. On rotation the PGY2 resident is expected to function independently with daily preceptor feedback and oversight. 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.

Buffalo General – MICU
The Buffalo General medical intensive care unit (MICU) teaching team covers on average 16 - 20 patients. The team members rotate monthly and include an attending physician, a pulmonary/critical care fellow, three residents, four interns, a medical student and a pharmacist. The clinical pharmacist provides educational sessions and materials, as well as drug information to all health-care professionals on the team. 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 is also expected to participate in the medication reconciliation process, especially for clarification of medications prior to admission. Patient outcomes are also routinely assessed. The clinical pharmacist is also responsible for ADR and medication error reporting involving team patients. The PGY2 resident is expected to function independently with daily preceptor oversight and feedback. 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. Sixteen weeks are required, with additional elective MICU time available at BGH, MFG or MFS.

Buffalo General – Surgical ICU / Infectious Disease
The Buffalo General surgical ICU (SICU) includes vascular, colorectal, orthopedic, neurosurgical and general surgical patients. The clinical pharmacist is responsible for providing pharmaceutical care by rounding with the SICU consult service as well as reviewing therapeutic choices for non-consult patients. The consult team consists of an attending physician, nurse practitioners, a medical student and the pharmacist. As in the MICU, 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. During this experience a focused is placed on the reviewing the infectious disease literature that is pertinent to the ICU patient. 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. Eight weeks are required, with additional time being available to fulfill elective requirements.

Millard Fillmore Suburban (MFS) - ICU
The medical/surgical ICU (ICU) at Millard Suburban has a pulmonary/critical care consultant and a critical care nurse practitioner. Patients are managed by their primary medical doctor and the consultant if requested. The clinical pharmacist monitors all drug therapy regimens for all patients in the ICU and provides educational sessions and materials, as well as drug information to all health-care professionals in the ICU. 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 ICU patients. This is a four week elective experience.

Emergency Medicine: Buffalo General

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. This is a four week elective experience.

Pediatric and Neonatal ICU

Women & Children’s Hospital (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 has 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 and pharmacokinetics, appropriate antimicrobial selection, sedation and analgesia, narcotic withdrawal, discharge medication counseling for caregivers, and pharmacoeconomics.

Toxicology

Located at Women & Children’s Hospital, the Western New York Regional Poison Control Center offers an elective rotation that focuses on toxicology. The rotation offers the opportunity to work directly with the center’s staff, which includes nurses, physicians, residents, and students (both medical and pharmacy.) Residents are taught how to answer calls to the 24-hour hotline, which fields calls from the eight counties of Western New York. The hotline works closely with area hospitals, law enforcement, and veterinarians, and fields calls from the public that range from accidental ingestions to intentional overdoses. Depending on the resident’s demonstrated ability, the director may allow the resident to answer calls as they happen. Each morning, the previous night’s calls are reviewed with the staff member on-call, director, and the emergency medicine resident on toxicology rotation. Active cases are discussed daily, along with topic discussions of frequently occurring calls. The resident will accompany the medical director on any in-patient consults. The resident is expected to present to the center’s staff at their monthly staff meeting, as well as any presentations assigned by the staff. This rotation is ideal for a resident with a pre-existing interest in toxicology and one who is self-motivated to ask questions and self-learn. This is a four week elective experience.

Anticoagulation Management Service

The Anticoagulation Management Service (AMS) operates as a pharmacist driven consult service focused primarily on dosing warfarin (approximately 25-35 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 patients on warfarin admitted to the hospital. Once licensed, the PGY2 resident would be responsible for providing weekend coverage for this service every four weeks.